Benign Paroxysmal Positional Vertigo: 10‐Year Experience in Treating 592 Patients with Canalith Repositioning Procedure

Prokopakis, Emmanuel P.; Chimona, Theognosia S.; Tsagournisakis, M.; Christodoulou, Panayiotis; Hirsch, Barry E.; Lachanas, Vassilios A.; Helidonis, Emmanuel S.; Plaitakis, Andreas; Velegrakis, George A.

doi:10.1097/01.mlg.0000175062.36144.b9

Cited by 99 publications

(78 citation statements)

References 14 publications

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“…We used an Oster handheld vibrator on the ipsilateral mastoid in the first 110 patients at position 2 of the Epley maneuver, but found the use of the vibrator did not change our rates of successful treatment. Head shaking or tapping of the cranium accomplishes the same action as Epley's skull vibrator, and is more easily performed [Hain et al, 2000;Prokopakis et al, 2005].…”

Section: Discussionmentioning

confidence: 99%

“…Direct histopathological and molecular studies are difficult to perform either due to the self-limiting nature of the disease or because BPPV resolves in the majority of patients with conservative treatment [Prokopakis et al, 2005]. Epidemiological data, especially in relation to recurrence of BPPV, can provide indirect estimations of pathogenic factors and assessment of prognostic indices.…”

Section: Introductionmentioning

confidence: 99%

“…Patients usually report that their symptoms are triggered by a certain change in head position, such as lying down, rolling over in bed, bending over, or looking up [Prokopakis et al, 2005]. Since 1952, when Dix and Hallpike described their classical provocative maneuver [Dix and Hallpike, 1952], several theories have been proposed in order to explain the torsional vertical nystagmus that is provoked by a specific ear-down position with a latency of several seconds.…”

Section: Introductionmentioning

confidence: 99%

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Canalith Repositioning Procedures among 965 Patients with Benign Paroxysmal Positional Vertigo

Prokopakis¹,

Vlastos²,

Tsagournisakis

et al. 2012

Audiol Neurotol

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Background: Canalith repositioning procedure (CRP) has increasingly been utilized for the last 15 years for the treatment of benign paroxysmal positional vertigo (BPPV). We assess the short- and long-term efficacy of CRP on the treatment of patients with BPPV. Methods: Nine hundred sixty-five patients (481 men and 484 women, from 18 to 87 years of age) were enrolled in this prospective study during 1995–2010. Inclusion criteria were a patient history compatible with BPPV and a positive provocative maneuver (either Dix-Hallpike or Roll test). Reported duration of symptoms at the time of their first examination varied from 1 day to 18 months. Variants of the Epley and Barbeque maneuver were used for posterior and anterior canal involvement, and horizontal canal involvement, respectively. Short-term follow-up was obtained 48 h and 7 days after initial treatment, whereas long-term follow-up was obtained at repeated 6-month intervals. Results: Symptoms subsided immediately in 819 patients (85%) by the first CRP. Only 19 patients (2%) required CRP more than 3 times. Patients’ mean follow-up was 74 months; symptom recurrence was noted in 139 patients. A statistically significantly higher recurrence rate was noted in elderly people or those with head trauma or a history of vestibular neuropathy (p < 0.001). Conclusions: This study provides class IV evidence that CRP remains an efficient and long-lasting noninvasive treatment for BPPV, especially for younger patients without a history of head trauma or vestibular neuropathy. Elderly people have a significantly higher recurrence rate requiring additional education to minimize potential morbidity of their falls.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Canalith Repositioning Procedures among 965 Patients with Benign Paroxysmal Positional Vertigo

Prokopakis¹,

Vlastos²,

Tsagournisakis

et al. 2012

Audiol Neurotol

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“…544 (92%) of 592 patients treated reported no symptoms of vertigo after one month revealing the efficacy of Epley Maneuver. 19 In this study, we achieved 94% cure of BPPV from Epley's maneuver in 1 month. 83% of the patients were successfully cleared of symptoms with a single treatment and 11% required two treatments.…”

Section: Discussionmentioning

confidence: 65%

Epley’s maneuver versus Semont’s maneuver in treatment of posterior canal benign positional paroxysmal vertigo

2017

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Background: Benign paroxysmal positional vertigo (BPPV) is characterized by brief but violent attacks of paroxysmal vertigo provoked by certain positions of the head. BPPV is the most common cause of vertigo, resulting from migration of otoconia into the semicircular canals. Majority of patients have posterior canal BPPV. Epley’s Canalith Repositioning and Semont Liberatory Maneuver have been shown to be highly efficacious in the successfultreatment of posterior canal BPPV. The main objective of this study was to compare the efficacy of Epley’s maneuver versus Semont’s maneuver in the management of benign paroxysmal positional vertigo.Methods: This study was conducted in the Department of Otorhinolaryngology of a rural Medical College in Kerala, for a period of one and half year, from January 2015 to June 2016. It was an observational prospective cohort study. 200 patients with posterior canal BPPV were enrolled in this study based on inclusion and exclusion criteria. Patients were allotted alternatively to Epley’s group and Semont’s group, 100 patients in each group based on the treatment maneuvers they underwent. Efficacy of maneuvers were assessed at the end of 1st week, 1st month and 3rd month on the basis of resolution of symptoms and Dix-Hallpike negativity.Results: Of the 100 cases managed by Epley’s maneuver 95 cases showed complete relief of symptoms after 3 months. Out of 100 cases managed by Semont’s maneuver, 94 cases showed complete recovery after 3 months. The results were compared by Chi square test, as the data was mainly qualitative in nature. The results of both the groups were compared at the end of 1st week, 1st month and 3rd month, which revealed that both the Semont’s and Epley’s maneuver are equally effective in the treatment of posterior canal BPPV.Conclusions: Both Epley’s and Semont’s maneuver are equally effective for treating the patients of posterior canal benign paroxysmal positional vertigo.

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“…7,8 The PSC is affected in about 85% to 90% of cases, the horizontal semicircular canal (HSC) in 10% to 13%, and the anterior canal in 1% to 2% of cases. [9][10][11] The symptoms of BPPV occur because the otoliths, which are heavier than the surrounding endolymphatic fluid, move when the head is moved in relation to gravity or is moved in the plane of the affected canal. The movement of the endolymph causes the cupula, the angular acceleration-detecting receptor, to be deflected, which stimulates the hair cells and generates a neural signal that creates the perception that one side of the head is moving whereas the other (normal) side is not.…”

Section: Benign Paroxysmal Positional Vertigomentioning

confidence: 99%

Acute Vestibulopathy

Cha¹

2011

The Neurohospitalist

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The presentation of acute vertigo may represent both a common benign disorder or a life threatening but rare one. Familiarity with the common peripheral vestibular disorders will allow the clinician to rapidly ''rule-in'' a benign disorder and recognize when further testing is required. Key features of vertigo required to make an accurate diagnosis are duration, chronicity, associated symptoms, and triggers. Bedside tests that are critical to the diagnosis of acute vertigo include the Dix-Hallpike maneuver and canalith repositioning manuever, occlusive ophthalmoscopy, and the head impulse test. The goal of this review is to provide the clinician with the clinical and pathophysiologic background of the most common disorders that present with vertigo to develop a logical differential diagnosis and management plan.

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Benign Paroxysmal Positional Vertigo: 10‐Year Experience in Treating 592 Patients with Canalith Repositioning Procedure

Abstract: Our data, based on long-term follow-up, suggest that CRP remains an efficient and long-lasting noninvasive treatment for BPPV.

Cited by 99 publications

References 14 publications

Canalith Repositioning Procedures among 965 Patients with Benign Paroxysmal Positional Vertigo

Canalith Repositioning Procedures among 965 Patients with Benign Paroxysmal Positional Vertigo

Epley’s maneuver versus Semont’s maneuver in treatment of posterior canal benign positional paroxysmal vertigo

Acute Vestibulopathy

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