Diagnostic, Pathophysiologic, and Therapeutic Aspects of Benign Paroxysmal Positional Vertigo

Korres, Stavros; Balatsouras, Dimitrios G.

doi:10.1016/j.otohns.2004.02.046

Cited by 86 publications

(116 citation statements)

References 36 publications

(66 reference statements)

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“…For example, in highly selected subsets of patients referred for subspecialty evaluation of BPPV, additional otopathology and/or vestibulopathy has been identified in 31% to 53% of BPPV patients. 5,151,152 Abnormalities of the cervical vestibular evoked myogenic potential have been reported in 25.8% to 34.8% of patients with BPPV.…”

Section: Action Statement Profile For Statement 3amentioning

confidence: 99%

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Bhattacharyya¹,

Gubbels

Schwartz

et al. 2017

Otolaryngol.--head neck surg.

535

776

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Objective. This update of a 2008 guideline from the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV.Purpose. The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV.Action Statements. The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. The update group made a strong recommendation against postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. The update group made recommendations that the clinician should (1) perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate...

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Section: Action Statement Profile For Statement 3amentioning

confidence: 99%

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Bhattacharyya¹,

Gubbels

Schwartz

et al. 2017

Otolaryngol.--head neck surg.

535

776

View full text Add to dashboard Cite

show abstract

“…Almost 10% of patients admitted to emergency departments with moderate-to-severe vertigo have BPPV [1] . BPPV patients have episodic vertigo provoked by head movements, and they show classical horizontal, vertical, or torsional nystagmus with the characteristics of latency, crescendo and decrescendo pattern, fatigability, transciency, and reversibility [2] . In most cases, the underlying cause is canalolithiasis of the posterior semicircular canal; however, horizontal canal involvement can be greater than expected and may contribute to up to 20% of cases [2] .…”

Section: Introductionmentioning

confidence: 99%

“…BPPV patients have episodic vertigo provoked by head movements, and they show classical horizontal, vertical, or torsional nystagmus with the characteristics of latency, crescendo and decrescendo pattern, fatigability, transciency, and reversibility [2] . In most cases, the underlying cause is canalolithiasis of the posterior semicircular canal; however, horizontal canal involvement can be greater than expected and may contribute to up to 20% of cases [2] . Although most cases are idiopathic, head trauma (17%), vestibular neuritis (15%), vertebrobasilar ischemia, labyrinthitis, and ear surgery can be the underlying causes [3] .…”

Section: Introductionmentioning

confidence: 99%

The Role of Oxidative Stress and Inflammatory Mediators in Benign Paroxysmal Positional Vertigo

Gucluturk

Unal²,

İsmi³

et al. 2016

Int Adv Otol

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OBJECTIVE:Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by rapid changes in head position associated with a characteristic paroxysmal positional nystagmus. The aim of this study was to search for the possible role of oxidative stress and inflammatory mediators in the pathogenesis of BPPV. MATERIALS and METHODS:Total antioxidant status as well as paraoxonase, tumor necrosis factor alpha, interleukin (IL) 6, and IL-1β levels were evaluated in peripheral venous serum samples of 30 BPPV and 30 control patients. RESULTS:Total antioxidant status levels were lower in the BPPV group than in the control group (p=0.008). After Epley's repositioning maneuver in the vertigo group, there was a statistically significant decline in IL-1β levels at the first and third month visits (p=0.014 for first month and p=0.013 for third month). CONCLUSION:Our findings suggested that IL-1β and oxidative stress contributed to the pathogenesis of BPPV.

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“…The most often used diagnostic procedures are the Dix-Hallpike and Brandt-Daroff tests and the study of positional nystagmus towards the lateral canal 7 . The vertical, upwards and rotational nystagmus points towards an involvement of the posterior semi-circular canal 11 .…”

Section: Introductionmentioning

confidence: 95%

“…The theory of posterior canal canalolithiasis is considered the most convincing one, explaining BPPV's pathogenesis and one that is supported by the efficiency of specific therapeutic maneuvers 11 .…”

Section: Introductionmentioning

confidence: 99%

Manobra de Epley repetida em uma mesma sessão na vertigem posicional paroxística benigna

Korn

Dorigueto

Ganança

et al. 2007

Rev. Bras. Otorrinolaringol.

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Aim: To assess whether more than one Epley's maneuver in the same session, compared to a single one, decreases the number of sessions necessary to suppress positional nystagmus. Method: Epley's maneuver was done in 123 patients with BPPV due to unilateral posterior semicircular canal canalolithiasis. The number of sessions for positional nystagmus suppression was compared in two groups of patients. Group I consisted of 75 patients submitted to a single Epley's maneuver on weekly sessions and group II consisted of 48 patients that were submitted to four Epley's maneuvers during the first session. Results: Group II showed greater nystagmus latency and duration than group I (p<0.05). The number of sessions and standard deviation showed by group I was greater than in group II (p=0.008). We observed a significant association between number of sessions and group (p=0.039) studied. Group II had 21.4% more nystagmus-free patients following only one session (CI95% [7.7% -35.1%]). Conclusion: Repeated Epley's maneuvers in less sessions rendered more positional nystagmus-free patients when compared to those submitted to more sessions of single maneuvers.

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Diagnostic, Pathophysiologic, and Therapeutic Aspects of Benign Paroxysmal Positional Vertigo

Cited by 86 publications

References 36 publications

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

The Role of Oxidative Stress and Inflammatory Mediators in Benign Paroxysmal Positional Vertigo

Manobra de Epley repetida em uma mesma sessão na vertigem posicional paroxística benigna

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