Idiopathic benign paroxysmal positional vertigo with persistent vertigo/dizziness sensation is associated with latent canal paresis, endolymphatic hydrops, and osteoporosis

Kitahara, Tadashi; Ota, Ichiro; Horinaka, Akira; Ohyama, Hiroki; Sakagami, Masaharu; Ito, Taeko; Shiozaki, Tomoyuki; Wada, Yoshiro; Yamanaka, Toshiaki

doi:10.1016/j.anl.2018.05.010

Cited by 20 publications

(16 citation statements)

References 21 publications

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“…12 However, BPPV persists in 30% of patients if left untreated, 5 and a recent study found that 61% of patients with persistent BPPV suffered from horizontal canal involvement. 26…”

Section: Discussionmentioning

confidence: 99%

“…HC-BPPV is typically treated with barbecue roll or Gufoni maneuvers. 14,18 HC-BPPV can be difficult to treat, and persistence of symptoms ranges from 5% to 61%, [19][20][21][22][23][24][25][26] with a lower recovery rate for apogeotropic HC-BPPV. 21,27 Recently, the use of particle repositioning chairs has become more common in the treatment of difficult BPPV cases.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of horizontal canal BPPV—a randomized sham‐controlled trial comparing two therapeutic maneuvers of different speeds

Martens

Goplen

Aasen

et al. 2020

Laryngoscope Investig Oto

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Objectives To compare the effect of a high‐speed barbecue maneuver with the modified Lempert maneuver and sham in patients with benign paroxysmal positional vertigo (BPPV) of the horizontal canal. Methods Randomized sham‐controlled, single blinded multicenter clinical trial in two university hospitals investigating consecutive patients with horizontal canal BPPV. Patients were randomly assigned to high‐speed barbecue (HSB), modified Lempert maneuver (ML), or sham maneuver (SM). All treatments were performed in a biaxial rotational chair with weekly follow‐up to a maximum of three treatment sessions. The final follow‐up was 3 months after the last treatment. Results Primary outcome: 2‐week recovery rate per protocol. Secondary outcome: Cumulative recovery rate and Dizziness Handicap Inventory (DHI) scores after 3 months per protocol (HSB and ML) and intention to treat (all groups). Fifty‐four patients were analyzed after 2 weeks (HSB = 17; ML = 20; SM = 17). Two‐week recovery rate was 14/17 after HSB, 11/20 after ML, and 4/17 after SM, with significantly better recovery in HSB [OR 15.17, 95% CI (1.85, 124.63), P = .001] using sham as base level. Recovery rate after 3 months was 15/17 after HSB and 15/19 after ML. Cumulative recovery rate showed no significant differences between the two treatment groups [95% CI (0.30, 13.14), P = .46] in cure rate DHI [95% CI (−16.56, 15.02), P = .92]. No unexpected adverse events were observed. Conclusion Velocity change in horizontal canal BPPV treatment gives a faster initial recovery. Rapid recovery could reduce the disease burden. Trial Registration http://Clinicaltrials.gov. Identifier: NCT01905800. Level of Evidence 1b

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“…12 However, BPPV persists in 30% of patients if left untreated, 5 and a recent study found that 61% of patients with persistent BPPV suffered from horizontal canal involvement. 26…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of horizontal canal BPPV—a randomized sham‐controlled trial comparing two therapeutic maneuvers of different speeds

Martens

Goplen

Aasen

et al. 2020

Laryngoscope Investig Oto

View full text Add to dashboard Cite

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“…[12][13][14][15][16] If necessary, these patients received various kinds of vertigo/dizziness examinations, including the caloric test, vestibular evoked cervical myogenic potentials, subjective visual vertical assessment, inner ear magnetic resonance imaging, the Schellong test, and self-rating questionnaires for depression as described previously. 17,18 After careful interviewing and examinations, patients with dizziness of unknown origin were classified into unknown (UK).…”

Section: Patientsmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on Follow-Ups for Vertigo/Dizziness Outpatients

et al. 2020

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Objectives: In the present report, we aimed to investigate the impact of the coronavirus disease (COVID-19) pandemic on vertigo/dizziness outpatient cancellations in Japan. Methods: We examined 265 vertigo/dizziness outpatients at the ear, nose, and throat department of the Nara Medical University between March 01, 2020, and May 31, 2020, during the COVID-19 pandemic in Japan. We also focused on 478 vertigo/dizziness outpatients between March 01, 2019, and May 31, 2019, before the COVID-19 pandemic, to compare the number of cancellations between these 2 periods. The reasons for cancellation and noncancellation were investigated using telephone multiple-choice questionnaires (telMCQs), particularly for patients with benign paroxysmal positional vertigo (BPPV) and Meniere’s disease (MD). Results: There were many cancellations for medical examinations during the 2020 study period. The total number of vertigo/dizziness outpatients decreased by 44.6% in the 2020 period compared to the same period in 2019. The percent reduction in clinic attendance from 2019 to 2020 (ie, [2019-2020]/2019) for patients with BPPV was higher than that for patients with MD. Compared to the other vertigo-associated conditions, patients with MD exhibited a lower percent reduction in clinic attendance. According to the results of the telMCQs, 75.0% of BPPV cases and 88.2% of MD cases cancelled their appointment and gave up visiting hospitals due to fear of COVID-19 infection, even if they had moderate to severe symptoms. On the contrary, 25.0% and 80.0% patients with BPPV and MD, respectively, did not cancel their appointment; they should not have visited the hospital but stayed at home because they had slight symptoms. Conclusions: These findings suggest that advanced forms should be prepared for medical care, such as remote medicine. These forms should not only be for the disease itself but also for the mental distress caused by persistent symptoms.

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“…Furthermore, we found strong evidence that the percentages of patients experiencing objective positional/positioning nystagmus and who had subjective complaints decreased significantly more in the HUS group than in the HDS group. Previous studies revealed that cupula type, canal paresis positive status, EH positive status, osteoporosis, and mental distress could be negative prognostic factors on the duration of persistent floating sensation in intractable BPPV . There were no significant differences in such patient backgrounds between the HUS and HDS groups in this randomized controlled trial (RCT) study.…”

Section: Discussionmentioning

confidence: 62%

Head‐Up Sleep May Cure Patients With Intractable Benign Paroxysmal Positional Vertigo: A six‐Month Randomized Trial

Horinaka

Kitahara

Shiozaki

et al. 2019

Laryngoscope Investig Oto

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Objectives The aim of the present study was to assess head‐position management for intractable idiopathic benign paroxysmal positional vertigo (BPPV) when lying down. We hypothesized that head‐up sleep (HUS) could prevent free‐floating otoliths from entering the semicircular canals. Study Design A prospective two‐arm multicenter randomized controlled trial. Methods BPPV was diagnosed in 611 patients (611/1,520; 40.2%) according to the 2015 diagnostic guidelines issued by the International Classification of Vestibular Disorders. Among them, 201 patients were intractable (201/611; 32.9%), 88 of whom were idiopathic and subsequently enrolled in the study. Patients randomly received intervention with HUS at greater than 45° (n = 44) or head‐down sleep (HDS; n = 44) when lying down. Before treatment, they completed several examinations, including subjective visual vertical (SVV). The specific diagnoses for the 88 patients with BPPV included horizontal type cupula (n = 40), horizontal type canal (n = 13), posterior type (n = 26), and probable and/or atypical BPPV (n = 9). Results Patient backgrounds did not differ significantly between the HUS and HDS groups. Visual analog scale (VAS) scores of vertiginous sensation were significantly lower in the HUS group than in the HDS group at both the third month and sixth month post‐treatment. Positional/positioning nystagmus observed just before treatment disappeared significantly more often in the HUS group than in the HDS group until the sixth post‐treatment month. Further, especially in HUS group, VAS scores in SVV− group (n = 24) were significantly lower than those in the SVV+ group (n = 20) sixth month post‐treatment. Conclusions Controlling free‐floating otoliths is not easy due to aging of the otolith organs. Repeatedly returning the endless free‐floating debris from the canals to the utricle through physical means is not a good strategy. Therefore, HUS when lying down at home could be recommended as an initial treatment for patients with intractable idiopathic BPPV. Level of Evidence 1b

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Idiopathic benign paroxysmal positional vertigo with persistent vertigo/dizziness sensation is associated with latent canal paresis, endolymphatic hydrops, and osteoporosis

Cited by 20 publications

References 21 publications

Treatment of horizontal canal BPPV—a randomized sham‐controlled trial comparing two therapeutic maneuvers of different speeds

Treatment of horizontal canal BPPV—a randomized sham‐controlled trial comparing two therapeutic maneuvers of different speeds

The Impact of the COVID-19 Pandemic on Follow-Ups for Vertigo/Dizziness Outpatients

Head‐Up Sleep May Cure Patients With Intractable Benign Paroxysmal Positional Vertigo: A six‐Month Randomized Trial

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