Randomized clinical trial for apogeotropic horizontal canal benign paroxysmal positional vertigo

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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“…83,194,198 Geotropic: Nystagmus usually beats toward the affected ear. Apogeotropic: Nystagmus beats away from the affected ear.…”

Section: Technique or Circumstance Conclusion Regarding The Affected Earmentioning

confidence: 99%

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Bhattacharyya¹,

Gubbels

Schwartz

et al. 2017

Otolaryngol.--head neck surg.

570

776

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“…Beyond the Gufoni and BBQ maneuvers, two other procedures were used in our cupulolithiasis patients; the HSM (in three patients) and forced prolonged position 20 . Kim J-S et al 12 showed in 157 patients that both the Gufoni and HSM maneuvers were equally effective in the treatment of HC-BPPV cupulolithiasis, with success rates of 73.1% and 62.3%, respectively. Oh Sy, et al 25 compared the efficacy of HSM versus the modified Semont maneuver in 103 patients, concluding that the former is more effective (37.3% versus 17.3%) in the resolution of vertigo/nystagmus.…”

Section: Resultsmentioning

confidence: 99%

“…In addition to its higher success rate, the Gufoni maneuver 15 is not only less time consuming 12 but also easier to perform than the BBQ 360° maneuver in obese or elderly persons and in patients with cervical pain and stiffness 9,17 . It is worth mentioning that one third of our patients were over 70 years old.…”

Section: Resultsmentioning

confidence: 99%

“…Eighty-six percent of affected individuals seek medical care but only 8% receive effective treatment 8 . When considering the frequency of affected semicircular canals, certainly for anatomical / positional reasons, BPPV of the horizontal canal (HC-BPPV) is four times less frequent than the posterior canal (PC-BPPV) 6,10 , but this frequency is increasing and currently, depending on the study, the recognition of HC-BPPV ranges from 10% to 42.7% 11,12 . Although the symptoms in HC-BPPV and PC-BPPV are similar, important 1 Instituto Nacional de Câncer, Departamento de Fisioterapia, Rio de Janeiro RJ, Brazil.…”

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confidence: 99%

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Horizontal canal benign paroxysmal positional vertigo: diagnosis and treatment of 37 patients

Maranhão

Filho

2015

Arq. Neuro-Psiquiatr.

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Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo 1,2,3 with prevalence between 10.7 and 64.0 per 100,000 population, and lifetime prevalence estimated of 3.2% in females, 1.6% in males, and 2.4% overall 1 . BPPV generally has the highest age distribution in the sixth decade of life 3,4 , with a prevalence approaching 9% among the elderly population 5 . It is characterized by brief, recurrent episodes of vertigo triggered by changes in head position. Its pathophysiology, so called the "vestibular stones, " concept, is either due to abnormal stimulation of the dome caused by free-floating otoliths within semicircular canals (canalolithiasis), or otoliths clinging in the dome (cupulolithiasis) 4,6,7 . The duration, frequency and intensity of symptoms, as well as the nystagmus phenotype, vary depending on the canal in question and the location of the debris within them. The idiopathic form is the most frequent and the average duration of episodic symptoms is about two weeks 8 . The right ear is usually more involved 9 . Eighty-six percent of affected individuals seek medical care but only 8% receive effective treatment 8 . When considering the frequency of affected semicircular canals, certainly for anatomical / positional reasons, BPPV of the horizontal canal (HC-BPPV) is four times less frequent than the posterior canal (PC-BPPV) 6,10 , but this frequency is increasing and currently, depending on the study, the recognition of HC-BPPV ranges from 10% to 42.7% 11,12 . Although the symptoms in HC-BPPV and PC-BPPV are similar, important 1 Instituto Nacional de Câncer, Departamento de Fisioterapia, Rio de Janeiro RJ, Brazil. ABSTRACTBenign paroxysmal positional vertigo (BPPV), the most frequent cause of vertigo is associated with high morbidity in the elderly population. The most common form is linked to debris in the posterior semicircular canal. However, there has been an increasing number of reported BPPV cases involving the horizontal canals. The purpose of this article is to highlight the clinical features, diagnosis, and treatment in 37 patients with horizontal canal BPPV; twenty-six with geotropic nystagmus, and eleven with the apogeotropic form. Treatment consisted of the Gufoni manoeuver in eighteen patients (48.6%), the barbecue 360° maneuver in twelve patients (32.4%), both manoeuvers in four patients (10.8%), both manoeuvers plus head shaking in one patient (2.7%), and the Gufoni maneuver plus head shaking in two patients. Cupulolithiasis patients were asked to sleep in a forced prolonged position. We obtained a complete resolution of vertigo and nystagmus in 30 patients (81.0%) on the initial visit.Keywords: benign paroxysmal positional vertigo, horizontal canal, dizziness, nystagmus, canalith-repositioning maneuvers. RESUMOVertigem posicional paroxística benigna (VPPB) é a causa mais frequente de vertigem e promove alta morbidade na população idosa. A forma mais comum está relacionada com otoconias no canal semicircular posterior. Entretanto, nos últimos anos identifica-se...

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“…Though positional nystagmus has many of the more important clinical characteristics of the horizontal canal BPPV by canalithiasis -latency, geotropic direction and finally exhaustion -its prolongued duration to both sides and the lack of response to Gufoni maneuver, which has an evidence-based efficacy [4,5], guided us towards an atypical form of HC BPPV and thus we requested neuroimaging studies [6].…”

Section: Discussionmentioning

confidence: 99%