Randomized clinical trial for geotropic horizontal canal benign paroxysmal positional vertigo

Kim, Ji Soo; Oh, Sun-Young; Lee, Seung-Han; Kang, Ji Hoon; Kim, Dong Uk; Jeong, Seong-Hae; Choi, Kwang-Dong; Moon, Ilkyeong; Kim, Byung-Kun; Kim, Hyo Jung

doi:10.1212/wnl.0b013e3182648b8b

Cited by 94 publications

(90 citation statements)

References 28 publications

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“…Yetiser et al [2] , Kim et al [7] , Lee et al [8] and Akkuzu et al [10] detected lower interpeak amplitudes on the affected sides of BPPV patients. In these studies, the VEMP asymmetry ratios of healthy controls were used as normalized data and compared with those of the BPPV group.…”

Section: Discussionmentioning

confidence: 95%

“…There has also been no standard approach for the evaluation of VEMP asymmetry. Yetiser et al [2] defined asymmetry over 25% as VEMP asymmetry, although in other studies, data obtained from the control group were regarded as normative data, and VEMP asymmetry was defined as a value above an upper limit calculated by the formula [upper limit=mean of the control group+(2×standary deviation)] [ 7,8,10] .…”

Section: Discussionmentioning

confidence: 99%

“…However, several studies have proposed that degenerative changes of the neuroepithelial membrane are the main reason behind the separation of the otoconia [7][8][9][10] . Aging, diabetes mellitus, hypertension, thyroiditis, hyperlipidemia, stroke, osteopenia, osteoporosis, and vitamin D deficiency are responsible for causing the degenerative changes of the neuroepithelial membrane [11][12][13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo

Karataş

Yüce²,

Cebi³

et al. 2016

Int Adv Otol

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OBJECTIVE:Although there has been a wide consensus on the mechanism of nystagmus and clinical presentation of benign paroxysmal positional vertigo (BPPV), the neuroepithelial pathophysiology of BPPV still remains unclear. In this study, we aimed to clarify the pathophysiology of BPPV by evaluating the cervical vestibular-evoked myogenic potential (cVEMP) findings of patients. MATERIALS and METHODS:Thirty-six BPPV patients and 20 healthy volunteers were included. Bilateral cVEMP tests were performed on all participants. The participants were divided into the following three groups: those with a BPPV-affected ear, those with a BPPV-unaffected ear, and the healthy control group. RESULTS:There were no significant differences regarding the latencies of the first positive (p1) and negative (n1) peaks among the three groups. The mean normalized amplitude asymmetry ratio also did not differ between the BPPV and control groups. However, the normalized amplitudes of the BPPV patients (with both affected and unaffected ears) were significantly lower than those of the healthy control group. CONCLUSION:We detected that the cVEMP data of the affected and unaffected ears of the BPPV patients was similar and that their normalized amplitudes significantly differed from those of the healthy controls. Eventually, we concluded that even if the symptoms of BPPV were unilateral, the findings suggest that the bilateral involvement of the macular neuroepithelium is important in understanding the pathophysiology of BPPV. This finding supports the conclusion that the pathophysiological process starts with neuroepithelial membrane degeneration and continues with otoconia separation.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo

Karataş

Yüce²,

Cebi³

et al. 2016

Int Adv Otol

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“…Kim JS et al 9 held a comparative study between the Gufoni maneuver and BBQ (270°) maneuver in 170 consecutive patients with geotropic HC-BPPV. They demonstrated that booth were effective treatment methods [38 of 55 (69.1%) for BBQ rotation, and 39 of 64 (60.9%) for the Gufoni maneuver], even when applied only twice in the initial visit day.…”

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%

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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Effect of Self-treatment of Recurrent Benign Paroxysmal Positional Vertigo

Kim

Choi

et al. 2023

JAMA Neurol

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ImportanceBenign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo with frequent recurrences.ObjectiveTo determine the efficacy of a web-based diagnosis and treatment of BPPV when it recurs in patients with confirmed and treated BPPV.Design, Setting, and ParticipantsThis randomized, controlled, parallel-group, double-blind trial took place in multiple referral-based university hospitals in South Korea between July 2017 and February 2020. Of 728 patients (age ≥20 years) with diagnosed and treated BPPV, 585 were enrolled after excluding 143 who declined participation, could not use the internet, or had spinal problems, multicanal BPPV, or cognitive dysfunction. Patients were followed up for recurrence at least for 2 years until February 2022.InterventionsPatients were randomly assigned (1:1) to the treatment or control group. The patients in the treatment group completed a questionnaire for diagnosis and received a video clip for self-administration of canalith repositioning maneuver (CRM) according to the type of BPPV diagnosed when they experienced positional vertigo again. Patients in the control group received a video clip for self-administration of CRM according to the type of BPPV that had been diagnosed on enrollment.Main Outcomes and MeasuresThe primary outcome was self-reported resolution of positional vertigo post-CRM. Secondary outcomes included difficulties and requirement for assistance when using the program and any falls or other adverse events related to CRM. The primary outcome was analyzed using both intention-to-treat and per-protocol methods.ResultsOf 585 patients enrolled, 292 were randomized to the treatment group (mean [SD] age, 60.3 [12.8] years, 37 [64%] women) and 293 were randomized to the control group (mean [SD] age, 61.1 [13.2] years; 50 [71%] women). Overall, 128 (21.9%) had recurrence (58 in the treatment group and 70 in the control group), and 109 (85.2%) successfully used the web-based system. In the intention-to-treat analysis, 42 of 58 individuals (72.4%) in the treatment group and 30 of 70 individuals (42.9%) in the control group reported vertigo resolution (χ2 test: 95% CI, 0.13-0.46; P &lt; .001).Conclusions and RelevanceThis trial proved the efficacy of a web-based system for the diagnosis and treatment of recurrent BPPV. Use of this system may play an important role in telemedicine for vestibular disorders.Trial RegistrationClinical Research Information Service Identifier: KCT0002364

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Randomized clinical trial for geotropic horizontal canal benign paroxysmal positional vertigo

Abstract: This study provides Class I evidence that barbecue rotation and Gufoni maneuvers are effective in the treatment of geotropic HC-BPPV.

Cited by 94 publications

References 28 publications

Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo

Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo

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

Effect of Self-treatment of Recurrent Benign Paroxysmal Positional Vertigo

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