Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome

Abstract

The objective was to evaluate the clinical value of repositioning chairs in management of refractory benign paroxysmal positional vertigo (BPPV) and to study how different BPPV subtypes respond to treatment. We performed a retrospective chart review of 150 consecutive cases with refractory vertigo referred to our clinic within a 10-month period. The BPPV patients were managed with classical manual manoeuvres, the Epley Omniax(®) rotator (EO) or the TRV chair (TRV). In addition, a comprehensive review of the literature was performed. BPPV was identified in 95 cases. The number of needed treatments for posterior canalolithiasis versus posterior cupulolithiasis, horizontal cupulolithiasis and multi-canal affection was significant (p < 0.01). Thirty-seven (38 %) patients required only one repositioning manoeuvre and the overall symptom relief was 91.7-100 % after 3 treatments. Eleven patients (12 %) experienced relapse within the ½-year follow-up period. Horizontal cupulolithiasis and multi-canal affection constituted the most resilient cases. The literature search identified 9 repositioning chair studies. The EO and the TRV are highly valuable assets in diagnosis and management of BPPV of particularly complex and refractory cases. However, further validation is anticipated through controlled clinical trials.

Patient reported outcomes of slow, single arc rotation: Do we need rotating gantries?

“…Motion tolerance of radiation therapy patients has been previously assessed in the context of continuous couch motion for adaptive radiation therapy. 10 The purpose of this study was therefore to collect the first cancer patient reported outcomes of slow, single arc rotation in both the upright and lying positions, both of which could be used to deliver radiation therapy without a rotating gantry. 7 However, study results did not show any evidence for a lack of tolerance, inertial anatomic motion, or changes in breathing patterns.…”

Neuro-otology- some recent clinical advances

“…The Epley Omniax Rotator and the TRV chair are expensive mechanical repositioning devices that allow for effective treatment of BPV that is refractory to bedside treatment or involves multiple SCCs, especially in those with the physical limitations described above. Both devices hold promise but have not yet been compared against bedside maneuvers in randomized trials [40]. …”

Benign paroxysmal positional vertigo

“…In instances of multiple failed repositioning maneuvers, a tertiary centre referral should be considered . If available, sophisticated patient positioning systems such as the Epley Omniax rotator and the TRV chair may be considered for multi‐canal involvement or patients with mobility issues . In the event of refractory disease, surgical intervention may also be appropriate.…”