Residual Dizziness after Successful Repositioning Maneuver for Idiopathic Benign Paroxysmal Positional Vertigo: A Review

Giommetti, Giorgia; Lapenna, Ruggero; Panichi, Roberto; Dehgani-Mobaraki, Puya; Longari, Fabrizio; Ricci, Giampietro; Faralli, Mario

doi:10.4081/audiores.2017.178

Cited by 42 publications

(34 citation statements)

References 51 publications

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“…A larger case-control study in the future is needed to verify this finding. The findings of more frequent RD in patients with short (≤4 days) symptom durations in our study were different from previous studies (11, 18, 27–29). We assumed that symptom durations may not be the sole factor in the development of RD.…”

Section: Discussioncontrasting

confidence: 99%

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Efficacy of Repositioning Therapy in Patients With Benign Paroxysmal Positional Vertigo and Preexisting Central Neurologic Disorders

et al. 2018

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With the exception of migraines, benign paroxysmal positional vertigo (BPPV) in patients with preexisting central neurologic disorders (CND) is rarely discussed in the literature. Demographic features of this patient group and the efficacy of repositioning therapy are still unknown. We hypothesized that a CND may alter the function of the central vestibular pathway, thus changing the pattern of BPPV and outcomes of repositioning. In this study, we enrolled 93 consecutive idiopathic BPPV patients and categorized them into two groups according to the presence or absence of a CND. In our series, 31.2% of BPPV cases had a CND. The most common associated CNDs were cerebrovascular disease and migraines. The two groups showed similar age distributions, canal involvement, success rates of repositioning, and cycles of treatment used to achieve complete resolution. The major differences were the proportion of females (89.7%) and a right-side predominance (75.9%) in the CND group. There was a trend of more residual dizziness (RD) after successful repositioning in the CND group, but the difference was not significant. The reason for the female and right-side predominance in the CND group is unclear. We concluded that the efficacy of repositioning therapy was excellent (with a success rate of 80.6% with one cycle and 93.5% within two cycles of treatment) for BPPV with or without a preexisting CND. Clinicians are encouraged to diagnose and treat BPPV in patients with a preexisting CND as early as possible to improve patients' quality of life, avoid complications, and reduce medical costs.

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Section: Discussioncontrasting

confidence: 99%

“…The pathogenesis of RD is still unclear. The following hypotheses have been proposed: (1) persistence of debris; (2) utricular dysfunction; (3) incomplete central adaptation; and (4) sympathoneural deregulation (11). …”

Section: Introductionmentioning

confidence: 99%

Efficacy of Repositioning Therapy in Patients With Benign Paroxysmal Positional Vertigo and Preexisting Central Neurologic Disorders

et al. 2018

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“…All patients suspected of positional vertigo from the history were first evaluated for the Dizziness Handicap Inventory (DHI) score and the DHI-E score as per response to question nos. 2,5,10,15,18,20,21,22, and 23 (even before the positional tests were done if the history suggested BPPV). If the DHI-Emotional (DHI-E) score was found to be more than 10 or if there was any evidence of anxiety and/or depression, or if the patient was aged above 65 years (in which case some anxiety is not unexpected), then the patient was first reassured and counseled by us (the author and the assistant neurotologist in the clinic) not the psychologist, once before the positional test and the requisite maneuver were done, but extensively immediately after the maneuver.…”

Section: Methodsmentioning

confidence: 99%

“…In studies where the DHI score of BPPV patients has been recorded prior to the CRM, it has been shown that those patients who have high scores in questions nos. 2,5,10,15,18,20,21,22, and 23 of the DHI are much more prone to developing post-BPPV syndrome. 26 These particular questions are all related to emotional issues.…”

Section: A Dysregulation Of the Sympathoneural System: It Ismentioning

confidence: 99%

Post-BPPV Syndrome: Our Experience in a Specialized Neurotology Clinic in Kolkata

Biswas¹,

Dutta²

2019

AONO

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Introduction The common cause of approximately 25 to 30% of all patients presenting to the neurotologist with the complaint of head-spinning is benign paroxysmal positional vertigo (BPPV) that is the commonest cause for which a patient attends a vertigo clinic. Though BPPV is very effectively treated with the canalith repositioning maneuver (CRM), a considerable percent of these patients (34–61% as per different studies)7 8 9 10 is not completely symptom-free even after a very successful maneuver (s) and complain of a new set of symptoms of light-headedness, unsteadiness, or dizziness or a combination of them termed as post-BPPV syndrome or as residual dizziness (RD) after successful correction of BPPV. Post-BPPV syndrome induces a very poor quality of life and is very incapacitating to most patients who suffer from it. Materials and Methods In Vertigo and Deafness Clinic, Kolkata, a total number of 200 patients were diagnosed with geotropic variety of BPPV in a period of 1 year from April 1, 2018 to March 31, 2019. Out of these 200 patients, the study was conducted on 178 patients who came for follow-up and also underwent all the necessary vestibular function tests. The remaining 22 patients who did not turn up for follow-up or did not undergo the tests either due to financial constraints or lack of time were excluded from the study group. The study was limited only to patients who had geotropic nystagmus and in patients with ageotropic nystagmus who were excluded from the study. One hundred seventy-eight patients of BPPV who were included in the study were managed by a protocol elaborated below devised by the first author. Results Following this protocol of BPPV management, only 23 (13%) patients after successful CRM presented with post-BPPV syndrome that is much less than the international figures of 34 to 61%. Analysis of data also showed that there was a huge psychic component in post-BPPV syndrome and that there was practically no organic vestibular deficit in post-BPPV syndrome. Conclusion Following our protocol of management of BPPV patients, which does not involve any new maneuver, only 13% of the patients complained of RD after the successful repositioning maneuvers. This is far lesser than the published international figures and this protocol may hence be tried and followed by other neurotology centers too. This protocol drastically reduces the morbidity of patients after the BPPV has been corrected by the requisite maneuvers. In our group of 23 patients who had post-BPPV syndrome out of 178 patients who had BPPV, the symptoms subsided spontaneously without medication within 3 weeks in more than 70% of patients. Only in three (13%) patients of post-BPPV syndrome, the RD persisted up to 12 weeks where drugs (selective serotonin reuptake inhibitor, benzodiazepines) and professional psychological counseling were required. None of these patients required any vestibular sedatives or the so called antivertigo drugs for amelioration of symptoms. It may hence be concluded that management of BPPV by this protocol reduces the incidence of post-BPPV syndrome and that antivertigo drugs have no role in the management of post-BPPV syndrome.

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“…Aunque en la actualidad se acepta que el tratamiento gold standard del VPPB son las maniobras de reposición canalicular, algunos pacientes manifiestan en las semanas posteriores a su recuperación con este tratamiento, síntomas de mareo e inestabilidad persistente sin nistagmo ni sensación vertiginosa en posiciones estáticas o dinámicas posiblemente en relación con la alteración de la información propioceptiva y visual [28,29]. La aparición de este cuadro se ha relacionado con factores tales como la edad, el tiempo de evolución del cuadro de VPPB [30,31] o con un componente de ansiedad. La rehabilitación vestibular en estos casos, especialmente en los pacientes de edad más avanzada, ha obtenido mejores resultados que con las maniobras de reposición como tratamiento único [29].…”

Section: Inestabilidad Residual Tras El Vértigo Posicional Paroxísticunclassified

Indicaciones de la rehabilitación vestibular

Alonso-Mesonero

Sánchez-Martínez

2019

ORL

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Introducción y objetivo: Desde la aplicación de la rehabilitación vestibular como tratamiento del paciente con mareo, las indicaciones han ido ampliándose en función del avance de los procedimientos aplicados, pasando de una terapia puramente física a otra en la que además, se usan instrumentos que aporta el avance tecnológico. En este capítulo, vamos a presentar las distintas indicaciones que hoy en día se han demostrado eficaces y aquellas que aún no han sido validadas a pesar de que muchos autores las defienden. Método: revisión narrativa. Resultados: Además de la utilidad de la rehabilitación vestibular en el déficit vestibular agudo, también lo es en diferentes patologías crónicas, aunque siguen quedando pendientes algunas cuestiones como conocer el momento idóneo de su aplicación. Discusión y conclusiones: la rehabilitación vestibular es fundamental en el tratamiento de muchos tipos de patología vestibular. Es importante tener en cuenta todas las indicaciones posibles para poder ofrecer al paciente un tratamiento adecuado que conlleve un mejor resultado terapéutico.

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Residual Dizziness after Successful Repositioning Maneuver for Idiopathic Benign Paroxysmal Positional Vertigo: A Review

Cited by 42 publications

References 51 publications

Efficacy of Repositioning Therapy in Patients With Benign Paroxysmal Positional Vertigo and Preexisting Central Neurologic Disorders

Efficacy of Repositioning Therapy in Patients With Benign Paroxysmal Positional Vertigo and Preexisting Central Neurologic Disorders

Post-BPPV Syndrome: Our Experience in a Specialized Neurotology Clinic in Kolkata

Indicaciones de la rehabilitación vestibular

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