The Effects of the Vestibular Rehabilitation on the Benign Paroxysmal Positional Vertigo Recurrence Rate in Patients with Otolith Dysfunction

Abstract

Background and ObjectivesAlthough repositioning maneuvers have shown remarkable success rate in treatments of benign paroxysmal positional vertigo (BPPV), the high recurrence rate of BPPV has been an important issue. The aims of present study were to examine the effects of otolith dysfunction on BPPV recurrence rate and to describe the effect of vestibular rehabilitation exercises on BPPV recurrence in BPPV patients with concomitant otolith dysfunction.Subjects and MethodsForty-five BPPV patients included in this study (three groups). Patients in group 1 had no otolith dysfunction and patients in groups 2 and 3 had concomitant otolith dysfunction. Otolith dysfunction was determined with ocular/cervical vestibular evoked myogenic potential (oVEMP and cVEMP) abnormalities. Epley’s maneuver was performed for the patients in all groups but patients in group 3 also received a 2-month vestibular rehabilitation program (habituation and otolith exercises). ResultsThis study showed that BPPV recurrent rate was significantly higher in patients with otolith dysfunction in comparison to the group 1 (p<0.05). Vestibular rehabilitation resulted in BPPV recurrence rate reduction. Utricular dysfunction showed significant correlation with BPPV recurrence rate. ConclusionsOtolith dysfunction can increase BPPV recurrence rate. Utricular dysfunction in comparison to saccular dysfunction leads to more BPPV recurrence rate. Vestibular rehabilitation program including habituation and otolith exercises may reduce the chance of BPPV recurrence.

Update on benign paroxysmal positional vertigo

“…Otolith dysfunction could be associated with an increase in the recurrences of BPPV [75,76]. Thus, the vestibular rehabilitation program including may reduce the recurrence rate of BPPV [77]. This program includes jumping on the trampoline-like surface with eyes open and closed, reading a text during linear head movements, standing on the tilt board and using an exercise ball.…”

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

“…Controlling age‐related free‐floating otoliths is difficult and continuously and repeatedly using physical maneuvers to return them from the canal to the utricle is not a good idea . Therefore, HUS when lying down at home is recommended as the first treatment for patients with intractable idiopathic BPPV.…”

“…It is not so easy to prevent debris from coming off the utricle or to wait for debris to diminish via turnover. It is not a good idea return the endless free‐floating debris in the canals to the utricle through repeated physical maneuvers, although Epley and Lempert methods have already turned out to be effective are widely used worldwide . For these reasons, here we propose keeping the head at 45° when lying down at home to prevent free‐floating debris from coming into the semicircular canal.…”

“…) during sleep for the following reasons: 1) Controlling free‐floating otoliths is not easy due to the effects of aging; 2) Repeatedly returning the free‐floating otoliths from the canals to the utricle through physical maneuvers is not a good idea. Free‐floating otoliths return to the canals whenever patients with intractable BPPV lie down using thin or flat pillows . This pilot study provides a good start for a new therapeutic strategy that uses head‐position management when lying down to prevent free‐floating otoliths from entering the semicircular canals.…”

“…Free-floating otoliths return to the canals whenever patients with intractable BPPV lie down using thin or flat pillows. 7,8 This pilot study provides a good start for a new therapeutic strategy that uses head-position management when lying down to prevent free-floating otoliths from entering the semicircular canals.…”