Treatment of Objective and Subjective Benign Paroxysmal Positional Vertigo

Huebner, Alexandra C; Lytle, Susan Ruth; Doettl, Steven M.; Plyler, Patrick N.; Thelin, James T

doi:10.3766/jaaa.24.7.8

Cited by 28 publications

(20 citation statements)

References 15 publications

(30 reference statements)

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“…The decision not to use Frenzel goggles or videonystagmography in our study was deliberate as we wished to reproduce the conditions faced by GPs in routine practice. Response to the EM in terms of perceived disability was not in uenced by the presence or absence of nystagmus at baseline, supporting previous ndings by Huebner et al [39] and Marques et al [41]. Nonetheless, we cannot completely rule out the possibility that some of the patients in the S-BPPV group may have had vestibular neuritis or vestibular migraine.…”

Section: Discussionsupporting

confidence: 83%

“…The higher proportion of patients with S-BPPV detected in our series compared with earlier series [14] [39] indicates that we may have underestimated the prevalence of O-BPPV. Patients seen in primary care often have early-stage nystagmus, which is more di cult to diagnosis, particularly if special tools such as Frenzel goggles or videonystagmography are not used [40].…”

Section: Discussioncontrasting

confidence: 75%

“…The gold standard diagnostic work-up for pc-BPPV does not include these tools [1], but they can increase the number of O-BPPV cases diagnosed. Testing primary care patients with S-BPPV in addition to those with O-BBPV (greater diagnostic sensitivity at the expense of speci city) in primary care may improve early diagnosis and treatment rates, and such an approach has been suggested by other authors [39]. The decision not to use Frenzel goggles or videonystagmography in our study was deliberate as we wished to reproduce the conditions faced by GPs in routine practice.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Epley manoeuvre on self-perceived disability: A randomised controlled trial in primary care

Muñoz

Moreno

Balboa

et al. 2020

Preprint

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Background: Posterior canal benign paroxysmal positional vertigo (pc-BPPV) causes physical, functional, and emotional impairment. The treatment of choice is the Epley manoeuvre (EM). The purpose of the study was to compare the impact of the EM and a sham manoeuvre in primary care on self-perceived disability.Method: Randomised, double-blind, sham-controlled clinical trial conducted in primary care with a follow-up of 1 year. Patients aged ≥18 years old diagnosed with pc-BPPV according to the Dix-Hallpike test (DHT) were randomised to an intervention (EM) group or a control (sham manoeuvre) group. The main study covariables were age, sex, history of depression and anxiety, presence of nystagmus in the DHT, patient-perceived disability assessed with the Dizziness Handicap Inventory-screening version (DHI-S). Data were analyzed using bivariate and multivariate mixed Tobit analyses. Results: Overall, 134 patients were studied: 66 in the intervention group and 68 in the control group. Median age was 52 years (interquartile range [IQR], 38.25–68.00 years) and 76.12% of the patients were women. The DHT triggered nystagmus in 40.30% of patients. The median total DHI-S score for the overall sample at baseline was 16 (IQR, 8.00–22.00); 16 [IQR, 10.5–24.0] vs 10 [6.0–14.0] for women vs men (P<0.001) and 16 [IQR, 10.0-24.0] vs 12 [IQR, 8.0–18.0] for patients without nystagmus vs those with nystagmus (P=0.033).Patients treated with the EM experienced a mean reduction of 2.03 points in DHI-S score over the follow-up period compared with patients in the sham group. Conclusion: Pc-BPPV affects the quality of life of primary care patients. A single EM can improve self-perceptions of disability by around 2 points on the DHI-S scale, Trial registration: ClinicalTrials.gov Identifier: NCT01969513. Retrospectively registered. First Posted: October 25, 2013. https://clinicaltrials.gov/ct2/show/NCT01969513

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Section: Discussionsupporting

confidence: 83%

Section: Discussioncontrasting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Epley manoeuvre on self-perceived disability: A randomised controlled trial in primary care

Muñoz

Moreno

Balboa

et al. 2020

Preprint

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“…Subjective BPPV, defined as a positive history of BPPV with a positional testing positive for vertigo but negative for nystagmus, has been studied [19][20][21]. Balatsouras et al [20] diagnosed and treated 45 patients with subjective BPPV.…”

Section: Discussionmentioning

confidence: 99%

First-referral presentations of patients with benign paroxysmal positional vertigo who were negative on positional testing and who lacked nystagmus

Tan

Feng

et al. 2014

Eur Arch Otorhinolaryngol

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The aim of the present study was to explore the demographic, clinical, and pathogenetic features; and treatment outcomes of patients with benign paroxysmal positional vertigo (BPPV) who were negative upon positional testing at their first referral. A total of 133 patients presented with histories of BPPV but were negative, in our hands, upon positional testing. Patients were told to cease taking vestibular suppressant medication (if any) and were to return for re-examination when positional vertigo symptoms recurred. If BPPV was diagnosed, the appropriate repositioning maneuver was applied and patients were re-examined weekly until the characteristic nystagmus and vertigo disappeared. Follow-up was performed 1 week, 4 weeks, 3 months, 6 months, and 1 year after diagnosis. The 133 patients were compared with a group of 250 patients with typical BPPV. Sixty-five of the 133 patients (termed the n-BPPV group) were subsequently identified with typical BPPV. Such diagnoses were made within 10 days of the first referral in 37 (56.9%) cases. Patients of the n-BPPV group had a longer duration of the last episode of vertigo than did others (39.7 ± 38.4 vs. 26.1 ± 36.7 days, p < 0.001), and a higher proportion used vestibular suppressant medication prior to first referral (75.4 vs. 54.8%, p = 0.003). The n-BPPV and typical BPPV patients responded similarly to treatment and exhibited similar recurrence rates. BPPV patients who were negative upon positional testing at first referral were quite common, accounting for 26% of all typical BPPV patients. No significant difference in either treatment outcome or recurrence rate was evident between n-BPPV and typical BPPV positions. Positional vertigo and nystagmus are not always present as BPPV progresses.

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“…It is thought that the absence of vertigo may be the best indicator of success for CRP, and many trials also report the conversion from positive to negative DHT after EM as a secondary outcome, similar to reported rates of symptom resolution . Thus, the resolution of vertigo or nystagmus on the DHT may be evaluated separately due to the possible presence of subclinical BPPV . Our study showed that 117 (88.6%) of 132 patients with idiopathic PC‐BPPV had resolution of vertigo, and 108 (81.8%) patients had resolution of both vertigo and nystagmus on the DHT at the 1‐week follow‐up after CCRP.…”

Section: Discussionmentioning

confidence: 65%

Efficacy of computer-controlled repositioning procedure for benign paroxysmal positional vertigo

2014

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Treatment of Objective and Subjective Benign Paroxysmal Positional Vertigo

Cited by 28 publications

References 15 publications

Impact of Epley manoeuvre on self-perceived disability: A randomised controlled trial in primary care

Impact of Epley manoeuvre on self-perceived disability: A randomised controlled trial in primary care

First-referral presentations of patients with benign paroxysmal positional vertigo who were negative on positional testing and who lacked nystagmus

Efficacy of computer-controlled repositioning procedure for benign paroxysmal positional vertigo

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