Benign paroxysmal positional vertigo recurrence and persistence

The Laryngoscope, 2000

Objective To identify variables affecting outcome in patients with benign paro‐ysmal positional vertigo (BPPV) treated with canalith repositioning maneuvers.Study Design Retrospective review of patients at a tertiary vestibular rehabilitation center.Methods Variables identified for statistical analysis included method of diagnosis, age, se‐, onset association with trauma, semicircular canal involvement, presence of bilateral disease, treatment visits, and cycles of canalith repositioning maneuvers per treatment visit. Multivariate statistical analysis using Pearson χ2, likelihood ratio, linear‐by‐linear association, and cross‐tabulation tests were performed.Results Two hundred fifty‐nine patients with BPPV who received treatment were identified from 1996 to 1998. Average follow‐up time was 16.9 months. 74.8% required one treatment visit, 19.0% required a second treatment visit, and 98.4% were successfully treated after three treatment visits. The remainder required up to seven treat...

Audiology and Neurotology, 2013

symptom recurrence was noted in 139 patients. A statistically significantly higher recurrence rate was noted in elderly people or those with head trauma or a history of vestibular neuropathy (p ! 0.001). Conclusions: This study provides class IV evidence that CRP remains an efficient and long-lasting noninvasive treatment for BPPV, especially for younger patients without a history of head trauma or vestibular neuropathy. Elderly people have a significantly higher recurrence rate requiring additional education to minimize potential morbidity of their falls.

Objectives. To assess factors related to residual dizziness (RD) in patients who underwent successful canalith reposi-tioning procedures (CRPs) for benign paroxysmal positional vertigo (BPPV). Subjects and Methods. Ninety-seven consecutive patients with BPPV of the posterior semicircular canal were initially enrolled. Diagnosis was assessed according to clinical history and bedside evaluation. All patients were treated with CRPs until nystagmus disappeared. Three days after the successful treatment, presence of RD was investigated. If RD was present, patients were monitored every 3 days until the symptoms disappeared. Subjects who required 4 CRPs or who failed to meet the follow-up visit were excluded. The Dizziness Handicap Inventory (DHI) was obtained from patients at the time of diagnosis and at every subsequent visit. Results. At the end of selection, 86 patients were included; 33 (38.36%) reported RD after successful treatment. A significant difference in the incidence of RD was observed in consideration of the age of the subjects (P = .0003) and the DHI score at the time of diagnosis (P \ .001). A logistic regression analysis showed that the probability of RD occurrence increased with the increase of the emotional subdo-main score of the DHI questionnaire. Conclusion. RD is a common self-limited disorder, more frequent in the elderly, which may occur after the physical treatment for BPPV. The DHI score at the time of BPPV diagnosis represents a useful tool to quantify the impact of this vestibular disorder on the quality of life and to estimate the risk of RD after CRPs. B enign paroxysmal positional vertigo (BPPV) is a common disorder of the inner ear characterized by repeated episodes of vertigo that are triggered by changes in head position. 1,2 BPPV is the most prevalent peripheral vestibular impairment during the life span, which accounts for approximately 17% of complaints of vertigo. 1-4 The suggested pathophysiology is a displacement of otoconial matter from the utricle to the semicircular canals. The movement of the otoconial matter due to gravity causes the flow of endolymph, which consequently causes vertigo and nystagmus. BPPV is usually idiopathic but can occur after head trauma or secondary to various disorders that damage the inner ear and detach the otolith from the utricular macule. The posterior semicircular canal is affected in most cases. 1-5 BPPV is effectively managed via different repositioning maneuvers, which are noninvasive procedures meant to

The Journal of Laryngology & Otology, 2006

Objective: To evaluate the prognostic factors in benign paroxysmal positional vertigo (BPPV) treated with canalith repositioning procedures (CRPs).Material and methods: Retrospective study of consecutive BPPV cases diagnosed over three years. All patients underwent a complete otolaryngologic, audiologic and neurotologic evaluation. The appropriate CRP was performed, depending on the type of BPPV. Prognostic factors studied included age, sex, aetiology, duration of disease, abnormal electronystagmographic findings, canal involvement, improper performance of manoeuvres, response on first or repeat treatment, and presence of recurrences.Results: One hundred and fifty-five patients were studied, 66 men and 89 women, with mean ages of 58.7 and 60.4 years, respectively. Age and the involvement of two canals or bilateral disease had an effect on initial treatment outcome and were correlated to increased recurrences but not to repeat treatment outcome. Secondary BPPV, abnormal electronystag...

Family Medicine & Primary Care Review, 2016

Background. Vertigo as a symptom accompanies many pathological processes leading to damage of the vestibular system at a peripheral or central level. it is a manifestation of systemic diseases. Vertigo is one of the most common causes of presentation of the patient to a general practitioner. one of the most common causes of sudden vertigo is benign paroxysmal positional vertigo (BPPV). Objectives. assessment of the effectiveness of the canalith repositioning procedure in idiopathic and posttraumatic BPPV. Material and methods. 50 people with BPPV aged 22-78 (mean 53 ± 13), divided into 2 groups of 25 subjects each, suffering from posttraumatic (group a, aged 53 ± 15) and idiopathic (group B, aged 53 ± 11) vertigo. The treatment was conducted using the epley manoeuver, controlling its effectiveness by means of the Dix-hallpike manoeuvre. Results. all the treated patients benefited from the therapy. the percentage of patients cured after the first two medical manoeuvres was 52% (13) and 92% (23) in groups a and B, respectively, which is a statistically significant difference (p = 0.0016). Patients in group B had an 18 times higher chance of regression of symptoms as early as after the first medical manoeuvre. The number of performed manoeuvres which guaranteed full effectiveness was on average 1.16 per patient with only one semicircular canal affected, and 3.5 when semicircular canals on both sides were affected. Conclusions. 1. the application of motor rehabilitation in the course of BPPV is a non-invasive method for treating vertigo with high effectiveness. 2. trauma in medical history prolongs the treatment of BPPV using manoeuvre. 3. if BPPV affects both sides, the manoeuvre should be repeated more times. 4. the characteristic medical history and risk factors (trauma) facilitate forming a suspicion of the diagnosis with a high probability as early as in the office of a general practitioner.

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 2017

To define the risk factors and adverse effects associated with repeated canalith repositioning procedures (CRPs). A case series featuring chart review. An academic university hospital. We retrospectively reviewed 1900 patients (average age, 54.9 years; range, 11-88 years) diagnosed with benign paroxysmal positional vertigo (BPPV). All underwent repeated CRPs. We recorded clinical features including age, gender, BPPV cause (idiopathic or secondary), symptom duration, the canal involved, the number of sessions of CRP, recurrence, follow-up duration, and complications. We compared these factors using Pearson's chi-squared test and multiple linear regression analysis with dummy variables. BPPV was diagnosed based on the results of the head roll and Dix-Hallpike tests. The overall BPPV resolution rate for patients treated with repeated CRPs was 96.4%. The risk factors for the need for multiple CRPs in BPPV were the duration of vertigo before treatment (β = 0.326, p < 0.001), the t...

Clinical Chiropractic, 2009

Objective: Vertigo is a common clinical problem, particularly in older people. Benign paroxysmal positional vertigo (BPPV) is one of the most frequent causes of vertigo. It may be dangerous, especially in older individuals, because unsteadiness associated with BPPV can lead to falls. We aimed to investigate therapeutic effects of canalith repositioning maneuvers in patient with BPPV. Design: Prospective study. Setting: Patients complaining of vertigo referred to our Physical Medicine Outpatient Clinic for vestibular rehabilitation. Subjects: 26 patients (14 male, 12 female) were studied; mean age was 52.5 AE 6.5 year (range 35-65), and mean symptom duration was 9.5 AE 20 months (range 0.25-96). Methods: Detailed clinical examination, tests, and imaging studies were performed to exclude other possible diseases that may cause vertigo. Previous falls from the onset of symptoms were recorded. The Dix-Hallpike test for posterior and anterior semicircular canals (SCC) BPPV, and the supine roll test for horizontal SCC BPPV were performed. In all patients, the Epley maneuver (canalith repositioning maneuver, CRM) was performed initially. The Semont (liberatory) maneuver was performed in those patients who showed no signs of improvement with the Epley maneuver. Patients were followed up during 3 months. Results: All patients were diagnosed as having posterior SCC BPPV. Eight patients described immediate relief of their vertigo following the first maneuver. Ten days later 16 patients (61.5%) showed complete relief from vertigo. The Epley maneuver

Journal of Clinical Medicine

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or o...

Physical Therapy, 2014

<LEAP> highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions-medications, surgery, education, nutrition, exercise-and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature. 1 Each article in this PTJ series summarizes a Cochrane review or other scientific evidence on a single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on an adult patient with benign paroxysmal positional vertigo. Can a canalith repositioning procedure help this patient?

International Journal of Clinical Medicine, 2011

To determine the characteristics of 12 patients with a diagnosis of benign paroxysmal positional vertigo (BPPV) treated by the repositioning maneuver during a 24-month follow-up period after the initial discharge a longitudinal clinical study was performed in which a questionnaire for the assessment of discomfort caused by dizziness was applied at the first visit, at the last visit after treatment and 2 years after the initial discharge. Repositioning treatment was again offered to patients who suffered relapses. In 10 cases (83.34%) there was no recurrence of symptoms and 2 patients (16.66%) presented symptoms exactly 2 years after the original discharge showing that treatment of BPPV by repositioning manuevers is effective in the long term, but new studies in larger populations are needed to determine the pattern of the rates of recurrence of BPPV.