benign paroxysmal positional vertigo

Benign Paroxysmal Positional Vertigo (BPPV) impacts the quality of life of affected people, especially the elderly. The Epley maneuver and the Gans maneuver are used to treat Posterior Canal BPPV (PC-BPPV). The effectiveness of the Epley maneuver has been verified, but further studies are required to prove the effectiveness of the Gans maneuver. The main purpose of the current study was to compare the effectiveness of the Gans maneuver with the Epley maneuver in the treatment of the elderly with PC-BPPV, considering emotional, physical, and functional symptoms by assessing anxiety, dizziness, and quality of life after treatment.

Sixty-three elderly patient (74.38±5.34 years) with unilateral PC-BPPV were recruited in this study. They were randomly assigned to two groups. The experimental group received the Gans maneuver, and the control group received the Epley maneuver. All patients completed the Persian version of the Dizziness Handicap Inventory (DHI) and Vestibular Rehabilitation Benefit Questionnaire (VRBQ) before, 48 hours and 1 month after treatment. Recurrence rate was assessed after the 2-month follow up.

Significant differences were observed between pre-treatment and post-treatment questionnaire outcomes for both study groups; nevertheless, in each phase of the study, there were no significant differences between the two groups in the DHI and VRBQ scores.

Both the Gans maneuver and Epley maneuver were almost equally effective and made elderly with PC-BPPV report a better condition in terms of anxiety, emotional factors and quality of life after receiving the maneuvers.

Magnesium is essential for the morphogenesis of otoconia. The imbalance in the chemical composition of otoconia can make people susceptible to Benign Paroxysmal Positional Vertigo (BPPV). The primary outcome was to compare serum magnesium levels in BPPV patients with controls. The Ca/Mg ratios in participants are also recorded and analyzed in the present study.

In this case-control study, we measured the serum Mg, Ca, and vitamin D in BPPV patients and age-, sex-matched subjects without BPPV. The results were adjusted for Ca, vitamin D, hypertension, and body mass index.

A total of 123 BPPV patients participated in this study. The mean Mg value was higher in patients than controls (2.01 vs. 1.95 mg/dL, p=0.030). Condition logistic regression analyses showed a higher rate of BPPV among subjects with low Ca/Mg ratio (quartile 1), relative to subjects with medium ratio (quartiles 2 and 3) (adjusted OR: 3.92, p=0.003).

The present study demonstrated an imbalance of Ca and Mg in the BPPV patients as significantly higher Mg levels and lower serum Ca/Mg ratio. Although it appears decreased Ca/Mg ratio to be a risk factor for BPPV, this result should be confirmed in confirmatory studies.

 Benign paroxysmal positional vertigo (BPV) is the most common cause of the high prevalence of vertigo. Today, BPV is caused by the separation of autochthonous particles from the macular atrial. As a result, these particles float in a semicircular canal and change position by gravity. The majority of vertigo causes arise from the inner ear.

 This study aims to measure the vitamin D level in patients with BPPV who visited Loghman Hakim Hospital clinics and compare the results with controls.

 This comparative study evaluated the effect of vitamin D on reducing BPV. Demographic information of patients was collected through interviews. The physical examinations were recorded through a questionnaire. For the group with BPPV, we did the Epley maneuver and measured the vitamin D level. We compared the vitamin D levels of these patients with the matched control group.

 In this study, 148 patients were evaluated. Sixty-three patients were male, and 85 patients were female. All case and control patients were tested for vitamin D levels. Of 93 patients with benign vertigo, 39 (41.9%) patients had normal vitamin D levels, and 54(58.1%) patients had below normal. In the control group, 43 (78.2%) patients had normal vitamin D, and 12 (21.8%) patients had less than normal. There was a statistically significant difference between the two groups.

 The present study indicated that BPV was more prevalent in people with vitamin D deficiency, and vitamin D treatment could effectively control and reduce the prevalence of this disease.

Benign paroxysmal positional vertigo (BPPV) is a common cause of peripheral vestibular disturbances. Particle repositioning or liberatory maneuvers provide relief of symptoms in the majority of patients. However, studies mainly focus on success. This study aims to review the conditions that may have an impact on residual dizziness or recurrence following therapeutic maneuvers in patients with BPPV. 

A review of the literature about the analysis of quality of life after therapeutic maneuvers was conducted. Three hundred and seven articles after search in the PubMed database were classified into eight main groups after exclusion of those that are not suitable to predetermined criteria. 

Thirty-eight articles for residual dizziness in BPPV, eighty-three articles for the duration of BPPV, forty articles for the type of canal involvement, forty-three articles for the impact of age, one hundred and nine articles for the gender difference, forty-seven articles for co-morbid conditions, one hundred and twenty-four articles for medication and sixty-eight articles for vestibular exercises in BPPV were selected. 

VEMP abnormality is a reliable indicator to demonstrate the risk of recurrence. Duration of dizziness has no significant impact on recurrence. But the length of duration is important for residual dizziness. Vestibular rehabilitation or medication alone has no place in treatment but may help to reduce the symptoms in addition to maneuver. Self-perceived evaluation of balance after therapeutic maneuvers is recommended for the selection of those who need rehabilitation or additional medication.

Because of the limited information available regarding peripheral vertigo (PV) in physicians, we conducted this study to clarify this issue.

We used Taiwan National Health Insurance Research Database to identify 26,309 physicians and an identical number of general population matched by age and sex. All the participants who had PV before 2007 and residents were excluded. By tracing their medical histories between 2007 and 2013, comparisons of PV risk between physicians and general population and among physicians were performed.

Physicians had a significantly lower PV risk than the general population (adjusted odds ratio [AOR]: 0.811; 95% confidence interval [CI]: 0.662–0.994). In comparison among physicians, otolaryngologists had a significantly higher PV risk than other specialties. Physicians who were older or served in local hospitals or clinics had a significantly higher PV risk than physicians in medical centers.

Physicians had a significantly lower PV risk than the general population. Better medical knowledge in physicians than in the general population may explain the findings; however, further studies are warranted for elucidating the detailed mechanisms.

To identify the type of referrals received by vestibular physiotherapists for vertigo and assess whether medical review for these patients would be appropriate.

We performed a retrospective review of referral forms, vestibular assessment forms, and vertigo clinic letters of patients referred for vertigo or vestibular physiotherapy input between July 1, 2013, to December 31, 2013.

We studied 29 patients with a median age of 63 years. A diagnosis was provided in 65.5% of the referrals. Of 14 patients with possible benign paroxysmal positional vertigo (BPPV), Dix-Hallpike had been performed only for 4 patients. Almost half were seen for the medical review in the Vertigo Clinic due to the concerns of possible alternative non-vestibular diagnosis, medication issues, or syncope. Alternative diagnoses identified medically included orthostatic hypotension, stroke, vestibular migraine, medication-induced bradycardia, and phobic postural vertigo. Medication changes in vertigo clinic included treatment for heart failure, migraine, and medication optimization.

Medical review is appropriate for some patients referred for vestibular physiotherapy. A medical opinion should be sought by vestibular physiotherapists if there is uncertainty or concerns that the referred patients did not have straightforward vestibular problems, or there were possible alternative diagnoses, concerns with medications, or syncope.

We determined the diagnostic and therapeutic effects of SRM-IV vestibular function diagnosis and treatment system on benign paroxysmal positional vertigo (BPPV).
Overall, 120 patients with BPPV diagnosed in the outpatient and in-patient departments of the Vertigo Treatment Center of the First People's Hospital of Xuzhou from January 2013 to December 2015 were selected for this study. They were randomly divided into three groups. Automatic repositioning procedure was conducted for 40 patients in the equipment repositioning group by SRM-IV vestibular function diagnosis and treatment system, conventional manual repositioning procedure was used for 40 patients in the manual repositioning group, and combination of treatment drugs (alprostadil and safflower injection) with acclimatization training was adopted in 40 patients in the drug therapy group.
After 1 week of treatment, the cure rate and total effective rate in the equipment repositioning group and the manual repositioning group were significantly higher than those in drug therapy group (P The SRM-IV vestibular function diagnosis and treatment system are helpful in achieving effective and standard diagnosis and treatment of BPPV.

Benign paroxysmal positional vertigo (BPPV) is most common type of vertigo in general population. Epley maneuver is the most effective treatment technique. However, there is no clinically valid test to verify effectiveness of maneuver quickly after treatment in the same session. Modified clinical test of sensory interaction on balance (mCTSIB) is considered as a quick and simple test. This study aimed to use mCTSIB for assessing effectiveness of Epley maneuver in BPPV patients.
The study was carried out on 44 patients (36 female and 8 male, mean age of 53.11 (SD=7.09) diagnosed with posterior semicircular canals BPPV in Dix-Hallpike test and no other vestibular disorders. mCTSIB in four conditions was assessed, before and after Epley maneuver. Balance time, lateral and anterior-posterior sway were recorded. mCTSIB repeated after three weeks to assess reliability.
The time for balance control in mCTSIB after maneuver did not change significantly relative to before maneuver (p>0.05). Lateral sway changes in conditions 2, 3 and 4 in mCTSIB significantly reduced after maneuver (p=0.04). Anterior-posterior sway changes in conditions 1 and 2 showed no significant difference after maneuver, however, differences in conditions 3 and 4 were statistically significant (p mCTSIB is seems be a valid test with simple and quick apply for verifying the effectiveness of Epley maneuver in BPPV patients.

Benign paroxysmal positional vertigo (BPPV), involving the semicircular canals, is one of the most common diseases of the inner ear. The video head impulse test (vHIT) is a new test that examines the function of the canals. This study aimed to investigate the vestibulo-ocular reflex (VOR) gain, gain asymmetry and saccades after stimulating all six canals in patients definitively diagnosed with posterior semicircular canal BPPV (PSC-BPPV).
Twenty-nine unilateral PSC-BPPV patients with normal oculographic and caloric results were enrolled in this study. vHIT was performed on six canals, and VOR gain, gain asymmetry and saccades were measured.
Sixteen (55.17%) patients had abnormal posterior canal VOR gains in the ipsilesional ear. VOR gains in both horizontal canals were within normal limits. Superior canal VOR gains were mostly lower than normal and were not correlated to PSC abnormalities (P>0.05). No corrective saccades could be observed.
VOR gain in the direction of the posterior semicircular canal may be reduced in PSC-BPPV patients. Evaluation of PSC-VOR parameters could be beneficial, although superior canal measurements should be interpreted with caution.

Benign paroxysmal positional vertigo (BPPV) is linked to vitamin D deficiency. This clinical trial aimed to determine the influence of vitamin D supplementation on intensity of BPPV.
The study population was selected consecutively and the diagnosis of BPPV was made by history and clinical examination and exclusion of other conditions. Intensity of BPVV was assessed based on VAS score (0-10). Serum 25-hydroxyvitamin D (25-OHD) was measured using ELISA method and levels After two months of treatment, in both vitamin D treated and non-treated groups the intensity of BPPV decreased significantly as compared with control (P=0.001 for both groups) but at endpoint, the intensity of BPPV aggravated and regressed to the baseline value in vitamin D deficient non-treated group (P=0.001) whereas, in vitamin D treated group, improvement of BPPV remained stable and unchanged over the study period.
This study indicates that correction of vitamin D deficiency in BPPV provides additional benefit to rehabilitation therapy (Epley maneuver) regarding duration of improvement. These findings suggest serum 25-OHD measurement in recurrent BPPV.

Meniere’s disease (MD) is a chronic illness defined as an idiopathic syndrome of endolymphatic hydrops. Benign paroxysmal positional vertigo (BPPV) is a balance disorder and can be the sequel of diverse inner ear impairments. The purpose of this study was to investigate the prevalence of BPPV in MD patients. All patients with definite or probable MD participated in this cross-sectional descriptive and analytic study between March 2013 and February 2014. We used the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) criteria plus electrocochleography (ECochG) test results to define the presence of MD and positional tests to determine the presence of BPPV. The frequency was reported. Independent sample t-test was also used in SPSS19. A total of 39 patients (43 ears) with definite or probable MD (26 female, 13 male; mean age: 46.4 ± 9.2 years) were enrolled in this study. Six out of 39 cases (15.4%) had BPPV in the posterior semicircular canal. The mean duration of MD was 28.5 months in BPPV group and 13.2 months in the non-BPPV group. Regardless of the age of the patients, there was a significant difference (p = 0.02) between the duration of MD in the two groups. It seems that MD and BPPV are related and a longer duration of MD may result in a greater risk of developing BPPV.

Benign Paroxysmal Positional Vertigo (BPPV) is a condition that indicates a benign inner ear disorder. It is generally believed that BPPV is due to the dislodged otoconial particles from otolith organs and unusual collection of them within any of semicircular canals or even in all three semicircular canals. Although the typical features of nystagmus in BPPV have been well-studied, very few studies (just four articles) have highlighted the presence of spontaneous nystagmus in BPPV recently. During the past 10 years, 2850 patients have been examined at the audiology unit of our department, and 254 patients have received diagnoses of BPPV but recently 2 patients presented with BPPV and spontaneous nystagmus, a new symptom that has been never observed in our clinical records. We herein describe this rare symptom in 2 case of BPPV. A 50-year-old woman with BPPV who showed an 18 degree spontaneous nystagmus treated with Epley maneuver and a 53-year-old man with 3 degree spontaneous nystagmus.