Benign positional paroxysmal vertigo in the general ear, nose, and throat clinic

Benign positional paroxysmal vertigo is a common disease which may be caused by abnormal movement of utricular debris in the posterior semicircular canal. It is diagnosed by the Dix-Hallpike positional maneuver eliciting vertigo and nystagmus. Treatment generally consists of physical exercises with the Epley or Semont maneuvers. We review 43 consecutive patients diagnosed as BPPV in the last year and treated with physical therapy (Epley maneuvers). Results were very good, with a cure rate of 88.37% (53.5% after a single maneuver). Physical therapy is an effective treatment for BPPV.     

Particle repositioning maneuver for benign paroxysmal positional vertigo

The recent demonstration of free-floating particles in the endolymph of the posterior semicircular canal in patients with benign paroxysmal positional vertigo (BPPV)¹ has renewed interest in the physiology and treatment of this entity. The particle repositioning maneuver (PRM) relocates the free-floating particles from the posterior semicircular canal back into the utricle, relieving the patient of bothersome, often long-standing vertigo. This report represents a prospective study of 27 consecutive patients seen with a diagnosis of BPPV. Eighty-four percent of the patients treated with the particle repositioning maneuver who had no other associated pathology were cured or significantly improved with this new technique. Two patients who failed conservative management went on to surgical intervention with the posterior semicircular canal occlusion. The authors find the particle repositioning maneuver effective for many patients with benign positional vertigo and recommend it as the first-line treatment modality for BPPV.     

Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is characterized by positional vertigo (brief attacks of rotatory vertigo triggered by head position changes in the direction of gravity) and is the most common peripheral cause of vertigo. There are two types of BPPV pathophysiology: canalolithiasis and cupulolithiasis. In canalolithiasis, otoconial debris is detached from the otolithic membrane and floats freely within the endolymph of the canal. In cupulolithiasis, the otoconial debris released from the otolithic membrane settles on the cupula of the semicircular canal and the specific gravity of the cupula is increased. Consensus has been reached regarding three subtypes of BPPV: posterior-canal-type BPPV (canalolithiasis), lateral-canal-type BPPV (canalolithiasis) and lateral-canal-type BPPV (cupulolithiasis). In the interview-based medical examination of BPPV, questions regarding the characteristics of vertigo, triggered movement of vertigo, duration of vertigo and cochlear symptoms during vertigo attacks are important for the diagnosis of BPPV. The Dix–Hallpike test is a positioning nystagmus test used for diagnosis of posterior-canal-type BPPV. The head roll test is a positional nystagmus test used for diagnosis of lateral-canal-type BPPV. When the Dix–Hallpike test is repeated, positional nystagmus and the feeling of vertigo typically become weaker. This phenomenon is called BPPV fatigue. The effect of BPPV fatigue typically disappears within 30 min, at which point the Dix–Hallpike test again induces clear positional nystagmus even though BPPV fatigue had previously caused the positional nystagmus to disappear. For the treatment of BPPV, sequential head movements of patients can cause the otoconial debris in the semicircular canal to move to the utricle. This series of head movements is called the canalith repositioning procedure (CRP). The appropriate type of CRP depends on the semicircular canal in which the otoconial debris is located. The CRP for posterior-canal-type BPPV is called the Epley maneuver, and the CRP for lateral-canal-type BPPV is called the Gufoni maneuver. Including a time interval between each head position in the Epley maneuver reduces the immediate effect of the maneuver. This finding can inform the development of methods for reducing the effort exerted by doctors and the discomfort experienced by patients with posterior-canal-type BPPV during the Epley maneuver.     

突发性聋伴发良性阵发性位置性眩晕的临床特点及疗效观察

目的　探讨突发性聋伴发良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的临床特点,观察其疗效。方法　观察2012年10月～2014年6月耳 鼻咽喉科收治的36例突发性聋伴发BPPV发病情况,并与同期原发性BPPV患者40例及突发性聋不伴眩晕患者40例进行疗效比较。结果　伴发BPPV的36例突发性聋患者,受累半规管均与突发性聋发病侧一致,其中水平半规管BPPV 6例,占16.7%（6/36）;后半规管BPPV 27例,占75.0%（27/36）;混合管BPPV 3例,占8.3%（3/36）。36例患者出现BPPV的时间均在突发性聋发病后数小时至数天（＜10天）发生。突发性聋伴发BPPV组1次治愈率明显低于原发性BPPV组,但两种治疗方法的总治愈率均为100%。不伴眩晕突发性聋组的痊愈率、显效率及有效率均高于伴发BPPV组。结论　伴发于突发性聋的BPPV以后半规管多见,与原发性BPPV经耳石复位治疗后均可取得较好疗效。而不伴眩晕的突发性聋其疗效优于伴发BPPV的突发性聋。     

咳嗽对良性阵发性位置性眩晕手法复位疗效的影响

目的：分析患良性阵发性位置性眩晕（BPPV）的慢性咳嗽患者经手法复位治疗后的疗效,为BPPV的综合治疗及病因探索提供帮助。方法：分析2009—10—2012—12期间400例BPPV患者的治疗效果,包括观察患者的症状和行体位试验检查。结果：后半规管BPPV的一次治疗成功率为93．4％,水平半规管BPPV治疗成功率为83．0％。在400例BPPV患者中随访到372例,一次治疗成功的复诊患者中,有35例复位治疗好转后又出现阵发性眩晕发作,再次行手法复位仍取得良好效果。追问病史,有29例存在不同程度的咳嗽。控制咳嗽后再行手法复位治疗,眩晕症状消失,随访半年未再发作。结论：BPPV的发生机制可能与咳嗽所致的头部震动有关。     

手法复位治疗良性阵发性位置性眩晕36例

目的 评价体位治疗在良性阵发性位置性眩晕（BPPV）的应用价值。方法 回顾性分析36例原发性或继发性BPPV的临床资料,后半规管BPPV采用改良Epley手法或Semont手法复位,水平半规管采用Barbecue翻滚疗法复位治疗,评价其治疗效果。结果 33例后半规管BPPV患者应用改良Epley手法或Semont手法复位,有效率为93.9%。3例水平半规管BPPV患者采取Barbecue翻滚法复位后症状均明显改善。结论 手法复位治疗良性阵发性位置性眩晕方法简单,疗效可靠,治愈率高。     

Diagnosis and management of benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is a common disorder of the vestibular labyrinth which should be suspected in all patients with a history of vertigo during changes of head position. The BPPV appears to be caused by free-floating debris in the posterior semicircular canal. The diagnosis is confirmed by eliciting characteristic symptoms during the Dix-Hallpike test. Although the BPPV usually is a self-limited disorder treatment with a specific bedside maneuver is effective and can shorten the duration of symptoms.     

Surgical management for benign paroxysmal positional vertigo of the superior semicircular canal

Benign paroxysmal positional vertigo of the superior semicircular canal is a rare form of BPPV. It accounts for 1% to 3% of cases. The characteristic nystagmus is positional, down‐beating, with a torsional component elicited by the Dix‐Hallpike maneuver. Symptoms of superior semicircular canal BPPV often resolve spontaneously; however, it can be refractory to repositioning maneuvers. Surgical management is described for posterior semicircular canal BPPV. To date, however, there is only one reported case of surgical management for superior semicircular canal BPPV. Here we show video documentation of positional, down‐beating nystagmus and describe a case of superior semicircular canal BPPV requiring canal occlusion with successful resolution of symptoms. Laryngoscope, 125:1965–1967, 2015     

Effect of applying head-shaking maneuver before Epley maneuver in BPPV

IntroductionThe Epley maneuver is applied in the treatment of benign paroxysmal positional vertigo, the BPPV. However, dizziness and balance problems do not improve immediately after the treatment.ObjectiveIn this study, the effectiveness of the head-shaking maneuver before the Epley maneuver was investigated in the treatment of BPPV.MethodsBetween March 2020 and August 2020, ninety-six patients with posterior semicircular canal BPPV were analyzed prospectively. The patients were divided into two groups: patients who underwent the Epley maneuver only in the treatment (Group 1) and patients who underwent the Epley maneuver after the head-shaking maneuver (Group 2). The results of the Berg balance scale and dizziness handicap index were evaluated before the treatment and at the first week after the treatment.ResultsThe improvement in functional, emotional, and physical dizziness handicap index and Berg balance scale values after the treatment was found to be statistically significant in both groups. It was determined that the change in functional and physical dizziness handicap index and Berg balance scale values of the patients in Group 2 was statistically higher than those in Group 1. Although, the change in emotional dizziness handicap index values in Group 2 was higher than those in Group 1, no statistical significance was found between the groups.ConclusionAs a result of our hypothesis, we think that in the treatment of posterior semicircular canal BPPV, the otoliths adhered to the canal can be mobilized by the head-shaking maneuver, and this will contribute to the increase of the effectiveness of the Epley maneuver.     

The Epley maneuver for the treatment of benign paroxysmal positional vertigo

In recent years, different forms of physical therapy have been proposed for the treatment of benign paroxysmal positional vertigo (BPPV). These mainly consist of maneuvers aiming to reposition and disperse free-floating endolymph particles in the posterior semicircular canal. We report our experience with one of these procedures, the Epley maneuver (EM), in treating 30 cases of BPPV. Twenty-six patients (87%) were cured, while four (13%) did not respond to treatment. These results are similar to those reported in the literature for the EM and the Sémont maneuver.     

Treatment of anterior benign paroxysmal positional vertigo by canal plugging: a case report

A 75-year-old man with incapacitating anterior canal benign paroxysmal positional vertigo (BPPV) was relieved of symptoms following anterior semicircular canal occlusion using a transmastoid approach. The preoperative symptoms were similar to those of posterior canal BPPV. The preoperative findings on Dix-Hallpike's maneuver were a paroxysmal torsional nystagmus with a down-beating component that increased when the patient's gaze was directed towards the affected ear. The most provoking head movement for the vertigo/nystagmus was Dix-Hallpike's maneuver with the affected ear lowermost.     

继发于突发性聋的良性阵发性位置性眩晕的临床治疗分析

目的　回顾性分析继发于突发性聋的良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）患者的临床表现,并探讨其可能的发病机制,探索合适的诊断与治疗方案。方法　观察218例突发性聋患者中BPPV的发病情况和临床治疗效果,另有37例同期原发性BPPV作为对照组。所有患者均经Dix-Hallpike实验和Barbecue滚转检查确定诊断,继发性BPPV患者的原发病（突发性聋）符合中华医学会耳鼻咽喉头颈外科学分会制定的诊断标准。按照BPPV类型,进行Epley手法复位或Barbecue翻滚手法治疗,并评价治疗效果。结果　218例突发性聋患者中有9l例出现BPPV,发生率41.7%,均为同侧患耳。BPPV经耳石复位,其中1次治愈62例（68.1%）,2次治愈16例（17.6%）,3次治愈13例（14.3%）。随访6～22个月,高频听力改善均不及低频,外半规管型BPPV复发2例,后半规管型复发5例,经过再次复位后治愈。继发性BPPV与原发性BPPV均经手法复位治愈,疗效相似。结论　BPPV可继发于突发性聋,且突发性聋继发BPPV可达41.7%,其中以后半规管BPPV常见,耳石复位治疗是最为有效的治疗方法,治愈率与原发性BPPV相似。     

颗粒复位法治疗后半规管良性阵发位置性眩晕

目的 评价颗粒复位法治疗良性阵发性位置性眩晕的效果。方法 对１９９６年７月－１９９８年６月间治疗的３１一半规管性良性性位置性眩晕患者进行回顾分析。地规管耳右症假说,患者接受１次颗粒复位法治疗。治疗结束２周后复查并评价疗效。结果 ２１例患者的眩晕和眼一立刻或在１－２周内逐渐消失。６例改善,４例无效。总有效率８７．１％。结论 颗粒复位法对大多数良性阵发性位置性眩晕患者有效,推荐作为治疗该的首选方法。     

手法复位治疗良性阵发性位置性眩晕

目的回顾性分析60例良性阵发性位置性眩晕（BPPV）诊断和治疗方法,为提高BPPV疗效提供参考依据。方法60例患者（男34例,女26例）通过常规神经耳科学检查、Dix—Hallpike和滚转试验确诊为BPPV。40例在发病10天内就诊,6N在发病1月内就诊,10例在5月内就诊,4例在6月以上就诊。采用Semont摆动手法、Epley颗粒复位法和Barbecue翻滚疗法治疗。对治疗1次无效者间隔7天重复治疗,重复3次无效者采用其它方法治疗。完成冶疗后2周复查评定疗效。结果后半规管BPPV54例,22例采用Semont手法复位治疗,14例痊愈,4例改善,4例无效。4例无效改用Epley颗粒复位法。Epley颗粒复位法治疗36例,28例痊愈,4例改善,4例无效。6例外半规管BPPV采用Barbecue翻滚疗法治疗4例痊愈,2例无效。40例10天内就诊者治愈32例,8例改善。6例发病1月内就诊者治愈2例,改善4例。10例5月内就诊者4例痊愈,4例改善,2例无效。4例6月以上就诊者治疗3次均无效。46例治疗1次有效,4例患者治疗2次有效,4例患者治疗3次有效。结论手法复位治疗BPPV有效率高,BPPV治疗效果与发病至就诊时间相关。     

Effectiveness of treatments for benign paroxysmal positional vertigo of the posterior canal.

OBJECTIVE: To determine which common, nonpharmacological, nonsurgical treatments are most effective for treatment of benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Prospective, randomized, sham-controlled. PATIENTS: Patients (n = 124) with BPPV of the posterior semicircular canal. SETTING: Tertiary care center. INTERVENTIONS: Random assignment to one of five groups: modified canalith repositioning maneuver (CRP), modified liberatory maneuver (LM), sham maneuver, Brandt and Daroff's exercise, and vertigo habituation exercises. Subjects received a standard educational lecture about BPPV and the purpose of the intervention. No vestibular-suppressant medication or special instructions for head positioning were used. Post-tests were given at 1 week after treatment and at approximately 3 months and 6 months later. MAIN OUTCOME MEASURES: Vertigo intensity and frequency. RESULTS: Multilevel analyses showed that vertigo decreased significantly after LM, CRP, and Brandt-Daroff exercise; those three groups did not differ significantly. The habituation group did not differ from sham, Brandt-Daroff, LM, or CRP groups. Changes in scores were maintained throughout the 6-month follow-up period. CONCLUSION: LM, CRP, and exercises are all effective interventions; patient education plus the sham maneuver, however, had some beneficial effect. These results support two possible mechanisms of BPPV: displaced otoconia and a neural mechanism affecting interpretation of semicircular canal signals.     

Efficacy of the Semont maneuver in benign paroxysmal positional vertigo

OBJECTIVES: To assess the efficacy of the Semont maneuver in the treatment of benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal and to evaluate the possible effect of various factors on the efficacy of this maneuver. DESIGN AND SETTING: Retrospective study in an outpatient clinic. PATIENTS: Two hundred seventy-eight patients presenting with symptomatic, unilateral BPPV of the posterior semicircular canal, exclusively treated with the Semont maneuver. INTERVENTIONS: During the first consultation, each patient was treated with a Semont maneuver. When BPPV persisted, this maneuver was repeated during follow-up visits, performed at weekly intervals. MAIN OUTCOME MEASURES: Patients were considered cured when vertigo disappeared within 30 days (allowing up to 4 maneuvers). RESULTS: More than 90% of patients were cured after a maximum of 4 maneuvers, and 83.5% were cured after only 2 maneuvers. The efficacy of the maneuver decreased each time it was repeated (from 62.6% at the first maneuver to 18.2% at the fourth). The duration of symptoms before initial consultation and the etiology of BPPV had a significant effect on the maneuver's efficacy (P<.001 and P =.002, respectively), whereas age (P =.12), sex (P =.06), and affected side (P =.20) had no effect. CONCLUSIONS: The Semont maneuver demonstrated a 90.3% cure rate after a maximum of 4 sessions. Patients consulting late (>6 months after the beginning of symptoms) or having traumatic BPPV had lower recovery rates than patients without these factors (74.7% vs 96.5%).     

Anterior Canal benign paroxysmal positional Vertigo following surgical Management of superior canal dehiscence

Objective

Benign paroxysmal positional vertigo (BPPV) is a common post-surgical finding in patients managed for superior semicircular canal dehiscence (SSCD). The posterior semicircular canal has been reported as the involved canal in the majority of cases of post-surgical BPPV, with only two cases reported of lateral canal involvement. The objective of this report is to present a case in which an anterior semicircular canal BPPV response was identified in a patient following surgical management for SSCD.

Long-term postural abnormalities in benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is a disorder in which patients suffer from acute rotatory vertigo due to the presence of free otoconial debris migrating into one or more semicircular canals during head movements and resulting in abnormal stimulation of the ampullary crest. A prolonged loss of equilibrium of unclear origin is also present. Static posturography is a useful tool for the study of postural control systems and their role in these abnormalities. The aim of the present study was to evaluate the frequency of body sway and long-term instability of BPPV patients by posturography frequency analysis. Twenty patients with canalithiasis of the posterior semicircular canal and 20 normal controls were subjected to static posturography. Informed consent was obtained from all subjects. Patients were tested 1 h after diagnosis, and 3 days and 12 weeks after the characteristic Epley repositioning maneuver. Patients with BPPV showed significantly increased body sway both on lateral (X) and anteroposterior (Y) planes compared to normal subjects. Corporal oscillation with a broad-frequency spectrum was observed in both closed and open eye tests. The repositioning maneuver decreased the X plane body sway, while the anteroposterior sway was unchanged. Twelve weeks after treatment, a normalization of the anteroposterior sway was observed. Results of this study suggest that the long-term postural disturbance associated with BPPV differs from the acute disequilibrium that subsides after canalith repositioning: the former is a sagittal plane/broad spectrum body sway, while the latter is primarily a frontal plane/low frequency sway. The Epley maneuver was shown to reduce frontal sway, a postural abnormality that might therefore be linked to posterior semicircular canal function. Conversely, the observed sagittal body sway was only partially relieved by the restoration of canal function, and therefore, may be more related to the chronic dizziness observed in these patients.     

突发性聋继发良性阵发性位置性眩晕的临床观察

目的了解继发于突发性聋的良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的发病情况并探讨其治疗策略。方法观察眩晕门诊及耳内科病房中心2004年1月-2010年1月收治的210例突发性聋患者（包括伴有眩晕的突发性聋）合并BPPV的发病情况,并与同期183例原发性BPPV相比较。结果本组突发性聋病例并发BPPV为19．0％（40／210）;40例患者均为高频感音神经性聋或平坦型感音神经性聋。本文40例继发于突发性聋的BPPV,出现时间均在突发性聋发病后t周内。继发性BPPV的手法复位效果与原发性BPPV相似,大多数都于1～2次就诊后治愈。结论突发性聋继发的BPPV是临床常见的现象;继发于突聋的BPPV与原发性BPPV都是以后半规管BPPV多见,并与原发性BPPV手法复位的疗效相似。     

Success of the modified Epley maneuver in treating benign paroxysmal positional vertigo.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is a common condition seen by otolaryngologists. The purpose of this study is to determine the ability of the modified Epley maneuver to treat BPPV. STUDY DESIGN: Retrospective review. METHODS: A retrospective chart review of 107 patients diagnosed with BPPV at our institution between March of 1993 and June of 1995. Each patient was diagnosed with isolated BPPV by history and Hallpike-Dix maneuver. There were no other vestibular symptoms or electronystagmogram abnormalities. Patients diagnosed with BPPV received modified Epley maneuvers, were instructed to remain upright for 48 hours, and wore a soft collar for a week. Patients were followed up with repeat Hallpike-Dix maneuvers at 1 to 2 weeks. If symptoms persisted, the maneuver was repeated for up to a maximum of three times, at which point patients were considered to have failed treatment. RESULTS: The average age of patients was 57.8 years old. Thirty percent were male and the right ear was affected in 54%. The posterior semicircular canal was affected in 105 ears. The average patient received 1.23 Epley maneuvers, with a success rate of 93.4%. No successfully treated patients received mastoid vibration. Seven out of 107 patients failed after three Epley maneuvers. Two failure patients had a history of temporal bone fracture. Two failure patients were treated with posterior semicircular canal block surgery. CONCLUSION: The modified Epley maneuver is an excellent treatment for BPPV.