氟桂利嗪联合手法复位治疗后半规管原发性良性阵发性位置性眩晕的临床疗效观察

目的探讨氟桂利嗪联合手法复位治疗后半规管原发性良性阵发性位置性眩晕(posterior semicircular canal benign paroxysman positional vertigo,PC-BPPV)的治疗效果。方法对96例原发性PC-BPPV患者随机分为单纯手法治疗(Epley管石复位法)与联合氟桂利嗪进行治疗,观察治疗效果。结果经1次手法复位治疗后症状消失或明显减轻,一次治愈率两组基本相同。治疗4wk后,治疗组的治愈率为高于对照组(P<0.05)。随访3个月,共计有8例患者复发,总复发率为9.6%,其中治疗组为2.2%,对照组为18.4%。结论 Epley手法复位联合氟桂利嗪治疗PC-BPPV疗效显著,复发率低。     

Epley加Semont联合手法复位治疗后半规管良性阵发性位置性眩晕

目的 探讨Epley与Semont联合手法复位治疗后半规管良性阵发性位置性眩晕(posterior semicircular canal benign paroxysman positional vertigo,PC-BPPV)的治疗效果.方法 对48例PC-BPPV患者随机分为单纯手法治疗(Epley管石复位法)与联合手法治疗(Epley加Semont联合复位法),观察治疗效果.结果 48例经1次手法复位治疗后症状消失或明显减轻,一次治疗有效率为83.3%,其中单纯组为78.3%,联合组为88.0%.无效患者继续重复相应手法治疗,至第三次复诊时统计总治疗有效率为93.8%,其中单纯组为91.3%,联合组为96.0%.随访3个月,共计有7例患者复发,总复发率为14.6%,其中单纯组为21.7%,联合组为8.0%.结论 Epley加Semont联合手法复位治疗PC-BPPV疗效显著,复发率低.     

Repositioning intervals in the modified Epley’s maneuver and their effect on benign paroxysmal positional vertigo treatment outcome

Introduction: This study showed that short and long interval treatments achieved comparable success rates. There was no statistically significant difference in the rate of early and late recurrences between the two groups. Modified Epley maneuver can be applied in a short interval time with comparable success and recurrence rates which are as effective as in a long interval time.

Objective: The Epley maneuver is called the particle repositioning or canalith repositioning procedure. If a short time interval in each position is effective, it will allow for reduced time and avoid unnecessary physical burden. How long of a stay in each position is not determined in the literature. There is an absence of comparative studies of the BPPV repositioning time. The aim of this study is to compare the treatment time in patients with benign paroxysmal positional vertigo (BPPV).

Study design: Longitudinal prospective study.

Setting: Outpatient practice in a tertiary care facility.

Subjects and methods: Sixty consecutive patients with BPPV were included in this study. These patients were sequentially allocated to one of two groups (A or B). The interval times between each position in group A and B were 15 and 120?s, respectively. Modified Epley maneuver was performed in all patients. The maneuvers in both groups were exactly the same sequence of movements, except interval times.

Results: The mean age of the patients was 49.25 years (range =19–76 years). Of the 60 patients, 48 (80%) were women and 12 (20%) were men. Successful outcome was achieved in 26 patients (86.7%) after the first modified Epley maneuver in both groups. Three patients from each group (total six patients) responded to the third modified Epley maneuver and the remaining two patients did not respond to any modified Epley maneuver. Therefore, the Semont maneuver was applied with a successful result.     

A prospective randomized controlled study of Li quick repositioning maneuver for geotropic horizontal canal BPPV

Background: Li quick repositioning maneuver for treatment of geotropic horizontal canal benign paroxysmal positional vertigo (HC-BPPV) was reported in the literature.

Objective: The aim of this study is to observe the clinical efficacy of the Li quick repositioning maneuver for the treatment of geotropic HC-BPPV.

Methods: The single-blind method was used to conduct a prospective controlled study on 120 patients with geotropic HC-BPPV from May 2014 to May 2017. Patients were randomly assigned to the Li quick repositioning maneuver (Li maneuver) group or the barbecue repositioning maneuver (barbecue maneuver) group.

Results: The successful repositioning rates were 53.3%, 70.4%, 90.7% and 92.3%, respectively, in barbecue maneuver group and 61.7%, 80.7%, 93.0% and 96.3%, respectively, in Li maneuver group at 1-day, 3-day, 1-week and 1-month follow-up. Differences in success rates of repositioning between Li and barbecue maneuver groups at 1?day, 3 days, 1 week and 1 month after initial treatment were not statistically significant using the Kaplan–Meier survival curve with a log-rank test (p?=?.270) .

Conclusion: The Li maneuver is a rapid, simple and efficacious repositioning method for geotropic HC-BPPV and can be widely applied in clinical practice as an alternative method.     

A comparative study of two methods for treatment of benign paroxysmal positional vertigo in the emergency department

IntroductionPosterior canal benign paroxysmal positional vertigo (PC-BPPV) is considered the most common cause of peripheral vertigo in the emergency department (ED). Although the canalith repositioning maneuver (CRM) is the standard of care, the most effective method to deliver it in the ED has been poorly studied.ObjectiveTo compare two protocols of the Epley maneuver for the treatment of PC-BPPV.Patients and methodsWe prospectively recruited 101 patients with unilateral PC-BPPV on physical examination, randomizing them to either a single Epley maneuver (EM) (n = 46) or multiple maneuvers (n = 55) on the same visit. Measured outcomes included presence/absence of positional nystagmus, resolution of vertigo, and score on the dizziness handicap inventory (DHI) at follow-up evaluations. The DHI was stratified into mild (≤30) and moderate-severe (>30).ResultsNormalization of the Dix-Hallpike maneuver at day 5 was observed in 38% of the single EM group and 44.4% in the multiple EM group (p = 0.62). The DHI showed reduction from 42.2 (SD 18.4) to 31.9 (SD 23.7) in the single EM group and from 43.7 (SD 22.9) to 33.5 (SD 21.5) in the multiple EM group (p = 0.06). A higher number of patients improved from moderate-severe to mild DHI (p = 0.03) in the single EM group compared to the multi-EM group (p = 0.23).ConclusionThere was no statistically significant difference between performing a single EM versus multiple EMs for treatment of PC-BPPV in the emergency department. The single EM approach is associated with shorter physical contact between patients and examiner, which is logically safer in a pandemic context.     

Double-blind randomized controlled trial on efficacy of cupulolith repositioning maneuver for treatment of apogeotropic horizontal canal benign paroxysmal positional vertigo

Abstract

Backgrounds: Although various therapeutic maneuvers have been proposed, it is still unclear which maneuver is better to treat apogeotropic horizontal canal benign paroxysmal positional vertigo (HC-BPPV).

Objectives: This study aimed to assess the therapeutic efficacy of the cupulolith repositioning maneuver (CuRM) in apogeotropic HC-BPPV in comparison with the therapeutic head-shaking maneuver and modified Lempert maneuver.

Materials and Method: This is double-blind randomized prospective study. Forty-nine consecutive patients diagnosed with apogeotropic HC-BPPV were allocated randomly to CuRM (n?=?18), therapeutic head-shaking (n?=?16), or modified Lempert maneuver (n?=?15). The presence of nystagmus and vertigo on positional testing were evaluated at 30?min, on 1?day, and 1?week after treatment.

Results: There were no significant differences in any clinical characteristics between the three groups at randomization. After a single trial of therapeutic maneuvers on the initial visit day, the CuRM (38.9%) and therapeutic head shaking maneuver (12.5%) did not show differences compared to modified Lempert maneuver (33.3%). The therapeutic effects on the 2nd day and at 1?week after treatment also did not differ between the three groups.

Conclusions: Although the CuRM is theoretically considered to be a better therapeutic method, the therapeutic efficacy of CuRM was not statistically different compared to the other two maneuvers.     

Treating benign paroxysmal positional vertigo with the canalith repositioning maneuver of Epley. Our experience

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common peripheral vestibular disorders. Particle repositioning maneuvers are simple and effective treatments for patients with BPPV. This study included 37 consecutive cases of BPPV treated with the particle repositioning maneuver of Epley. 97% of patients improved and the maneuver was well tolerated. We conclude that Epley Maneuver is safe and effective in the treatment of BPPV.     

门诊复位加自我复位治疗后半规管良性阵发性位置性眩晕

目的：比较首次治疗时单纯门诊复位法（改良Epley法）与门诊复位加自我复位法（自我改良Epley法）治疗单侧原发性后半规管良性阵发性位置性眩晕（PC-BPPV）的疗效。方法：我科眩晕门诊确诊为原发性单侧PC-BPPV的150例患者中,147例符合条件并配合随访。将其随机分为单纯门诊复位组（73例）和门诊复位加自我复位组（74例）,前者在门诊采用改良Epley法治疗,后者采用门诊改良Epley法复位加自我复位法（自我改良Epley法）治疗。结果：1周时,单纯门诊复位组治愈率为53．4％,门诊复位加自我复位组治愈率为83．8％（P〈O．01）。单纯门诊复位组中,手法复位与复位椅复位成功率分别为45．9％和61．1％（P〉0．05）,风险比为0．752,95％CI为0．486～1．163;门诊复位加自我复位组中,手法复位与复位椅复位成功率分别为87．5％和81．O％（P〉0．05）,风险比为1．081,95％CI为0．8881．316。两组严重不良反应发生率：单纯门诊复位组0,门诊复位加自我复位组为1．3％（P〉O．05）。结论：门诊复位配合自我复位比单纯门诊复位法能更快、更有效地治愈后半规管BPPV,能有效地减少患者的就诊次数;两组患者严重不良反应发生率无明显差异。单纯复位椅比手法复位效果更好,但自我复位可减少两种复位方法的效果差距,可用于配合程度较好的后半规管BPPV患者。     

318例良性阵发性位置性眩晕的诊治分析

目的:研究不同类型良性阵发性位置性眩晕(BPPV)的诊断、治疗及疗效。方法:回顾性分析318例BPPV患者的资料,根据变位试验诱发的眼震特点进行分型,并采用相应的耳石复位技术治疗,对治疗1次无效者间隔7d重复治疗,重复3次无效者采用Brandt-Daroff习服练习;完成治疗后随访观察总有效率。结果:①后半规管BPPV患者221例(69.5%),采用Epley管石复位法;②水平半规管BPPV患者62例(19.5%),采用Bar-becue翻滚加强迫侧卧体位疗法;③前半规管BPPV患者23例(7.2%),采用Epley管石复位法;④混合型BPPV患者12例(3.8%),采用Epley加Barbecue翻滚联合治疗。1周后随访总有效率为82.1%(261/318),3个月后随访总有效率为91.8%(292/318)。结论:结合病史,根据不同变位试验诱发的眼震特征对BPPV患者进行诊断并采用相应手法复位治疗是一种非常有效的方法,能有效缩短病程,减轻患者痛苦,可在临床广泛应用。     

Efficacy of a new treatment maneuver for posterior canal benign paroxysmal positional vertigo

Existing treatment maneuvers for posterior canal benign paroxysmal positional vertigo (PC-BPPV) include the Semont liberatory maneuver (SLM) and canalith repositioning maneuver (CRM). Independent investigations reveal that these maneuvers provide an excellent outcome for most patients. However, certain aspects of these maneuvers, such as hyperextension of the neck for CRM and brisk lateral motion for the SLM, are contraindicated for patients with vertebrobasilar insufficiency, cervical spondylosis, back problems, and so forth. A hybrid approach, the Gans repositioning maneuver (GRM) was developed for use with these patients. The purpose of this project was to assess efficacy of the GRM for treatment of PC-BPPV. Two-hundred seven participants were enrolled in this prospective study. All participants were treated with the GRM. Six different clinicians performed the treatments. Participants returned for follow-up at one-week intervals until it was determined that the PC-BPPV was clear. On average, 1.25 GRM treatments were required to resolve the PC-BPPV. The majority of the participants (80.2%) were cleared with one GRM treatment, and 95.6% were clear after two treatments. Recurrence rate was 5%. There was no difference in outcome based on clinician. The GRM is an efficacious treatment maneuver for PC-BPPV and may be preferential for use in patients with neck, back, hip, and/or mobility issues that contraindicate the use of SLM or CRM.     

Adverse effects of semicircular circle angles variation on Epley repositioning procedure: a study on reconstruction of Micro-CT images 3D

Abstract

Background: For patients with posterior semicircular canal (PSC) BPPV, Epley re-position maneuver and some improvement methods are the most efficient treatment methods. But there were still 9.43% patients who were not benefit from Epley re-position maneuver.

Objective: To measure the angles of semicircular canals and evaluate its effect on Epley maneuver.

Methods: Fifteen skull specimens, containing 30 temporal bone specimens were included. After Micro-CT scanning, 3D reconstruction was loaded with the CT image. The angles between each semicircular canal and each standard skull plane were measured. Furthermore, the angles’ effect on Epley maneuver was evaluated according to the three-dimension (3D) model.

Results: Angles of PSC plane: Frankfurt plane was 71.54?±?6.51, sagittal plane was 53.77?±?5.36°, and the coronal plane was 43.33?±?3.56°. Angles between PSC and the sagittal plane of skulls had an adverse effect on Epley maneuver, when it was less than 45°.

Conclusion: 1. Variation could be found in angles between the semicircular canals and the standard planes of skulls, which meant variation of semicircular canals’ location existing in skulls. 2. The variation of angles between PSC and sagittal plane could have an adverse effect on the Epley maneuver when the angle was less than 45°, which may cause the Epley maneuver to be invalid.     

Therapeutic efficacy of the Epley canalith repositioning maneuver

OBJECTIVES/HYPOTHESES: The hypotheses of the current study are as follows: 1) That if the Epley canalith repositioning maneuver is an effective treatment for benign positional vertigo (BPV), relief from the vertigo should occur virtually immediately after the performance of the maneuver; 2) that the Epley canalith repositioning maneuver does provide almost immediate relief in BPV and should be the established treatment of choice for this disorder in both primary and tertiary care settings; and 3) that residual symptoms of lightheadedness and imbalance do persist after the resolution of the vertigo. The distinction of these symptoms from the vertigo is required for the accurate evaluation of the efficacy of positional maneuvers. STUDY DESIGN: Prospective cohort study in a tertiary care balance center. METHODS: Eighty-six patients (95 cases) with a history and physical examination consistent with active BPV were entered in the study. Patients were treated with a modified Epley canalith repositioning maneuver. A modified 360 degrees roll was used to treat those patients with horizontal canal BPV. Patients were provided with a preprinted diary in which they were to circle the answer most relevant to their symptoms for 14 days after the maneuver. Patients were then re-evaluated in the office at 2 weeks after the maneuver. RESULTS: The mean duration of the BPV before treatment was 9 weeks. Seventy-four percent of cases that were treated with one or two canalith repositioning maneuvers had a resolution of vertigo as a direct result of the maneuver. A resolution attributable to the first intervention was obtained in 70% of cases within 48 hours of the maneuver. An additional 14% of cases that were treated had a resolution of vertigo; however, it is not possible to say that these patients definitely benefited from the canalith repositioning maneuver. Only 4% of cases (three patients) manifested BPV that persisted after four treatments. Residual symptoms of lightheadedness or imbalance, or both, were frequent (47% of cases) but rarely required formal intervention with vestibular rehabilitation physical therapy. CONCLUSIONS: The Epley canalith repositioning maneuver results in a resolution of vertigo in the majority of patients (70% of cases) immediately after one treatment. It is safe and requires no special equipment or investigations. It should be established as the treatment of choice for BPV in both primary and tertiary care settings.     

Role of subjective visual vertical in patients with posterior canal benign paroxysmal positional vertigo as a prognostic marker after canalith repositioning maneuver

ObjectiveTo study the potential role of subjective visual vertical (SVV) as a prognostic marker for canalith repositioning maneuver (CRM) in patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV) for the Indian population.MethodsSVV was examined in 30 patients with PC-BPPV before and after canalith repositioning maneuver and after complete resolution of PC-BPPV. Study parameters included the mean of 10 angular tilt readings and direction of deviation, which were compared before and after CRM and following complete resolution of PC-BPPV.ResultsThe angle of SVV tilt was greater and deviated towards the affected ear before CRM in all patients, which decreased significantly shortly after CRM and continued to decrease after complete resolution of PC-BPPV (p < 0.0001).ConclusionsSVV can be used to test utricular dysfunction in PC-BPPV. The angle of tilt improves in response to CRM, which may be used as a prognostic marker in patients with PC-BPPV receiving CRM.     

Clinical characteristics and treatment outcomes for benign paroxysmal positional vertigo comorbid with hypertension

Conclusions: Patients with BPPV comorbid with hypertension (h-BPPV) tend to receive a delayed diagnosis of BPPV. Comorbidity with hypertension did not influence the efficacy of the repositioning maneuver; however, comorbidity with hypertension was associated with an increased recurrence rate of BPPV.

Objectives: To determine the clinical characteristics and outcomes of h-BPPV, as well as the clinical differences between h-BPPV and idiopathic BPPV (i-BPPV).

Methods: The authors reviewed the medical records of 41 consecutive patients with h-BPPV (the h-BPPV group) from March to December 2014 and 47 patients with i-BPPV (the i-BPPV group) during the same period.

Results: There were no significant differences in age, sex ratio, or the affected side between the h-BPPV and i-BPPV groups. The proportion of patients reporting an initial episode of positional vertigo was significantly lower in the h-BPPV group (51.22% vs 74.47%; p?=?.024). Patients in the h-BPPV group reported a longer median episode duration than did those in the i-BPPV group (60 days vs 15 days; p?=?.017). The results of treatment using repositioning maneuvers were similar between the two groups. At follow-up, 13 patients in the h-BPPV group were diagnosed with recurrent BPPV compared with six in the i-BPPV group (p?=?.031).     

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.     

Orthotropic nystagmus in predicting the efficacy of treatment in posterior canal benign paroxysmal positional vertigo

ObjectiveTo observe the type of nystagmus in each position of posterior semicircular canal benign paroxysmal positional vertigo (BPPV) after treatment with the Epley maneuver and analyze the relationship between the type of nystagmus in the second and third positions of the Epley maneuver and the effect of treatment. Then, the role of orthotropic nystagmus in predicting the success of posterior semicircular canal BPPV treatment was explored.MethodsTwo hundred seventy-six patients diagnosed with posterior semicircular canal BPPV who were admitted from September 2018 to October 2019 to Zhejiang Hospital were included. All patients were treated with BPPV diagnosis and treatment system (Epley maneuver). During the treatment, we observed and recorded the type of nystagmus in the second and third positions, including the direction and duration of nystagmus. One hour after the first treatment, all patients were evaluated by both the Dix-Hallpike and Roll tests to determine whether the treatment was successful. The difference in the success rate of treatment between different types of nystagmus was compared, and the differences in sensitivity and specificity of orthotropic nystagmus in the second and third positions in predicting the effect of treatment were compared.ResultsAmong the 234 patients who had successful repositioning for the first time, the proportion of orthotropic nystagmus during the third position of the Epley maneuver was 88.9%, which was significantly higher than 23% in the unsuccessful group (42 cases) (P < 0.05) The proportion of patients with reversed nystagmus (4.7% vs 33.3%, P < 0.05) and no nystagmus (6.4% vs 42.9%, P < 0.05) was lower in the successful group than in the unsuccessful group. The proportion of orthotropic nystagmus during the second position of the Epley maneuver was 50.9%, which was also higher than the 19% in the unsuccessful group (P < 0.05). The proportion of reversed nystagmus (13.7% vs 31%, P < 0.05) was lower in the successful group than in the unsuccessful group. Additionally, the proportion of no nystagmus (35.5% vs 50%, P = 0.074) was lower in the successful group than in the unsuccessful group, but the difference was not statistically significant. The sensitivity of orthotropic nystagmus in the third position (88.9%) of the Epley maneuver in predicting the efficacy of treatment was higher than that of orthotropic nystagmus in the second position (50.9%), but there was no significant difference in specificity between the two.ConclusionOrthotropic nystagmus during the Epley maneuver, especially in the third position, has certain value in predicting the efficacy of posterior semicircular canal BPPV repositioning, which is better than its predictive effect in the second position, whereas reversed nystagmus or no nystagmus in the third position is suggestive of unsuccessful repositioning. Therefore, clinicians can carry out individualized treatments based on nystagmus types during repositioning to improve the effect of treatment.     

Effects of postural restriction after modified Epley maneuver on recurrence of benign paroxysmal positional vertigo

Objective

In the present study, we calculated the success rate of the modified Epley maneuver and determined the effectiveness of post-maneuver positional restriction in terms of the prevention of early and late recurrence.

Methods

The present study was conducted on 78 patients who had unilateral benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal (SCC) and who were treated in the Otorhinolaryngology Department of Susehri State Hospital. The Dix–Hallpike test was performed on all patients. After the involved canal was identified using this test, we guided patients through the modified Epley repositioning maneuver. A maximum of two maneuvers were performed in the same session. The patients were randomly divided into two groups. One group was not advised any positional restriction, while the second group was advised positional restriction for 10 days after the procedure. Recurrences during 1–90 days after the treatment were noted as early recurrences, while those that occurred after 90 days were noted as late recurrences.

Results

In the restriction group (n = 39), repositioning was successful after a single maneuver in 32 (82.05%) patients and after two maneuvers in 5 (12.8%) patients. Repositioning failed in two (5.1%) patients. In the non-restriction group (n = 39), repositioning was successful after a single maneuver in 31 (79.4%) patients and after two maneuvers in 6 (15.3%) patients. Repositioning failed in two (5.1%) patients. Thus, the success rate was 94.8% in each group. Early recurrence occurred in 3 (8.1%) of 37 patients in the restriction group and 2 (5.4%) of 37 patients in the non-restriction group (p > 0.05). Late recurrence occurred in 5 (13.5%) of 37 patients in both the restriction and non-restriction groups (p > 0.05).

Conclusion

Postural restriction after a canalith repositioning procedure does not improve procedural success or decrease early and late recurrence rates. However, the number of patients was too small to detect a difference between both treatment groups.     

Conduct after Epley's maneuver in elderly with posterior canal BPPV in the posterior canal

Benign Paroxysmal Positional Vertigo is the most common peripheral vestibular disorder, especially in the elderly and presents as the predominant etiology in this population of the degeneration of the utricular macula.Aim: To compare the effectiveness of the approaches after Epley maneuver. Study Design: longitudinal cohort.Materials and Methods: The study included 53 volunteers with Benign Paroxysmal Positional Vertigo of the posterior semicircular canal, divided into Group 1, who underwent Epley maneuver associated with the use of neck collar and post-maneuver instructions, Group 2 underwent the Epley maneuver without the use cervical collar and/or post-maneuver restrictions, and Group 3 underwent the Epley maneuver associated with the use of a mini vibrator, without the use of neck collar and/or post-maneuver restrictions.Results: In the three groups, the number of Epley maneuvers ranged from one to three. We employed the Brazilian Dizziness Handicap Inventory – pre-and post-treatment and observed a statistically significant difference on most scores pre-and post-treatment for both groups.Conclusion: Regardless of the post Epley maneuver treatment selected for the treatment of Benign Paroxysmal Positional Vertigo, it was effective when comparing the Brazilian Dizziness Handicap Inventory pre-and post-treatment.     

Modified Particle Repositioning Procedure

Objectives To evaluate the efficacy of modifications to traditional particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo. Study Design Prospective trial of 118 patients with cupolocanalithiasis of the posterior canal treated with three different canal‐repositioning techniques. Methods Results were compared with the maneuvers employed and the statistical importance of rotating patients by 360° along their longitudinal axis and head shaking on reaching each single position were evaluated. Results Treatment of patients with our maneuver, which, in comparison with traditional repositioning maneuvers, was modified by breaking the procedure up into seven positions and rotating patients by 360° along their longitudinal axis, gives a higher, but not statistically significant, number of treatment successes (84.5%) than the traditional Parnes maneuver (60%) (P = .154); treatment of a third group of patients with our modified particle repositioning maneuver with the addition of head‐shaking on reaching each single position gives a higher (95.6%), statistically significant number of treatment successes than traditional Parnes maneuver (P = .00011). Conclusions The success rates achieved from modified particle repositioning maneuvers are statistically significant. Onset or persistence of dizziness, which patients frequently complain of after liberatory maneuvers, affects only 5.6% of the patients treated. This low incidence is statistically correlated to head‐shaking.     

Treatment and recurrence of traumatic versus idiopathic benign paroxysmal positional vertigo: a meta-analysis

Abstract

Background: So far, there has been a controversy surrounding repositioning difficulty and recurrence rate between traumatic benign paroxysmal positional vertigo (t-BPPV) and idiopathic BPPV (i-BPPV).

Objectives: This meta-analysis was aimed to explore whether or not the differences between t-BPPV and i-BPPV in the repositioning difficulty and recurrence rate existed.

Material and methods: A literature search was performed in the databases including Pubmed, Embase, CENTRAL, which completed in 21 January 2019, with no restriction of publication language. Relative risk (RR) of number of repositioning maneuvers and the recurrence rate was calculated with its 95% confidence interval. Sensitive analysis was performed simultaneously.

Results: Six retrospective cohort studies were included in our meta-analysis, including 865 t-BPPV patients and 3027 i-BPPV patients. All studies were high quality according to Newcastle-Ottawa Scale (NOS) assessment. Patients with t-BPPV required more repositioning maneuvers for resolution than those with i-BPPV (RR = 3.27, 95% CI = 1.88–5.69, p?<?.0001), and the recurrence rate of t-BPPV was higher than that of i-BPPV (RR = 2.91, 95% CI = 2.04–4.14, p?<?.00001).

Conclusions and significance: Compared with i-BPPV, patients with t-BPPV require more repositioning maneuvers to resolve, and the recurrence of t-BPPV was more frequent.