Otol Neurotol. 2016 Dec 7.

[Epub ahead of print]

Otolith Dysfunction in Persons With Both

Diabetes and Benign Paroxysmal Positional
Vertigo.
DSilva LJ1, Staecker H, Lin J, Maddux C, Ferraro J, Dai H, Kluding PM.

Author information

Abstract

OBJECTIVE:

Vestibular dysfunction is a well-recognized complication of type 2 diabetes (DM) that may

contribute to increased fall risk. The prevalence of benign paroxysmal positional vertigo (BPPV)
is higher in people with DM. The impact of DM on the otolith organs of the vestibular system in
people with BPPV is unknown. The purpose of this study was to analyze otolith function using
vestibular-evoked myogenic potential (VEMP) tests in people with DM and concurrent BPPV
(BPPV+DM), and to examine the relationships between VEMP variables and diabetes-related
variables.

STUDY DESIGN:

Prospective, cross-sectional study.

SETTING:

Tertiary academic medical center.

SUBJECTS AND METHODS:

Participants 40 to 65 years were recruited in four groups: controls (n=20), people with DM
(n=19), BPPV (n=18), and BPPV +DM (n=14). Saccule and utricle function were examined
using cervical VEMP (cVEMP) and ocular VEMP (oVEMP), respectively. Diabetes-related
variables such as HbA1c, duration of diabetes, and presence of sensory impairment due to
diabetes were collected.

RESULTS:

The frequency of abnormal cVEMP responses was higher in the DM (p=0.005), BPPV
(p=0.003), and BPPV +DM (p<0.001) groups compared with controls. In the participants with
diabetes, higher HbA1c levels were correlated with prolonged P1 (p=0.03) and N1 latencies
(p=0.03). The frequency of abnormal oVEMP responses was not different between groups
(p=0.2).

CONCLUSION:

Although BPPV and DM may independently affect utricle and saccule function, they do not
seem to have a distinct cumulative effect.

Acta Otolaryngol. 2016 Dec 6:1-5. [Epub ahead of print]

Efficacy of the Li maneuver in treating

posterior canal benign paroxysmal positional
vertigo.
Li J1, Tian S1, Zou S1.

Author information

Abstract

CONCLUSION:

The Li maneuver is a safe, effective, and simple repositioning method for the treatment of BPPV.
It is simple to master and exerts an exact effect. As a rapid repositioning method, the Li
maneuver can result in reduced treatment times and increased treatment efficacy, and is,
therefore, especially suitable for patients with limited cervical spine movement.

OBJECTIVE:

To compare the short-term efficacies of the Li and Epley maneuvers in treating posterior canal
benign paroxysmal positional vertigo (PC-BPPV).

METHODS:

A total of 120 patients with PC-BPPV were randomly treated by either the Li or Epley
maneuvers at our department between May 5, 2014 and July 30, 2015. Follow-up examinations
were performed 3 days and 1 week after the first repositioning.

RESULTS:
Of the 120 patients initially enrolled, 113 (72 females; 41 males; average age=52 years; Li and
Epley maneuver groups, 56 and 57 cases, respectively) satisfied the inclusion and exclusion
criteria of this study. There were no statistically significant differences between the two groups
of patients in terms of the success rates of treatment at either the 3-day or 1-week follow-ups
(p=.756 and .520, respectively).

J Int Adv Otol. 2016 Nov 28. doi: 10.5152/iao.2016.3014. [Epub ahead of print]

A Pilot Study Using Intratympanic

Methylprednisolone for Treatment of
Persistent Posterior Canal Benign
Paroxysmal Positional Vertigo.
Prez P1, Franco V, Oliva M, Lpez Escmez JA.

Author information

Abstract

OBJECTIVE:

To assess the effect of intratympanic methylprednisolone (ITMP) in posterior canal benign

paroxysmal positional vertigo (BPPV) that fails treatment involving repositioning maneuver in a
case series.

MATERIALS AND METHODS:

Nine patients with persistent posterior canal BPPV after 6 or more repositioning maneuvers were
treated by ITMP (two weekly doses of 0.3-0.4 mL at 40 mg/mL) before repeating the
repositioning procedures.

RESULTS:

Following ITMP treatment, 7 out of 9 patients were relieved of their symptoms and did not
exhibit positional nystagmus after 1 or 2 repositioning maneuvers. The number of positional
maneuvers performed before and after ITMP treatment in these 7 patients showed a statistically
significant (p=0.016) reduction in the amount of repositioning treatments required. None of the 7
respondent patients showed any relapses during the follow-up period (follow-up range: 11-95
months).

CONCLUSION:
Administering ITMP before resuming repositioning procedures can be a useful treatment for
persistent BPPV of the posterior canal.

Acta Otolaryngol. 2016 Nov 14:1-3. [Epub ahead of print]

Clinical characteristics and treatment

outcomes for benign paroxysmal positional
vertigo comorbid with hypertension.
Tan J1, Deng Y2, Zhang T1, Wang M2.

Author information

Abstract

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).
Cochrane Database Syst Rev. 2012 Apr 18;(4):CD008675. doi:
10.1002/14651858.CD008675.pub2.

Modifications of the Epley (canalith

repositioning) manoeuvre for posterior canal
benign paroxysmal positional vertigo
(BPPV).
Hunt WT1, Zimmermann EF, Hilton MP.

Author information

Abstract

BACKGROUND:

Benign paroxsymal positional vertigo (BPPV) is a syndrome characterised by short-lived

episodes of vertigo associated with rapid changes in head position. It is a common cause of
vertigo presenting to primary care and specialist otolaryngology (ENT) clinics. BPPV of the
posterior canal is a specific type of BPPV for which the Epley (canalith repositioning)
manoeuvre is a verified treatment. A range of modifications of the Epley manoeuvre are used in
clinical practice, including post-Epley vestibular exercises and post-Epley postural restrictions.

OBJECTIVES:

To assess whether the various modifications of the Epley manoeuvre for posterior canal BPPV
enhance its efficacy in clinical practice.

SEARCH METHODS:

We searched the Cochrane ENT Group Trials Register; the Cochrane Central Register of
Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS
Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and
unpublished trials. The date of the search was 15 December 2011.

SELECTION CRITERIA:

Randomised controlled trials of modifications of the Epley manoeuvre versus a standard Epley
manoeuvre as a control in adults with posterior canal BPPV diagnosed with a positive Dix-
Hallpike test. Specific modifications sought were: application of vibration/oscillation to the
mastoid region, vestibular rehabilitation exercises, additional steps in the Epley manoeuvre and
post-treatment instructions relating to movement restriction.
DATA COLLECTION AND ANALYSIS:

Two authors independently selected studies from the search results and the third author reviewed
and resolved any disagreement. Two authors independently extracted data from the studies using
standardised data forms. All authors independently assessed the trials for risk of bias.

MAIN RESULTS:

The review includes 11 trials involving 855 participants. A total of nine studies used post-Epley
postural restrictions as their modification of the Epley manoeuvre. There was no evidence of a
difference in the results for post-treatment vertigo intensity or subjective assessment of
improvement in individual or pooled data. All nine trials included the conversion of a positive to
a negative Dix-Hallpike test as an outcome measure. Pooled data identified a significant
difference from the addition of postural restrictions in the frequency of Dix-Hallpike conversion
when compared to the Epley manoeuvre alone. In the experimental group 88.7% (220 out of
248) patients versus 78.2% (219 out of 280) in the control group converted from a positive to
negative Dix-Hallpike test (risk ratio (RR) 1.13, 95% confidence interval (CI) 1.05 to 1.22, P =
0.002). No serious adverse effects were reported, however three studies reported minor
complications such as neck stiffness, horizontal BPPV, dizziness and disequilibrium in some
patients.There was no evidence of benefit of mastoid oscillation applied during the Epley
manoeuvre, or of additional steps in the Epley manoeuvre. No adverse effects were reported.

AUTHORS' CONCLUSIONS:

There is evidence supporting a statistically significant effect of post-Epley postural restrictions in

comparison to the Epley manoeuvre alone. However, it important to note that this statistically
significant effect only highlights a small improvement in treatment efficacy. An Epley
manoeuvre alone is effective in just under 80% of patients with typical BPPV. The additional
intervention of postural restrictions has a number needed to treat (NNT) of 10. The addition of
postural restrictions does not expose the majority of patients to risk of harm, does not pose a
major inconvenience, and can be routinely discussed and advised. Specific patients who
experience discomfort due to wearing a cervical collar and inconvenience in sleeping upright
may be treated with the Epley manoeuvre alone and still expect to be cured in most
instances.There is insufficient evidence to support the routine application of mastoid oscillation
during the Epley manoeuvre, or additional steps in an 'augmented' Epley manoeuvre. Neither
treatment is associated with adverse outcomes. Further studies should employ a rigorous
randomisation technique, blinded outcome assessment, a post-treatment Dix-Hallpike test as an
outcome measure and longer-term follow-up of patients.

J Int Adv Otol. 2016 Aug 1. doi: 10.5152/iao.2016.2170. [Epub ahead of print]
Evaluation of Cervical Vestibular-Evoked
Myogenic Potential Findings in Benign
Paroxysmal Positional Vertigo.
Karata A1, Yce T, ebi IT, Yceant GA, Hac C, Salviz M.

Author information

Abstract

OBJECTIVE:

Although there has been a wide consensus on the mechanism of nystagmus and clinical
presentation of benign paroxysmal positional vertigo (BPPV), the neuroepithelial
pathophysiology of BPPV still remains unclear. In this study, we aimed to clarify the
pathophysiology of BPPV by evaluating the cervical vestibular-evoked myogenic potential
(cVEMP) findings of patients.

MATERIALS AND METHODS:

Thirty-six BPPV patients and 20 healthy volunteers were included. Bilateral cVEMP tests were
performed on all participants. The participants were divided into the following three groups:
those with a BPPV-affected ear, those with a BPPV-unaffected ear, and the healthy control
group.

RESULTS:

There were no significant differences regarding the latencies of the first positive (p1) and
negative (n1) peaks among the three groups. The mean normalized amplitude asymmetry ratio
also did not differ between the BPPV and control groups. However, the normalized amplitudes
of the BPPV patients (with both affected and unaffected ears) were significantly lower than those
of the healthy control group.

CONCLUSION:

We detected that the cVEMP data of the affected and unaffected ears of the BPPV patients was
similar and that their normalized amplitudes significantly differed from those of the healthy
controls. Eventually, we concluded that even if the symptoms of BPPV were unilateral, the
findings suggest that the bilateral involvement of the macular neuroepithelium is important in
understanding the pathophysiology of BPPV. This finding supports the conclusion that the
pathophysiological process starts with neuroepithelial membrane degeneration and continues
with otoconia separation.
Otolaryngol Head Neck Surg. 2008 Nov;139(5 Suppl 4):S47-81. doi:
10.1016/j.otohns.2008.08.022.

Clinical practice guideline: benign

paroxysmal positional vertigo.
Bhattacharyya N1, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, Chalian AA, Desmond
AL, Earll JM, Fife TD, Fuller DC, Judge JO, Mann NR, Rosenfeld RM, Schuring LT, Steiner
RW, Whitney SL, Haidari J; American Academy of Otolaryngology-Head and Neck Surgery
Foundation.

Author information

Abstract

OBJECTIVES:

This guideline provides evidence-based recommendations on managing benign paroxysmal

positional vertigo (BPPV), which is the most common vestibular disorder in adults, with a
lifetime prevalence of 2.4 percent. The guideline targets patients aged 18 years or older with a
potential diagnosis of BPPV, evaluated in any setting in which an adult with BPPV would be
identified, monitored, or managed. This guideline is intended for all clinicians who are likely to
diagnose and manage adults with BPPV.

PURPOSE:

The primary purposes of this guideline are to improve quality of care and outcomes for BPPV by
improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of
vestibular suppressant medications, decreasing the inappropriate use of ancillary tests such as
radiographic imaging and vestibular testing, and to promote the use of effective repositioning
maneuvers for treatment. In creating this guideline, the American Academy of Otolaryngology-
Head and Neck Surgery Foundation selected a panel representing the fields of audiology,
chiropractic medicine, emergency medicine, family medicine, geriatric medicine, internal
medicine, neurology, nursing, otolaryngology-head and neck surgery, physical therapy, and
physical medicine and rehabilitation.

RESULTS:

The panel made strong recommendations that 1) clinicians should diagnose posterior
semicircular canal BPPV when vertigo associated with nystagmus is provoked by the Dix-
Hallpike maneuver. The panel made recommendations against 1) radiographic imaging,
vestibular testing, or both in patients diagnosed with BPPV, unless the diagnosis is uncertain or
there are additional symptoms or signs unrelated to BPPV that warrant testing; and 2) routinely
treating BPPV with vestibular suppressant medications such as antihistamines or
benzodiazepines. The panel made recommendations that 1) if the patient has a history compatible
with BPPV and the Dix-Hallpike test is negative, clinicians should perform a supine roll test to
assess for lateral semicircular canal BPPV; 2) clinicians should differentiate BPPV from other
causes of imbalance, dizziness, and vertigo; 3) clinicians should question patients with BPPV for
factors that modify management including impaired mobility or balance, CNS disorders, lack of
home support, and increased risk for falling; 4) clinicians should treat patients with posterior
canal BPPV with a particle repositioning maneuver (PRM); 5) clinicians should reassess patients
within 1 month after an initial period of observation or treatment to confirm symptom resolution;
6) clinicians should evaluate patients with BPPV who are initial treatment failures for persistent
BPPV or underlying peripheral vestibular or CNS disorders; and 7) clinicians should counsel
patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and
the importance of follow-up. The panel offered as options that 1) clinicians may offer vestibular
rehabilitation, either self-administered or with a clinician, for the initial treatment of BPPV and
2) clinicians may offer observation as initial management for patients with BPPV and with
assurance of follow-up. The panel made no recommendation concerning audiometric testing in
patients diagnosed with BPPV.

DISCLAIMER:

This clinical practice guideline is not intended as a sole source of guidance in managing benign
paroxysmal positional vertigo. Rather, it is designed to assist clinicians by providing an
evidence-based framework for decision-making strategies. The guideline is not intended to
replace clinical judgement or establish a protocol for all individuals with this condition, and may
not provide the only appropriate approach to diagnosing and managing this problem.

Ann Otol Rhinol Laryngol. 2017 Jan;126(1):54-60. Epub 2016 Oct 25.

Benign Paroxysmal Positional Vertigo

Secondary to Mild Head Trauma.
Balatsouras DG1, Koukoutsis G2, Aspris A3, Fassolis A2, Moukos A2, Economou NC4,
Katotomichelakis M5.

Author information

Abstract

OBJECTIVES:

We studied the clinical characteristics, nystagmographic findings, and treatment outcome of a

group of patients with benign paroxysmal positional vertigo (BPPV) secondary to mild head
trauma and compared them with a group of patients with idiopathic BPPV.

METHODS:
The medical records of 33 patients with BPPV associated with mild head trauma were reviewed.
Data of a complete otolaryngological, audiological, neurotologic, and imaging evaluation were
available for all patients. Three hundred and twenty patients with idiopathic BPPV were used as
a control group.

RESULTS:

The patients with BPPV secondary to mild head trauma presented the following features, in
which they differed from the patients with idiopathic BPPV: (1) lower mean age, with more
intense symptoms; (2) increased rate of horizontal and anterior semicircular canal involvement
and frequent multiple canal and bilateral involvement; (3) greater incidence of canal paresis and
presence of spontaneous nystagmus; (4) poorer treatment results, attributed mainly to coexisting
canal paresis in many patients, and higher rate of recurrence.

CONCLUSIONS:

Benign paroxysmal positional vertigo associated with mild head trauma differs from idiopathic
BPPV in terms of several epidemiological and clinical features; it responds less effectively to
treatment and is prone to recurrence.

Zh Nevrol Psikhiatr Im S S Korsakova. 2014;114(4):100-4.

[Benign paroxysmal positional vertigo in a

female with arterial hypertension and
meningioma].
[Article in Russian]
Bestuzheva NV, Parfenov VA, Zamergrad MV.

Abstract

Diagnosis of benign paroxysmal positional vertigo (BPPV) often causes difficulties, in

particular, in elderly people with concomitant diseases. The article presents a case of a 77 year-
old woman with BPPV. A patient's complaint on vertigo was mistakenly diagnosed as brain
ischemia because the patient had long suffered from uncontrolled arterial hypertension. MRI-
study revealed leucoaraiosis and one lacuna as well as a meningioma which was mistakenly
linked to vertigo. The diagnosis of BPPV, use of Epley maneuver with the following vestibular
exercises resulted in complete stopping of vertigo. Effective treatment of arterial hypertension
with the normalization of arterial pressure, use of aspirin and statins reduced the risk of stroke.
Exclusion of BPPV is needed in all cases of vertigo with unclear etiology.

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Sep;29(18):1627-9.
[Investigation of the relationship between
chronic diseases and residual symptoms of
benign paroxysmal positional vertigo].
[Article in Chinese]
Zhou F, Fu M, Zhang N, Xu Y, Ge Y.

Abstract

OBJECTIVE:

To investigate the prognosis-related influence factors of the residual symptoms after the canalith
repositioning procedure (CRP) for the benign paroxysmal positional vertigo (BPPV) in the
second affiliated hospital of dalian medical university.

METHOD:

Among patients who were diagnosed with BPPV and treated by CRP, the one that still show
residual symptoms were enrolled in our study, then make a follow-up irregularly about the
tendency of their residual symptoms' self-healing,and respectively record in their gender, age and
chronic diseases and so on. Single-factor analysis and multi-factors analysis was utilized to
investigate the residual symptoms' related influencing factors.

RESULT:

In this study, 149 cases of patients were in record, for the residual symptoms, 71 patients can go
to self-healing, 78 patients can not; age is 23-88, 30 cases in the young group, 46 cases in the
middle aged group, 47 cases in the young elderly group, 26 cases in the elderly group; patients
suffering from high blood pressure are 76 cases, 76 cases had diabetes, 47 cases had
hyperlipidemia, 110 cases had heart disease, 43 cases had ischemic encephalopathy.

CONCLUSION:

The residual symptoms in the elderly females patients and patients suffering from the
hypertension, diabetes, heart disease patients and ischemic encephalopathy are not easy to heal
by itself, in which, the older and the fact suffering from the hypertension and diabetes are the
risk factors influencing the prognosis of the residual symptoms.

Nervenarzt. 2009 Aug;80(8):887-94. doi: 10.1007/s00115-009-2738-9.

[Epidemiology of dizziness and vertigo].

[Article in German]
Neuhauser HK1.

Author information

Abstract

Dizziness and vertigo rank among the most common symptoms in medical practice and belong to
the 10 most common reasons for a neurological examination. Epidemiological data on dizziness,
vertigo and underlying specific disorders of vestibular origin are useful for clinical decision
making, may contribute to a better understanding of disease mechanisms and help evaluate the
state of patient care. This article gives an overview on the epidemiology of dizziness/vertigo and
of four specific vestibular disorders: benign paroxysmal positional vertigo, vestibular migraine,
vestibular neuritis and Menire's disease.

Int Tinnitus J. 2008;14(2):131-4.

Arteriosclerotic changes as background

factors in patients with peripheral vestibular
disorders.
Wada M1, Naganuma H, Tokumasu K, Hashimoto S, Ito A, Okamoto M.

Author information

Abstract

Symptoms such as vertigo and unsteady gait occur in various diseases and are among the
relatively common chief complaints. Even at present, the mechanisms underlying these disorders
are unclear. We considered the possibility of peripheral vestibular disorders correlating with
lifestyle-related illnesses. Under these circumstances, we assessed correlations of lifestyle-
related illness as background factors for peripheral vestibular disorders and associated
arteriosclerotic changes. Using carotid ultrasonography, we assessed maximum intima-media
thickness (max IMT) and maximum common carotid artery IMT and evaluated biochemical
examinations in 85 patients with peripheral vertigo. The patients were divided into two groups:
those with benign paroxysmal positional vertigo (BPPV) and those with peripheral vestibular
disorders. The frequency of abnormal IMT was significantly higher in those in the BPPV group.
Calculating for average age, max IMT was significantly higher in the BPPV group. The
correlation coefficient between age and max IMT was 0.343 (p < .001). All other correlation
coefficients also reached statistical significance. Our results indicate that cervical
ultrasonography is useful for noninvasive examination of arteriosclerotic changes in patients
with peripheral vestibular disorders. Our results also indicated that peripheral vestibular disorder
patients show progression of arteriosclerotic changes

Int Tinnitus J. 2009;15(2):193-5.

Correlation between arteriosclerotic changes

and prognosis in patients with peripheral
vestibular disorders.
Wada M1, Naganuma H, Tokumasu K, Okamoto M.

Author information

Abstract

Symptoms such as vertigo and unsteady gait occur in various diseases and are among the
relatively common chief complaints. Even at present, the mechanisms underlying these disorders
are unclear. We report a significant correlation between a prolonged period of resolution of
benign paroxysmal positional vertigo (BPPV) and histories of lifestyle-related illnesses. We
consider the possibility of correlating between BPPV prognosis and arteriosclerotic changes.
Using carotid ultrasonography, we examined maximum intima-media thickness (IMT),
maximum common carotid artery IMT, and biochemical examinations in 105 patients with
peripheral vertigo. We divided patients with BPPV into groups with and without abnormal
thickness of the IMT. The maximum IMT was 1.35 mm in patients with peripheral vestibular
disorders. The proportion of peripheral vestibular disorder patients with a maximum IMT of > or
= 1.1 mm (i.e., thickening) was 58%. The rate at which the feeling of positional vertigo remained
at the halfway point in the observation period was significantly higher in the group of patients
with an IMT of > or =1.1 mm (p = .0007). Our results indicate that cervical ultrasonography is
useful for noninvasive examination of arteriosclerotic changes in patients with peripheral
vestibular disorders. We saw indications that such patients show progression of arteriosclerotic
changes. This study suggested that the arteriosclerotic change was related to prognosis.

Respir Med. 2009 Feb;103(2):165-72. doi: 10.1016/j.rmed.2008.03.013. Epub 2008 Jun 24.

Impact of volume targeting on efficacy of bi-

level non-invasive ventilation and sleep in
obesity-hypoventilation.
Janssens JP1, Metzger M, Sforza E.

Author information

Abstract

BACKGROUND:

Volume targeting by bi-level positive pressure ventilation (BPPV) has recently been made
available by several manufacturers for home care ventilators. Although it may improve nocturnal
ventilation, we hypothesized that increased pressure swings related to volume targeting may
have a deleterious effect on sleep structure and patient comfort.

METHODS:

Patients in stable clinical condition (n=12) treated by BPPV for obesity-hypoventilation (BMI:
44+/-8 kg/m(2)) for a median of 30 months (range: 2-138), underwent nocturnal
polysomnography with transcutaneous capnography on 2 consecutive nights with either BPPV
and usual ventilator settings or BPPV with volume targeting, in randomized sequence. Subjective
quality of sleep (St. Mary's Hospital Questionnaire) and comfort of ventilation (VAS scales)
were also assessed.

RESULTS:

Mean IPAP, mean tidal volume, and total ventilation increased significantly with volume
targeting. Control of nocturnal hypoventilation was slightly improved with volume targeting
(nocturnal TcPCO(2): 42+/-9 vs. 45+/-5 mmHg, p=0.04). However, total sleep time and stage 2
sleep were greater without volume targeting, and wake after sleep onset and awakenings >20s
increased with volume targeting. Subjectively, patients described a lighter sleep, of lesser quality
and more frequent awakenings with volume targeting; ventilation was perceived as less
comfortable, with an increased perception of leaks and of "too much air".

CONCLUSION:

In stable patients treated by BPPV for obesity-hypoventilation, volume targeting improved

control of nocturnal hypoventilation at the expense of a slight decrease in objective and
subjective sleep quality, and comfort of ventilation.

Neurology. 2004 Dec 28;63(12):2376-9.

Suggestive linkage to chromosome 6q in

families with bilateral vestibulopathy.
Jen JC1, Wang H, Lee H, Sabatti C, Trent R, Hannigan I, Brantberg K, Halmagyi GM, Nelson
SF, Baloh RW.

Author information

Abstract

BACKGROUND:

Of the more than 40 genetically defined dominantly inherited hearing loss syndromes, only a few
are associated with bilateral vestibulopathy. No genetic mutations have been identified in
families with bilateral vestibulopathy and normal hearing.

OBJECTIVE:

To perform a genome-wide scan for linkage in four families with dominantly inherited bilateral
vestibulopathy.

METHODS:

Patients in four families reported brief episodes of vertigo followed by imbalance and
oscillopsia. Bilateral vestibulopathy was documented with quantitative rotational testing. Most
patients with bilateral vestibulopathy also had migraine. A 10 cM genome-wide screen was
conducted using 423 microsatellite markers to identify linkage with vestibulopathy.

RESULTS:

The authors identified a 24 cM region on chromosome 6q suggestive of linkage to vestibulopathy

in these four families (maximum lod score of 2.9 at marker D6S1556). A small fifth family with
a different phenotype was not linked to this region on chromosome 6q.

CONCLUSIONS:

This is the first report of linkage in families with dominantly inherited vestibulopathy and normal
hearing. Genetic heterogeneity is likely with inherited vestibulopathy.

Aging Clin Exp Res. 2012 Aug;24(4):317-23.

Benign paroxysmal positional vertigo is a

common cause of dizziness and unsteadiness
in a large population of 75-year-olds.
Kolln L1, Frndin K, Mller M, Fagevik Olsn M, Mller C.
Author information

Abstract

BACKGROUND AND AIMS:

Studies have shown that 65% of people with dizziness may have a vestibular etiologic diagnosis,
possibly benign paroxysmal positional vertigo (BPPV). The diagnosis of BPPV is based on
medical history and findings after the Dix-Hallpike test. It is sometimes difficult to perform the
Dix-Hallpike test in elderly persons, due to the limited range of motion when extending the neck.
In this study, we used a side-lying test to stimulate the posterior semicircular canal, while the
head and neck were fully supported on the examination table. The aims of this study were to
investigate the prevalence of dizziness and/or impaired balance and BPPV in a population of 75-
year-olds by means of a questionnaire and clinical tests, and to compare elderly persons with and
without BPPV.

METHODS:

A representative population sample of 675 persons completed a questionnaire about dizziness

and 571 persons underwent side-lying, static balance and dynamic walking tests.

RESULTS:

Subjective dizziness and/or impaired balance were found in 36% of subjects, especially when
walking outdoors. A significant gender difference was found, with a higher prevalence in women
(40%) compared with men (30%) (p<0.01). BPPV was found in 11% and was significantly more
common in women (p<0.01). Elderly individuals with BPPV also displayed significantly
impaired balance in static and dynamic balance tests compared with persons without BPPV
(p<0.01). Persons with BPPV reported significantly more sub- jective problems with dizziness
and balance compared with persons without BPPV (p<0.001).

CONCLUSIONS:

Subjective and objective unsteadiness, dizziness and BP PV are common in the elderly.

Vestibular rehabilitation for unilateral

peripheral vestibular dysfunction.
McDonnell MN1, Hillier SL.

Author information

Abstract
BACKGROUND:

This is an update of a Cochrane review first published in The Cochrane Library in Issue 4, 2007
and previously updated in 2011.Unilateral peripheral vestibular dysfunction (UPVD) can occur
as a result of disease, trauma or postoperatively. The dysfunction is characterised by complaints
of dizziness, visual or gaze disturbances and balance impairment. Current management includes
medication, physical manoeuvres and exercise regimes, the latter known collectively as
vestibular rehabilitation.

OBJECTIVES:

To assess the effectiveness of vestibular rehabilitation in the adult, community-dwelling

population of people with symptomatic unilateral peripheral vestibular dysfunction.

SEARCH METHODS:

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane
Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of
Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for
published and unpublished trials. The most recent search was 18 January 2014.

SELECTION CRITERIA:

Randomised controlled trials of adults living in the community, diagnosed with symptomatic
unilateral peripheral vestibular dysfunction. We sought comparisons of vestibular rehabilitation
versus control (e.g. placebo), other treatment (non-vestibular rehabilitation, e.g.
pharmacological) or another form of vestibular rehabilitation. Our primary outcome measure was
change in the specified symptomatology (for example, proportion with dizziness resolved,
frequency or severity of dizziness). Secondary outcomes were measures of function, quality of
life and/or measure(s) of physiological status, where reproducibility has been confirmed and
shown to be relevant or related to health status (for example, posturography), and adverse effects

DATA COLLECTION AND ANALYSIS:

We used the standard methodological procedures expected by The Cochrane Collaboration.

MAIN RESULTS:

We included 39 studies involving 2441 participants with unilateral peripheral vestibular

disorders in the review. Trials addressed the effectiveness of vestibular rehabilitation against
control/sham interventions, medical interventions or other forms of vestibular rehabilitation.
Non-blinding of outcome assessors and selective reporting were threats that may have biased the
results in 25% of studies, but otherwise there was a low risk of selection or attrition
bias.Individual and pooled analyses of the primary outcome, frequency of dizziness, showed a
statistically significant effect in favour of vestibular rehabilitation over control or no intervention
(odds ratio (OR) 2.67, 95% confidence interval (CI) 1.85 to 3.86; four studies, 565 participants).
Secondary outcomes measures related to levels of activity or participation measured, for
example, with the Dizziness Handicap Inventory, which also showed a strong trend towards
significant differences between the groups (standardised mean difference (SMD) -0.83, 95% CI -
1.02 to -0.64). The exception to this was when movement-based vestibular rehabilitation was
compared to physical manoeuvres for benign paroxysmal positional vertigo (BPPV), where the
latter was shown to be superior in cure rate in the short term (OR 0.19, 95% CI 0.07 to 0.49).
There were no reported adverse effects.

AUTHORS' CONCLUSIONS:

There is moderate to strong evidence that vestibular rehabilitation is a safe, effective

management for unilateral peripheral vestibular dysfunction, based on a number of high-quality
randomised controlled trials. There is moderate evidence that vestibular rehabilitation resolves
symptoms and improves functioning in the medium term. However, there is evidence that for the
specific diagnostic group of BPPV, physical (repositioning) manoeuvres are more effective in
the short term than exercise-based vestibular rehabilitation; although a combination of the two is
effective for longer-term functional recovery. There is insufficient evidence to discriminate
between differing forms of vestibular rehabilitation.

PM R. 2013 Sep;5(9):778-85. doi: 10.1016/j.pmrj.2013.05.010. Epub 2013 May 22.

Prevalence of benign paroxysmal positional

vertigo in the young adult population.
Kerrigan MA1, Costigan MF, Blatt KJ, Mathiason MA, Domroese ME.

Author information

Abstract

OBJECTIVE:

To evaluate the prevalence of benign paroxysmal positional vertigo (BPPV), defined as

positionally induced nystagmus (PIN) with associated symptoms on provocative testing, in the
young healthy adult population.

DESIGN:

A prospective, cohort, screening study.

SETTING:

A community-based hospital located in a small midwestern city with a greater metropolitan

population of approximately 125,000.
PARTICIPANTS:

One hundred ninety-eight young adults (99 men and 99 women), ages 18-34 years and not being
treated for dizziness or balance problems, were recruited from November 2009 to April 2010.

METHODS:

The participants completed questionnaires that detailed demographics, medical and surgical
history, sports and/or activity participation history, and baseline symptoms commonly associated
with BPPV. The participants were screened for inclusion with an ocular motor assessment in
room light, followed by a vestibular positional assessment for BPPV with infrared camera-
equipped goggles recorded on digital video disk.

MAIN OUTCOME MEASUREMENT:

The prevalence of BPPV, defined as PIN, along with symptoms in study participants.

RESULTS:

The prevalence of BPPV was 9% in this young adult population. Symptoms during testing were
reported in 14% of all subjects (22% of women, 5% of men). Of 22 women who reported
symptoms, 12 had PIN (P = .519), whereas the 5 men who reported symptoms all had PIN (P =
.001). PIN, characteristic of that seen in BPPV (with or without associated symptoms), was
identified in 53% of subjects, with 43% of subjects having posterior canal involvement, 10%
having anterior canal involvement, and 8% having horizontal canal involvement. Eleven percent
of subjects had bilateral semicircular canal involvement.

CONCLUSION:

Nine percent of our young adult subjects were diagnosed with previously unrecognized BPPV,
with provoked symptoms of dizziness, headache, nausea, or imbalance, symptoms that may
cause significant physical and psychosocial limitations if left untreated. This is an important
finding because BPPV is an often-overlooked diagnosis that has a known, very effective
treatment.

Otol Neurotol. 2008 Oct;29(7):976-81. doi: 10.1097/MAO.0b013e318184586d.

Daily exercise does not prevent recurrence of

benign paroxysmal positional vertigo.
Helminski JO1, Janssen I, Hain TC.

Author information
Abstract

OBJECTIVE:

The purpose of this study was to analyze if a daily routine of self-canalith repositioning
procedure (CRP) will increase the time to recurrence and reduce the rate of recurrence of benign
paroxysmal positional vertigo (BPPV).

STUDY DESIGN:

Prospective study, nonrandomized control group.

SETTING:

Outpatient clinic.

PATIENTS:

Thirty-nine patients diagnosed with posterior canal BPPV successfully treated with the CRP.
Based on a convenience sample, 17 (44%) patients were assigned to the treatment group,
whereas 22 (56%) were assigned to the no-treatment group. The number of subjects lost at the
time of follow-up were 5 (29.4%) of the treatment group and 2 (9%) of the no-treatment group.

INTERVENTIONS:

Patients assigned to the treatment group performed the self-CRP daily, whereas those assigned to
the no-treatment group performed no exercises. Patients were followed for up to 2 years.

MAIN OUTCOME MEASURES:

The main outcome measures were the rate of recurrence of BPPV and the time for BPPV to
recur.

RESULTS:

Of the 39 subjects, symptoms recurred in 16 (41%) of the total population, 6 (35%) of 17 of the
treatment group, and 10 (46%) of 22 of the no-treatment group. There was no difference in the
frequency of recurrence (Pearson chi; p = 0.522) or the time to recurrence (survival analysis; log-
rank test; p = 0.242).

CONCLUSION:

Our results suggest that a daily routine of the self-CRP does not affect the time to recurrence and
the rate of recurrence of posterior canal-BPPV.
Kulak Burun Bogaz Ihtis Derg. 2007;17(6):307-10.

Benign paroxysmal positional vertigo in

swimmers.
Aksoy S1, Sennarolu L.

Author information

Abstract

OBJECTIVES:

This study was designed to evaluate the relationship between swimming and benign paroxysmal
positional vertigo (BPPV).

PATIENTS AND METHODS:

This prospective study was comprised of 30 subjects (15 females, 15 males, mean age 15.6
years; range 11 to 23 years) who had been swimming regularly for at least two years. Twenty
subjects (9 females, 11 males; mean age 15.4 years; range 11 to 21 years) with no vertigo and ear
complaints comprised the control group. The Dix-Hallpike maneuver was used in all the
swimmers and controls to diagnose BPPV.

RESULTS:

Four swimmers (13%) exhibited characteristic findings of BPPV, being unilateral in three, and
bilateral in one. Interestingly, no swimmer experienced vertigo during swimming. The
characteristics of nystagmus were typical of posterior semicircular canal BPPV in all cases. None
of the subjects in the control group exhibited symptoms or findings of BPPV. Patients with
BPPV underwent the Epley maneuver for therapy. All were free of vertigo after one month.
There was no relationship between swimming and BPPV with respect to the frequency and
duration of swimming.

CONCLUSION:

Swimming may be one of the etiological factors of BPPV. It appears that rapid head movements
during swimming cause otoconia to be dislodged from the macula and enter the semicircular
canals.
Benign paroxysmal positional vertigo after
intense physical activity: a report of nine
cases.
Giacomini PG1, Ferraro S, Di Girolamo S, Villanova I, Ottaviani F.

Author information

Abstract

The aim of this study was to report some clinical cases suggesting a possible correlation between
benign paroxysmal positional vertigo (BPPV) and intense physical activity. Out of 430 BPPV
cases referred to our out-patients clinic, 9 patients, showing symptoms of BPPV arising after an
intense period of physical activity, were selected for this study. The posterior semicircular canal
was affected in all the nine patients. The canalith repositioning procedure was successful and
eliminated vertigo and nystagmus in all patients. During the follow-up period (12 months) all
patients continued with the usual physical activity; four of the nine patients showed a recurrence
of the BPPV symptoms after a new intense period of exercises: all were successfully treated by a
new single Epley repositioning procedure. BPPV due to intense physical activity is a rare
condition (9/430) and it may be caused by repeated vibratory vertical accelerations of a minor
degree associated with metabolic variations during strenuous exercise.

Braz J Otorhinolaryngol. 2006 May-Jun;72(3):388-92.

Circumstances and consequences of falls in

elderly people with vestibular disorder.
Gazzola JM1, Ganana FF, Aratani MC, Perracini MR, Ganana MM.

Author information

Erratum in

Rev Bras Otorrinolaringol (Engl Ed). 2006 Jul-Aug;72(4):576.

Abstract

AIM:
To investigate the circumstances and consequences of falls in the chronically dizzy elderly and to
correlate them with the number of falls (one/two and more).

METHOD:

Transversal descriptive analytic study with 64 patients aged 65 or over, with history of falls and
diagnostic of chronic vestibular dysfunction. We performed a descriptive analysis and Chi-
Square test (x2<0.05).

RESULTS:

The sample was constituted by a female majority (76.6%) with a mean age of 73.62+/-5.69
years. The vestibular examination showed peripheral vestibulopathy in 81.5% of the cases and
the most prevalent diagnostic hypothesis were benign paroxysmal positional vertigo (43.8%) and
metabolic inner ear disease (42.2%). Recurrent falls were seen in 35 elderly (53.1%). In relation
to the last fall, 39.1% of the patients had fallen in their homes, 51.6% of them occurred during
the morning, 51.6% with some propulsion mechanism, 53.1% when walking, 25.0% caused by
dizziness and 23.4% by stumbling. Activity restriction was significantly greater in patients that
have already had two and more falls, when compared with those who had fallen only once
(p=0.031). We found a significant association between the number of falls and their causes
(p<0.001). Falls that have happened by slipping were more frequent in the elderly that reported
one fall (p=0.0265) and falls that had happened because of dizziness were more frequent in the
elderly that complained of two or more falls (p=0.0012).

CONCLUSION:

Fear and tendency to fall are referred by the majority of chronically dizzy elderly. Fall are more
frequent in the morning, in the home and during walking. The propulsion direction is mentioned
by half of the elderly and the most common cause for falls are dizziness and stumbling. The
number of falls is significantly associated with activity restrictions after the last fall and with the
causes for falling (slipping and dizziness).

Acta Otorrinolaringol Esp. 2007 Aug-Sep;58(7):296-301.

[Benign paroxysmal vertigo of childhood:

categorization and comparison with benign
positional paroxysmal vertigo in adult].
[Article in Spanish]
Martn Sanz E1, Barona de Guzmn R.

Author information
Abstract

INTRODUCTION:

The differential diagnosis of vertigo in children is extensive. This implies an additional difficulty
in diagnosing dizziness in paediatric population.

PATIENTS AND METHOD:

Twenty-three children consecutively examined for paroxysmal attacks of dizziness and/or

vertigo attacks entered our study, and were compared to a 15 adults group with benign positional
paroxysmal vertigo. Fifteen healthy paediatric subjects and 18 adults were selected as control
groups. The clinical characteristics of vertigo, presence of triggering factors, family history of
migraine, presence of motion sickness, migraine, and other accompanying symptoms were
considered. Neurological, vestibular, and auditory functions were assessed including the
performance of a posturography in every group of patients.

RESULTS:

The presence of migraine, physical activity prior to vertigo, and positional trigger of vertigo were
the clinical elements which differentiated both populations of patients with vertigo. There were
significant differences in adult posturography between vertigo and control groups. In paediatric
population, there were no differences between vertigo and control group in the posturography
study.

CONCLUSIONS:

The benign paroxysmal vertigo of childhood complex is the most frequent aetiology of paediatric
dizziness. The duration and triggers of vertigo in children are quite similar to those found in
VPPB adults. The instability posterior to vertigo, measured by posturography, were less intense
in children than in adult population.

Phys Ther. 1997 Aug;77(8):848-55.

The individualized treatment of a patient

with benign paroxysmal positional vertigo.
Ford-Smith CD1.

Author information

Abstract
The purpose of this case report is to describe the evaluation and treatment of a patient with
vertigo. The patient was a 32-year-old male carpenter with a 17-year history of episodic vertigo
that occurred when his neck was in the extended position while positioned supine and during
walking. His medical and physical therapy evaluative findings were consistent with a diagnosis
of benign paroxysmal positional vertigo (BPPV). He was treated with an individualized home
exercise program of eye movement exercises, Brandt/Daroff exercises, and general conditioning
exercises. Twenty-four days from the start of physical therapy, the patient was free of symptoms
even when his neck was in the extended position.

J Neurol Neurosurg Psychiatry. 1999 Jun;66(6):787-90.

Click evoked myogenic potentials in the

differential diagnosis of acute vertigo.
Heide G1, Freitag S, Wollenberg I, Iro H, Schimrigk K, Dillmann U.

Author information

Abstract

OBJECTIVE:

In response to loud clicks, a vestibular evoked potential can be recorded from

sternocleidomastoid muscles, called "click evoked myogenic potential" (CEMP). This paper
reports on the usefulness of CEMP in the differential diagnosis of acute vertigo of presumed
vestibular origin.

METHODS:

CEMP was examined in 40 patients with acute vertigo of vestibular origin (26 with acute
peripheral vestibulopathy, five with Mnire's disease, three with benign paroxysmal positioning
vertigo (BPPV), six with psychogenic vertigo) and the results compared with standard caloric
reaction (CR). For CEMPs, clicks were delivered unilaterally via a pair of headphones. EMG
activity was collected by surface electrodes placed on the sternocleidomastoid belly and
averaged.

RESULTS:

In 29 patients, CR was unilaterally abnormal, pointing to a peripheral vestibular lesion.

Seventeen of them had a corresponding loss of CEMPs; the other 12 patients had a normal
CEMP. The remaining 11 patients had normal results in both tests. In comparison with CR,
CEMP showed a sensitivity of 59% and a specificity of 100% for peripheral vestibular disorders.

CONCLUSION:
CR is a test of the horizontal canal whereas CEMP is thought to be a sacculus test. Different
results of CR and CEMP may be due to this difference between target organs stimulated and may
be of prognostic value.

Auris Nasus Larynx. 2016 Jul 13. pii: S0385-8146(16)30187-0. doi: 10.1016/j.anl.2016.06.006.
[Epub ahead of print]

Clinical features of recurrence and

osteoporotic changes in benign paroxysmal
positional vertigo.
Kim SY1, Han SH2, Kim YH2, Park MH3.

Author information

Abstract

OBJECTIVE:

Several previous studies have demonstrated that comorbidities, secondary causes, physical
inactivity, and osteoporosis may cause recurrence of benign paroxysmal positional vertigo
(BPPV). However, there has also been some controversy over the clinical course(s) and cause(s)
of recurrent BPPV (rBPPV). We identified clinical features and associated factors, including
decreased bone mineral density, in the recurrence of BPPV.

METHODS:

In total, 198 patients with idiopathic BPPV, diagnosed at the otolaryngology clinics of Seoul
National University Boramae Medical Center, were enrolled. The medical data of these patients
were reviewed retrospectively. Recurrent BPPV was defined as the recurrence of BPPV after at
least 1 month of a symptom-free interval following previous successful treatment.

RESULTS:

Of the BPPV patients, 67 (33.8%) were classified as rBPPV. Among them, about 16% showed
changes in the involved semicircular canals and about 6% showed multiple semicircular canal
involvement. rBPPV was more common in patients with comorbidities (P<0.001). Involved
semicircular canals showed no statistically significant difference according to the recurrence of
BPPV. The mean symptom-free interval of the rBPPV group varied from 1 to 50.2 (mean, 11.6)
months; however, 90% of BPPV recurrence occurred within 24 months. Bone mineral density in
dual-energy X-ray absorptiometry (DEXA) was markedly decreased in BPPV patients versus
normal controls, but there were no significant differences according to BPPV recurrence.
CONCLUSION:

The incidence of rBPPV in idiopathic BPPV patients was 33.8% in the present study. The mean
period of recurrence after a symptom-free interval was about 11.6 months; most patients showed
recurrence within 2 years after the first attack of BPPV. Furthermore, about 16% of patients
suffered from rBPPV at a different kind or type of canal from the semicircular canal of the initial
BPPV attack. Comorbidities, but not age, gender, or the involved semicircular canal, might be
correlated with BPPV recurrence. Decreased bone mineral density did not show significant
association with BPPV recurrence, but showed a significant relation with BPPV occurrence.

Acta Otolaryngol. 2016 Dec;136(12):1267-1272. Epub 2016 Jul 7.

Comparison between objective and subjective

benign paroxysmal positional vertigo: clinical
features and outcomes.
Jung JY1, Kim SH2.

Author information

Abstract

CONCLUSIONS:

Objective benign paroxysmal positional vertigo (O-BPPV) and subjective BPPV (S-BPPV) have
similar demographic and clinical features. Canalith repositioning manoeuvres (CRMs) can be an
effective treatment for patients with S-BPPV, and a diagnosis of positional nystagmus is not
essential for considering CRMs. This study supports the use of CRMs as the primary treatment
for S-BPPV.

OBJECTIVE:

To examine differences in demographic and clinical features, as well as treatment outcomes,

between O-BPPV and S-BPPV.

METHODS:

The medical records of 134 patients with BPPV were reviewed for demographic characteristics,
past medical history, associated symptoms, response to CRMs, interval between symptom onset
and the first medical visit, and recurrence rate. The O-BPPV group (n=101) comprised patients
who experienced vertigo and accompanying autonomic symptoms, and showed typical
nystagmus. The S-BPPV group (n=33) comprised patients who, when subjected to a provoking
manoeuvre, showed all of the classic BPPV symptoms but did not show nystagmus. All patients
had at least 3 years of follow-up.

RESULTS:

The demographics (age and sex ratio), past medical history, and associated symptoms were not
significantly different between the two groups. Posterior semi-circular canal BPPV appeared
more than twice as often as horizontal semi-circular canal BPPV in patients with S-BPPV.
However, both canals were affected to a similar proportion in patients with O-BPPV, and the
difference was marginally significant (p=0.073). Overall improvement was better in O-BPPV
than in S-BPPV; however, there was no significant difference. The total numbers of manoeuvres
for recovery and the interval between symptom onset and the first medical visit also did not show
any significant inter-group differences. During a 3-year follow-up, the recurrence rate was 13.8%
for O-BPPV and 21.2% for S-BPPV.

Int J Audiol. 2016;55(5):279-84. doi: 10.3109/14992027.2016.1143981. Epub 2016 Mar 10.

Comorbidities and recurrence of benign

paroxysmal positional vertigo: personal
experience.
Picciotti PM1, Lucidi D1, De Corso E1, Meucci D1, Sergi B1, Paludetti G1.

Author information

Abstract

OBJECTIVE:

The aim of this study is to evaluate the correlation between clinical features of benign
paroxysmal positional vertigo (BPPV) and age, sex, trauma, presence of one or more
comorbidities such as cardiovascular, neurological, endocrinological, metabolic, psychiatric
diseases.

DESIGN:

Retrospective review of medical records (chart review).

STUDY SAMPLE:

A total of 475 patients aged from 14 to 87 years, affected by BPPV.

RESULTS:
Recurrence of BPPV occurred in 139/475 patients (29.2%). The recurrence rate was significantly
higher in female and older patients. Comorbidities were present in 72.6% of subjects with
recurrent BPPV vs. 48.9% of patients with no recurrence (p < 0.01). Forty-two patients (8.8%)
reported a cranial trauma as a triggering event. Post-traumatic patients showed a significantly
higher persistence rate (45.2%) compared to patients affected by non-traumatic BPPV (20.5%).
Recurrence rates are overlapping between the two groups.

CONCLUSION:

Our results confirm the association between recurrence of BPPV and age, female sex, and
presence of comorbidities. The correlation is stronger in patients affected by multiple associated
diseases; the most frequently involved pathologies are psychiatric disorders, followed by
neurological and vascular diseases. Collecting a complete medical history is important for
prognostic stratification and detection of potential underlying pathological conditions.

Eur Arch Otorhinolaryngol. 2016 Nov;273(11):3567-3572. Epub 2016 Mar 9.

10 years of Vertigo Clinic at National

Hospital Abuja, Nigeria: what have we
learned?
Olusesi AD1,2, Abubakar J3,4.

Author information

Abstract

The clinician's major role in management of the dizzy patient involves determining what
dizziness is vertigo, and what vertigo is of central or peripheral origin. These demand attention to
details of history, otolaryngological workup including vestibular assessment, and often use of
diagnostic and management algorithms. There is paucity of published reports of the management
outcomes of peripheral vestibular diseases from Africa. Two tertiary care otologist-led dedicated
vertigo clinics are located in Abuja, Nigeria. A prospective, non-randomized study of patients
presenting with features of peripheral vestibular diseases attending the National Hospital Abuja
Nigeria (between May 2005 and April 2014) and CSR Otologics Specialist Clinics (May 2010 to
April 2014) was carried out. Both institutions adopted the same diagnostic and management
protocols. Data extracted from anonymized databases created for this study include age, sex,
vertigo duration (acute <12 weeks, chronic >12 weeks), dizziness handicap inventory score at
presentation and at subsequent visits, otological and vestibular findings, ice-water caloric testing
results, other investigation outcomes, treatments offered and outcomes. 561/575 (97.5 %) of the
cases recorded had peripheral vestibular disease. The male-to-female ratio was 290:271. The
mean age of the subjects was 44.7 years. Duration of vertigo at presentation was acute in 278
subjects and chronic in 283 subjects. Identifiable clinical diagnostic groups include BPPV
(n = 200), Meniere's disease (n = 189), cervicogenic vertigo (n = 35), labyrinthitis (n = 32),
Migraine-associated vertigo (MAV) (n = 32), cholesteatoma/perilymph Fistula (n = 10),
climacteric vertigo (n = 8) and unclassified vertigo (n = 55). Migraine-associated vertigo
recorded the highest DHI score (95 % CI 75 4.3), followed by cholesteatoma/perilymph fistula
(95 % CI 72 6.1) and labyrinthitis (95 % CI 62 1.9). Pure tone audiometry (95 % CI
67.3 3.43), followed by thyroid function tests (95 % CI 66.7 23.55) and ice-water caloric
testing (95 % CI 59.7 2.69) were investigations with the highest yields. 86.5 % of cases were
treated by either vestibular suppressant medications alone (n = 285) and/or particle repositioning
maneuver (n = 200) with improvement in vertigo control (95 % CI 63.63 to 74.37 % and 62.59 to
75.41 %, respectively). Peripheral vestibular diseases constitute majority of cases of self-reported
vertigo seen in our setting. Migraine-associated vertigo seen in our setting all have peripheral
vestibular signs. Dedicated vertigo clinics could significantly improve the diagnostic and
treatment yield in a resource-constrained setting like ours. Most cases can be managed using
non-operative measures.

Acta Neurol Scand. 2016 Mar 1. doi: 10.1111/ane.12581. [Epub ahead of print]

Association of dementia in patients with

benign paroxysmal positional vertigo.
Lo MH1, Lin CL2,3, Chuang E4, Chuang TY1, Kao CH5,6.

Author information

Abstract

OBJECTIVE:

We conducted a cohort study to investigate whether benign paroxysmal positional vertigo

(BPPV) is correlated with an increased risk of dementia.

METHODS:

We established a case cohort comprising 7818 patients aged over 20 years who were diagnosed
with BPPV from 2000 to 2010. In addition, we formed a control cohort by randomly selecting
31,272 people without BPPV and matched them with the BPPV patients according to gender,
age, and index year. Cox proportional hazard regressions were performed to compute the hazard
ratio (HR) of dementia after we adjusted for demographic characteristics and comorbidity.

RESULTS:

The prevalence of comorbidity was higher among patients with BPPV than among those without
BPPV. In addition, patients with BPPV exhibited a 1.24-fold (95% confidence interval, CI 1.09-
1.40; P < 0.001) higher risk of dementia than those without BPPV after we adjusted for age,
gender, and comorbidity. An analysis stratified according to demographic factors revealed that
women with BPPV exhibited a 1.36-fold (95% CI 1.16-1.59; P < 0.001) higher risk of dementia.
Patients with BPPV aged over 65 years exhibited a significantly higher risk of dementia
(adjusted HR: 1.26; 95% CI 1.10-1.43; P < 0.001) than those without BPPV.

CONCLUSIONS:

Patients with BPPV exhibited a higher risk of dementia than those without BPPV.

J Vestib Res. 2016;25(5-6):233-9. doi: 10.3233/VES-150563.

Retrospective data suggests that the higher

prevalence of benign paroxysmal positional
vertigo in individuals with type 2 diabetes is
mediated by hypertension.
D'Silva LJ1, Staecker H2, Lin J2, Sykes KJ2, Phadnis MA3, McMahon TM4, Connolly D4, Sabus
CH1, Whitney SL5,6, Kluding PM1.

Author information

Abstract

OBJECTIVE:

Benign Paroxysmal Positional Vertigo (BPPV) has been linked to comorbidities like diabetes
and hypertension. However, the relationship between type 2 diabetes (DM) and BPPV is unclear.
The purpose of this retrospective study was to examine the relationship between DM and BPPV
in the presence of known contributors like age, gender and hypertension.

METHODS:

A retrospective review of the records of 3933 individuals was categorized by the specific
vestibular diagnosis and for the presence of type 2 DM and hypertension. As the prevalence of
BPPV was higher in people with type 2 DM compared to those without DM, multivariable
logistic regressions were used to identify variables predictive of BPPV. The relationship between
type 2 DM, hypertension and BPPV was analyzed using mediation analysis.

RESULTS:

BPPV was seen in 46% of individuals with type 2 DM, compared to 37% of individuals without
DM (p< 0.001). Forty two percent of the association between type 2 DM and BPPV was
mediated by hypertension, and supported hypertension as a complete mediator in the relationship
between type 2 DM and BPPV.

CONCLUSIONS:

Hypertension may provide the mediating pathway by which diabetes affects the vestibular
system. Individuals with complaints of dizziness, with comorbidities including hypertension and
diabetes, may benefit from a screening for BPPV.

J Neurol. 2016 Jan;263(1):45-51.

Risk factors for the recurrence of post-

semicircular canal benign paroxysmal
positional vertigo after canalith repositioning.
Su P, Liu YC, Lin HC.

Abstract

This retrospective study was conducted to determine the relationship between variable factors
and the recurrence rate of post-semicircular canal benign paroxysmal positional vertigo (PSC-
BPPV) after canalith repositioning procedure (CRP). Patients with PSC-BPPV were diagnosed
by history and the presence of a positive Dix-Hallpike maneuver between 2008 and 2010. In
total, 243 patients (47 males and 196 females, average age = 57.5 -years) treated with Epley's
maneuver or canalith repositioning procedure (CRP) were included in the study. The
demographic factors studied were age, sex, sleep disorders, inner ear diseases, head trauma
history, and cardiovascular diseases. Multivariate statistics using SPSS version 15, Pearson's
Chi-squared test (2), Kaplan-Meier analysis, log-rank test, and Cox proportional hazards
regression model were used for the analysis. The success rate of vertigo control after the initial
CRP was 83.1 %. Pearson's 2 test results showed that females and participants with sleep
disorders exhibited a significant difference in the recurrence of vertigo after the initial CRP. In
addition, the Kaplan-Meier analysis and log-rank test survival analysis revealed that the
recurrence was associated with females and participants with sleep disorders and inner ear
diseases.However, Cox proportional hazards regression showed no differences in recurrences
associated with old age, sex, sleep disorders, inner ear diseases, head trauma, and cardiovascular
diseases. Epley's maneuver or CRP is an effective, safe, and simple treatment for BPPV. Females
and participants with sleep disorders and inner ear diseases are likely associated with the
recurrence of BPPV after CRP.
KARAKTERISTIK PASIEN PENDERITA BPPV DI RSUP H. ADAM MALIK MEDAN
PADA TAHUN 2012-2013
Oleh : W.A. LUBIS (2014)
Benign Paroxysmal Positional Vertigo (BPPV) adalah salah satu jenis
vertigo vestibular tipe perifer yang paling sering dijumpai dan ditandai dengan
serangan-serangan pusing berputar oleh karena perubahan posisi kepala terhadap
gaya gravitasi tanpa adanya keterlibatan lesi di susunan saraf pusat.
Tujuan penelitian ini adalah untuk mengetahui karakteristik pasien penderita
BPPV di RSUP H. Adam Malik Medan pada tahun 2012-2013.
Penelitian ini bersifat deskriptif retrospektif dan menggunakan teknik total
sampling untuk pengumpulan data. Jumlah keseluruhan pasien yang didiagnosis
BPPV adalah 33 orang. Prosedur pengumpulan data adalah dengan menganalisa
setiap data rekam medis pasien yang terdapat di rumah sakit H. Adam Malik selama
dua tahun terakhir. Kemudian, data dianalisis menggunakan studi analisis deskriptif

Hasil penelitian ini menunjukkan bahwa prevalensi BPPV meningkat dari

21,2% pada tahun 2012 menjadi 78,8% pada tahun 2013. Karakteristik pasien
meliputi: kategori usia terbanyak 41-60 tahun (51,5%), pada wanita (69,7%),
pekerjaan sebagai pegawai negeri sipil (PNS) (33,3%), dan penyebab tersering
adalah idiopatik (45,5%).

KARAKTERISTIK PENDERITA BPPV DI RSUP HAJI ADAM MALIK.

Oleh: MSE. MARPAUNG (2016)
Benign Paroxysmal Positional Vertigo adalah gangguan vestibuler yang
paling sering ditemui, dengan gejala seperti rasa pusing berputar diikuti mual muntah
dan keringat dingin, yang dipicu oleh perubahan posisi kepala terhadap gaya
gravitasi. Etiologi dari BPPV ini diduga disebabkan oleh perpindahan otokonia kristal
(kristal karbonat Ca yang biasanya tertanam di sakulus dan utrikulus). Ketika kepala
bergerak, maka perpindahan otokonia akan merangsang kupula untuk mengirimkan
sinyal yang salah ke otak, dan memicu vertigo dan nistagmus. Tujuan dari penelitian
ini adalah untuk mengetahui karakteristik penderita BPPV di RSUP Haji Adam
Malik. 2011-2015
Penelitian ini merupakan penelitian deskriptif, dengan cara mengambil data
dari rekam medis. Populasi dari penelitian ini adalah seluruh penderita BPPV yang
datang ke poli neurologi RSUP Haji Adam Malik dimulai dari 01 Januari 2011
sampai 30 September 2015. Sampel penelitian ini berjumlah 55 orang yang diperoleh
dengan metode total sampling.

Dari karakteristik penderita BPPV, ditemukan bahwa dari 55 penderita,

sebagian besar berjenis kelamin wanita (74,5%) dengan usia terbanyak >60 tahun
(34,5%). Pekerjaan terbanyak dari penderita adalah Ibu Rumah Tangga (34,5%).
Untuk suku terbanyak penderita adalah Batak Karo (34,5%), dan diikuti dengan
agama terbanyak adalah Kristen (56,4%). Tekanan darah sebagai salah satu faktor
resiko dari BPPV sendiri menunjukkan bahwa penderita BPPV terbanyak meiliki
hipertensi grade I (29,1%). Dan untuk gejala klinis yang paling sering dirasakan oleh
penderita adalah pusing berputar, mual muntah, dan keringat dingin (27,3%).
Acta Neurol Taiwan. 2011 Jun;20(2):101-6.

The relationship between isolated dizziness/vertigo and

the risk factors of ischemic stroke: a case control study.
Chang CC1, Chang WN, Huang CR, Liou CW, Lin TK, Lu CH.

Author information
Abstract
PURPOSE:
Dizziness/vertigo are important public heath care issues especially in elderly
patients. Isolated dizziness/vertigo without neurological deficits has seldom been considered a
symptom/sign due to vascular origin. Recently, some studies have suggested that vascular origin
should be considered in cases of positional vertigo and isolatedvertigo or dizziness when the
etiology remains unclear. In this study, we tried to delineate the correlation
of dizziness/vertigo and risk factors of stroke.

METHODS:
We collected adult subjects receiving health screening of the brain at their own expense. All subjects
had undergone brain magnetic resonance imaging (MRI), magnetic resonance angiography (MRA)
and carotid duplex. The chief complaints, body height, body weight, waist circumference and blood
pressure of all subjects were recorded. Most received blood tests including fasting sugar, total
cholesterol, low density lipoprotein, high density lipoprotein (HDL), triglycerides, and uric acid (UA).
The relationships between dizziness/vertigo and blood test data, blood pressure, body mass index
(BMI), waist circumference, metabolic syndrome, carotid duplex, silent brain infarction, leukoaraiosis
and MRA were analyzed.

RESULTS:
After exclusion, a total of 170 out of 210 subjects were collected. The analysis revealed
that dizziness/ vertigo had a significant correlation to age, UA , BMI, male HDL and female waist
circumference. Among them, female waist circumference had the highest statistical significance (P =
0.001). Leukoaraiosis on brain MRI also had a close relationship with dizziness/vertigo.

CONCLUSION:
After careful examination and approach, a vascular origin should be considered in dizzy patients of
unknown etiology.