JOURNAL

READING
RISK FACTORS FOR RECURRENCE OF BENIGN
PAROXYSMAL
POSITIONAL VERTIGO (BPPV)

Tutors :
dr. Tris Sudyartono, Sp.THT-
KL
dr. Agus Sudarwi, Sp.THT-KL
dr. Afif Zjauhari, Sp.THT-KL

Presented by :
Irkham Setya Wisudawan
(01.208.5684)
Joko Arif Kurniawan
(01.208.5692)
VESTIBULAR SYSTEM
ANATOMY & HISTOLO
PATHOLOGY
Vestibular
Neuronitis
INTRODUCTION
The displaced
otoliths are
returned to the
utricle
spontaneously or by
the
Canalith
Repositioning
Procedure (CRP) and
are eventually
phagocytosed or
resolved
Although both untreated patients and

OBJECTIVE
To assess the results
of treatment for a
first episode BPPV
and risk factors for
recurrence.
 MATERIALS AND
METHODS

PLACE & TIME

Department of Otolaryngology-Head and Neck
Surgery,
Kobe University Hospital, Kobe, Japan, between June
2002 and April 2006.
 Dix
Hallpike
Test

lateral
roll test
Treatment was considered successful if nystagmus was absent
and positional vertigo
was completely resolved.
osteoporosis was diagnosed on the basis of
STATISTICAL ANALYZE
RESULTS
 BPPV resolved spontaneously in many patients without recurrence.
Recurrent BPPV-PSC patients required more CRP sessions and a longer
period of treatment for the initial episode than those without recurrent
BPPV-PSC to eliminate positioning nystagmus and positional vertigo (Table
1).
 24 of these patients were female.
19 of them were aged 65 years or over.
in 7 patients with
osteoporosis (33%),
6 with endolymphatic hydrops (75%),
and 3 with head trauma (17%).
 Recurrenc
e within 1
year was Recurre
seen in nce of
31 (21%) BPPV
patients. was
observe
d

In the idiopathic group, BPPV recurred more rarely in patients who were
under 65 years old and had no history of osteoporosis or endolymphatic
Although the first BPPV episode and recurrent BPPV affected
the same ear as that with endolymphatic hydrops in all
patients with this complication, no significant difference was
found in comparison with patients without endolymphatic
hydrops (Table 3).
 In all of them, worse hearing loss
or vertigo attack due to
endolymphatic hydrops was
experienced during the period
until relapse of BPPV.
DISCUSSION

can lead to
inner ear
damage and
repeated
detachment of
otoconia from
the utricular
macula
 Other risk factors of BPPV, for example,
ear surgery, labyrinthitis, and ototoxicity, have also been reported,
However, we excluded them from this analysis because fewer
than 5 of our patients had these conditions.
previous observational studies
This suggests the importance of sufficient control of endolymphatic hydrops
for prevention of recurrent BPPV.
 The rate of BPPV recurrence was low in the idiopathic
group that had no persistent risk factors, advanced
age, osteoporosis, and endolymphatic hydrops.
However, this study did not demonstrate a significant
association between BPPV recurrence and each
continuous risk factor, apart from endolymphatic
hydrops.
A further large-scale study is needed to confirm
whether these factors can also predict recurrent
BPPV. The present results suggest that, in a clinical
setting, these continuous problems should be taken
into account to prevent recurrence of BPPV.
 Patients with recurrent BPPV-PSC tended to
require more CRP sessions and a longer
period for successful treatment of the first
BPPV episode than patients without recurrent
BPPV-PSC.
Therefore, conditions that predispose
patients to repeated release of otoconia may
cause not only recurrence but also resistance
to CRP.
CONCLUSION
CONCLUSION
 VESTIBULAR
EXAMINATION
Hallpike Manoever
 fig7: Mechanism of canalolithiasis
of bilateral geotropic horizontal
canal BPPV (the involved
horizontal canal sare colored
black). (a) Patient in supine
position with debris in the
posterior part of both horizontal
canals. (b) Supine roll test on
either side would result in
excitation of the horizontal canal
of the lowermost ear, due to
ampullopetal endolymph flow and
at the same time inhibition of the
horizontal canal of the uppermost
ear, due to ampullofugal
endolymph flow. Vectorial
summation would result in an
intense, symmetric geotropic
nystagmus.

Mentions: In a theoretical case of

bilateral horizontal BPPV with
geotropic nystagmus, supine roll
test on either side would result in
excitation of the horizontal canal
of the lowermost ear, due to
ampullopetal endolymph flow and
at the same time inhibition of the