Dataset Information

Posterior canal benign paroxysmal positional vertigo with long duration: Heavy or light cupula?

ABSTRACT:

Objective

To investigate the characteristics of positional nystagmus in posterior semicircular canal (PSCC) benign paroxysmal positional vertigo (BPPV) patients with longer durations, and to discuss the possible underlying mechanism of this nystagmus.

Methods

We conducted a retrospective review, and enrolled 118 consecutive patients with unilateral PSCC BPPV. The duration of nystagmus during a Dix-Hallpike test was classified into short (<1 min) and long (≥1 min) durations. For the identification of a neutral point in PSCC BPPV patients with long durations, the patient's head was turned 45° to the lesioned side to set the affected PSCC on the sagittal plane, and the disappearance of positional nystagmus was investigated in a pitch plane.

Results

Among 118 patients with PSCC BPPV, positional nystagmus during a Dix-Hallpike test showed short durations (<1 min) in 112 patients and long durations (≥1 min) in 6 patients. Of 6 PSCC BPPV patients with a long duration, a neutral point was identified in 5 patients whose nystagmus lasted for longer than 2 min; interestingly, a neutral point was observed when the patient's head was slightly tilted backward in all 5 patients.

Conclusion

Considering that a neutral position was identified when the patient's head was slightly tilted backward while keeping the head turned 45° to the right or left, we assume that the light cupula condition of the ipsilateral PSCC or the contralateral anterior semicircular canal, and not PSCC BPPV cupulolithiasis, could be responsible for the occurrence of persistent torsional-upbeating nystagmus in a Dix-Hallpike test.

Level of evidence

SUBMITTER: Kim CH

PROVIDER: S-EPMC10446259 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Publications

Posterior canal benign paroxysmal positional vertigo with long duration: Heavy or light cupula?

Kim Chang-Hee CH Shin Jung Eun JE Kim Hansol H Park Joon Yong JY

Laryngoscope investigative otolaryngology 20230712 4

<h4>Objective</h4>To investigate the characteristics of positional nystagmus in posterior semicircular canal (PSCC) benign paroxysmal positional vertigo (BPPV) patients with longer durations, and to discuss the possible underlying mechanism of this nystagmus.<h4>Methods</h4>We conducted a retrospective review, and enrolled 118 consecutive patients with unilateral PSCC BPPV. The duration of nystagmus during a Dix-Hallpike test was classified into short (<1 min) and long (≥1 min) durations. For th ...[more]

PMID: 37621261

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Project description:BACKGROUND:Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Little is known on how posterior canal BPPV affects health-related quality of life in patients diagnosed and treated at primary care facilities or on whether patients with subjective and objective disease perceive the effects differently. This study was designed to describe how patients diagnosed with posterior canal BPPV in primary care perceive disability. METHODS:Cross-sectional descriptive study performed at two urban primary care centers. Participants were patients aged 18 years or older with suspected posterior canal BPPV recruited for baseline evaluation in a clinical trial on the effectiveness of the Epley maneuver in primary care. The recruitment period was from November 2012 to January 2015. Perceived disability was evaluated using the Dizziness Handicap Inventory - Screening version (DHI-S). Other variables collected were age and sex, a history or diagnosis of anxiety or depression, treatment with antidepressants and/or anxiolytics, and results of the Dix-Hallpike (DH) test, which was considered positive when it triggered vertigo with or without nystagmus and negative when it triggered neither. RESULTS:The DH test was positive in 134 patients, 40.30% of whom had objective BPPV (vertigo with nystagmus). The median age of the patients was 52 years (interquartile range [IQR], 39.00-68.50 years) and 76.1% were women. The median total score on the DHI-S was 16 out of 40 (IQR, 8.00-22.00). Scores were higher (greater perceived disability) in women (p < 0.001) and patients with subjective BPPV (vertigo without nystagmus) (p = 0.033). The items perceived as causing the greatest disability were feeling depressed (67.1%) and worsening of the condition on turning over in bed (88%). CONCLUSIONS:Patients diagnosed with posterior canal BPPV in primary care perceive their condition as a disability according to DHI-S scores, with higher levels of disability reported by women and patients with subjective BPPV. Feelings of depression and turning over in bed were associated with the greatest perceived difficulties. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT01969513. Retrospectively registered. First Posted: October 25, 2013. https://clinicaltrials.gov/ct2/show/NCT01969513.

Project description:ImportanceHead-shaking and mastoid oscillation maneuvers effectively treat cupulolithiasis of horizontal canal benign paroxysmal positional vertigo. However, to date there are no validated treatments for cupulolithiasis of posterior canal benign paroxysmal positional vertigo (PC-BPPV-cu).ObjectiveTo determine the immediate and short-term therapeutic efficacy of head-shaking and mastoid oscillation maneuvers in PC-BPPV-cu.Design, setting, and participantsThis double-blind randomized clinical trial was conducted at 6 referral-based university hospitals in South Korea between November 1, 2019, and April 30, 2023. The inclusion criteria consisted of (1) repetitive episodes of positional vertigo or dizziness; (2) positional nystagmus beating torsionally with the upper pole of the eye to the lower ear and vertically upward (to the forehead) and lasting longer than 1 minute, which was evoked by Dix-Hallpike or half Dix-Hallpike maneuver; and (3) absence of accompanying neurologic symptoms or signs suggesting central nervous system disorders. Patients were excluded who declined to participate or had cervical spine problems, multicanal BPPV, or cognitive dysfunction.InterventionsPatients were randomly assigned to the head-shaking, mastoid oscillation, or sham maneuver groups. After a maximum of 2 trials of each maneuver, therapeutic response was assessed within 30 minutes and the following day.Main outcomes and measuresThe primary outcome was the short-term resolution rate of positional vertigo and nystagmus the following day. The secondary outcome was the immediate efficacy of 2 trials of each maneuver within 30 minutes.ResultsA total of 159 patients were included in the analysis (108 [67.9%] women; mean [SD] age, 65.4 [10.5] years). Fifty-three participants were randomized to the head-shaking group (mean [SD] age, 64.0 [11.2] years; 33 [62.3%] women), 53 to the mastoid oscillation group (mean [SD], age, 66.5 [11.1] years; 41 [77.4%] women), and 53 to the control group (mean [SD] age, 65.6 [9.2] years; 34 [64.2%] women). A total of 142 patients (89.3%) completed the assessment the following day. In the intention-to-treat analysis, 20 patients in the head-shaking group (37.7%), 14 in the mastoid oscillation group (26.4%), and 7 in the control group (13.2%) showed the resolution of vertigo and nystagmus the following day (χ2 = 8.40; odds ratio, 2.86; 95% CI, 1.32-6.18; P = .004; α = .0167). For the secondary outcome (the immediate effectiveness of 2 trials of each maneuver compared with sham within 30 minutes), no significant difference was detected (6 of 53 [11.3%] vs 4 of 53 [7.5%] vs 2 of 53 [3.8%]; P = .34; α = .05).Conclusions and relevanceIn this randomized clinical trial, the head-shaking maneuver was effective in the treatment of PC-BPPV-cu.Trial registrationCRIS clinical trial registration: KCT0004756.

Dataset Information

Posterior canal benign paroxysmal positional vertigo with long duration: Heavy or light cupula?

Objective

Methods

Results

Conclusion

Level of evidence

Publications

Posterior canal benign paroxysmal positional vertigo with long duration: Heavy or light cupula?

Similar Datasets

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