Anxiety characteristics in benign paroxysmal positional vertigo: first vs. recurrent episodes.

PURPOSE: To assess the difference in state and trait anxiety levels in patients with Benign Paroxysmal Positional Vertigo (BPPV) at the first episode (FE) versus recurrent episodes (RE), before and after vestibular physiotherapy. A secondary objective was to assess the difference in the prevalence of underlying health conditions between FE and RE BPPV patients. METHODS: Fifty-five patients with BPPV, aged 40-70, were recruited. The diagnosis of BPPV was confirmed based on subjective complaints of vertigo and positive results from the Dix-Hallpike and Supine Roll tests. Twenty-four patients were in their FE, and 31 had RE. All patients completed the State-Trait Anxiety Inventory (STAI) questionnaire three times; before, immediately after, and a week after vestibular physiotherapy treatment. RESULTS: The RE group demonstrated higher trait anxiety than the FE group in all testing points: before treatment (median value of 38 versus 29, p-value = 0.02), immediately after treatment (median value of 36 versus 28, p-value < 0.01) and a week later (median value of 38 versus 28, p-value < 0.01). State anxiety decreased immediately after treatment in both groups, but at the second session, it was significantly higher in the RE than in the FE group (median value of 38 versus 28.5, p-value = 0.03). Hypothyroidism was significantly more frequent in the RE group (RE 16%, FE 0%, p-value = 0.04). CONCLUSIONS: Based on the current study's findings, we recommend assessing anxiety levels in patients with recurrent BPPV and consider referring them for appropriate treatment when necessary.

Customised vestibular rehabilitation with the addition of virtual reality based therapy in the management of persistent postural-perceptual dizziness.

OBJECTIVE: Visual-vestibular mismatch patients experience persistent postural and perceptual dizziness. Previous studies have shown the benefit of vestibular rehabilitation for visual desensitisation using gaze stabilisation exercises and optokinetic stimulation. This study assessed the benefit of customised vestibular rehabilitation with visual desensitisation and virtual reality based therapy rehabilitation in the management of patients with persistent postural-perceptual dizziness. METHODS: This retrospective study included 100 patients with Situational Characteristic Questionnaire scores of more than 0.9. All patients received virtual reality based therapy along with usual vestibular rehabilitation using gaze stabilisation exercises with a plain background followed by graded visual stimulation and optokinetic digital video disc stimulation. Patients' symptoms were assessed before and after vestibular rehabilitation using the Situational Characteristic Questionnaire, Generalised Anxiety Disorder Assessment-7, Nijmegen Questionnaire and Dizziness Handicap Inventory. RESULTS: There were statistically significant improvements in Situational Characteristic Questionnaire scores, Nijmegen Questionnaire scores and Dizziness Handicap Inventory total score. However, there was a statistically insignificant difference in Generalised Anxiety Disorder Assessment-7 scores. There was a significant positive correlation between post-rehabilitation Situational Characteristic Questionnaire scores and other questionnaire results. CONCLUSION: Incorporating virtual reality based therapy with customised vestibular rehabilitation exercises results in significant improvement in persistent postural-perceptual dizziness related symptoms.

Mood Disorders are Associated With Increased Risk of BPPV: A National Sample Cohort.

OBJECTIVES: Few studies have reported that mood disorders increase the risk of benign paroxysmal positional vertigo (BPPV). The purpose of our study was to demonstrate whether the incidence of BPPV in those with mood disorders differs from that in a matched control group. STUDY DESIGN: Nationwide cohort observational study. METHODS: Korean Health Insurance Review and Assessment Service-National Patient Samples were collected from 2002 to 2013. A 1:4 matched mood disorder group (n = 59,340) and control group (n = 237,720) were selected. The crude and adjusted (cerebral stroke, ischemic heart disease, anxiety disorder, and osteoporosis histories) hazard ratios (HRs) for depression and BPPV were analyzed using a stratified Cox proportional hazard model. The results were stratified by age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia in these analyses. RESULTS: The incidence of BPPV was significantly higher in the mood disorder group than in the control group (3.2% vs. 2.1%, P < .001). Mood disorder increased the risk of BPPV (adjusted HR = 1.31, 95% confidence interval [CI] = 1.23-1.39, P < .001). In subgroup analyses, the incidence of BPPV in all age groups and in both sexes was significantly higher in the mood disorder group than in the control group. CONCLUSION: This population-based cohort study demonstrates that mood disorder was significantly associated with BPPV. LEVEL OF EVIDENCE: N/A. Laryngoscope, 131:380-385, 2021.

Dizziness handicap and anxiety depression among patients with benign paroxysmal positional vertigo and vestibular migraine.

ABSTRACT: To investigate the dizziness handicap and anxiety depression among patients with benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM).A prospective cohort study in which patients came from the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University was conducted. Patients were diagnosed with BPPV and VM from September 2016 to December 2017. Dizziness handicap inventory (DHI) scale and hospital anxiety and depression scale (HADS) were assessed among subjects before treatment and 3 months follow-up.We used the Mann-Whitney U test to compare the DHI and HADS scores of BPPV and VM patients before and after 3 months and found significantly statistical difference. Before treatment, the median DHI scores of BPPV and VM were 34 and 60, with a Z = -5.643 (P = .001); The median HADS scores were 6 and 14, with Z = -4.807 (P = .001). After 3 months follow-up, the median DHI scores of BPPV and VM were 0 and 22, with a Z = -8.425 (P = .001); The median HADS scores were 6 and 14, with Z = -7.126 (P = .001) 51.11% VM patients and 12.21% BPPV patients have anxiety and depression. A Spearman correlation revealed a significantly moderate positive correlation (r = .455, P < .001) between DHI and HADS scores.The emotional, functional and physical effects of vertigo on VM patients were more significant than BPPV patients. The change of DHI scores in BPPV and VM patients was positively correlated with changes in the anxiety and depression in the HADS.

Efficacy of Epley Maneuver on Quality of Life of Elderly Patients with Subjective BPPV.

OBJECTIVES: This study aimed to evaluate the efficacy of the repositioning maneuver on quality of life in elderly patients with dizziness and/or vertigo. MATERIALS AND METHODS: This controlled, prospective randomized clinical trial was conducted in elderly patients aged 65 years and above with a positive history of benign paroxysmal positional vertigo (BPPV), presence of vertigo, and no observable nystagmus during the Dix-Hallpike test, so-called Subjective BPPV (S-BPPV). Individuals were evaluated by visual analog scale (VAS) and dizziness handicap inventory (DHI). Groups were defined as treatment (treated with Epley maneuver bilaterally) or no treatment control (no treatment modality or canalith repositioning maneuver). Ten days after the first assessment, all patients were reassessed using VAS and DHI. RESULTS: A total of 50 patients were randomized into two groups: 25 to the treatment group, and 25 to the control group. No significant differences were observed for baseline VAS and total DHI scores between the groups (p=0.636, p=0.846, respectively). On the other hand, after the reassessment, VAS and total DHI scores were both significantly reduced in the treatment group (p<0.001, p<0.001, respectively), but no reduction in either score was found in the control group (p=0.216, p=0.731, respectively). CONCLUSION: This study showed that elderly patients with S-BPPV benefit from the Epley maneuver, in particular global and disease-specific quality of life.

Disability perceived by primary care patients with posterior canal benign paroxysmal positional vertigo.

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.

Determination of Anxiety, Health Anxiety and Somatosensory Amplification Levels in Individuals with Benign Paroxysmal Positional Vertigo.

OBJECTIVES: Psychiatric comorbidities may intensify peripheral vertigo and increase the number of repositioning maneuvers required. This study was designed to examine the relationship between benign paroxysmal positional vertigo (BPPV) and anxiety and assess its association with somatic amplification and health anxiety. MATERIALS AND METHODS: Sixty patients with BPPV (43 women, 17 men; age range: 24-81 years, mean age 40.4±13.3), and 60 healthy participants (29 women, 31 men; age range: 18-71, mean age 38.2±11.43) were prospectively enrolled. The participants completed the Beck Anxiety Inventory (BAI), Short Health Anxiety Inventory (SHAI), and Somatosensory Amplification Scale (SSAS) questionnaires. RESULTS: The BAI scores of the patients with BPPV were higher than those of the control group participants and were as follows: (16.4 vs. 12.7; p=0.01). The SHAI (p=0.44) and SSAS (p=0.60) scores were not significantly different between the two groups. The BAI scores were positively correlated with the SHAI (rho: 0.273, p=0.035) and SSAS (rho: 0.357, p=0.005) scores. Neither the number of BPPV attacks nor the number of Epley maneuvers required showed any correlation with the BAI [(rho: 0.208, p=0.11); (rho: -0.007, p=0.96)], SHAI [(rho: 0.068, p=0.06); (rho: 0.021, p=0.87)], and SSAS [(rho: -0.081, p=0.53); (rho: -0.012, p=0.92)] scores. CONCLUSION: Our findings indicate that patients with BPPV had higher anxiety scores than healthy participants. Although our findings indicated normal health anxiety and somatic amplification levels in patients with BPPV, regular evaluation of psychological status would be a good strategy to prevent chronic dizziness.

Effects of treatment on anxiety levels among patients with benign paroxysmal positional vertigo.

PURPOSE: The association of vertigo with anxiety disorders is well known. Herein, we aimed to determine the relationship between pre-treatment and post-treatment anxiety levels, assessed with Beck anxiety inventory, with educational status among patients diagnosed with and treated for Benign paroxysmal positional vertigo (BPPV), and to evaluate the effect of treatment on the sub-parameters of the Beck anxiety inventory. METHODS: Our study included a total of 33 patients that presented to the otorhinolaryngology outpatient clinic with acute vertigo and were diagnosed to have posterior canal BPPV. Patients diagnosed with posterior BPPV were applied Beck anxiety inventory prior to the treatment as well as 1 week and 4 weeks after the treatment. RESULTS: Compared to the control group, statistically significant changes were observed in relation to pre-treatment and post-treatment inventory scores (p < 0.05). A comparison of the pre-treatment and post-treatment assessments revealed significant differences (p < 0.05). Improvements were observed in 48% (10/21) of the subparameters by the end of the first week at the earliest. Educational status had no significant effect on inventory scores (p > 0.05). CONCLUSION: Anxiety-related subjective symptoms mostly started to improve 1 week after the treatment at the earliest, and symptoms showed persistence at a certain level even at the end of the first month. Inequalities between the patients' educational levels affect anxiety levels. It should be remembered that educational status should be considered when approaching patients.

Vestibular Rehabilitation Therapy Outcomes in Patients With Persistent Postural-Perceptual Dizziness.

OBJECTIVES:: Persistent postural-perceptual dizziness (PPPD) represents an important category of vertigo. Medical treatment and psychotherapy provide convenient control of symptoms. However, these management strategies can have inconvenient side effects and short-term relief, respectively. Vestibular rehabilitation therapy (VRT) is a self-conducted habituation program that can be personalized to the subject's needs to give adequate symptom relief without side effects. The present study aims to test the effect of VRT on patients with PPPD. METHODS:: Participants were diagnosed as having PPPD by the exclusion of organic vestibular lesions. The study involved 2 groups with PPPD: Group I, treated with the VRT, and Group II, treated with the VRT plus placebo. The Dizziness Handicap Inventory (DHI), a self-assessment scale, was used to evaluate the VRT outcomes. RESULTS:: There was a significant decrease in functional, physical, and total scores on the DHI in both groups after VRT. Adding the placebo did not have supplementary outcomes. The patients who did not benefit from the VRT had a significantly longer duration of PPPD, more complex aggravating factors, more composite VRT exercises, and a higher DHI score than the patients who benefited from VRT. CONCLUSIONS:: Customized VRT adequately reduced symptoms and improved quality of life in subjects with PPPD.

Assessment of sleep quality in benign paroxysmal positional vertigo recurrence.

OBJECTIVE: Despite the availability of highly effective treatments, there is a significant recurrence rate of benign paroxysmal positional vertigo (BPPV). This study is aimed to quantitatively measure sleep quality in BPPV patients and correlate it with the recurrence of BPPV. METHODS: In this longitudinal cohort study, the clinical records of 67 elderly or middle-aged adult patients who were diagnosed with BPPV at Neurology Clinic, Beijing Chaoyang Hospital affiliated to Capital Medical University between 2013 and 2014. The 'recurrent' and 'non-recurrent' BPPV were respectively defined. Primary data collection included the medical history, blood test and Pittsburgh Sleep Quality Index measurement. RESULTS: Among the total 67 patients after successful treatment, recurrent BPPV is observed in 37.31% patients (n = 25) within 2 years. Among all 11 variables analyzed between recurrent and non-recurrent groups, only the Pittsburgh Sleep Quality Index (PSQI) scores showed significant difference (p<.001). In details, these differences were also measured in five individual sleep items, including the subjective assessment of sleep quality, sleep latency, sleep duration, the use of sleep-aid medication and daytime dysfunctions (all p<.05). Regression analysis showed patients with higher PSQI score (lower sleep quality) had higher risk of BPPV recurrence [odds ratio (OR)=1.17, 95% confidence interval (CI): 1.04-1.32, p=.0082]. CONCLUSIONS: The sleep quality in patients with BPPV recurrence is significantly poorer compared to non-recurrent patients. Our result suggested sleep quality as measured by PSQI is an independent risk factor of BPPV recurrence.

[Therapeutic effects of psychological intervention combined with manual reduction on benign paroxysmal positional vertigo in the elderly].

Objective:To explore the best treatment for elderly patients with benign paroxysmal positional vertigo (BPPV). Method:Sixty-eight BPPV patients aged 60-85 years were randomly divided into two groups. The control group was treated by simple manipulation. The study group was treated by manual reduction combined with psychological intervention. The curative effect was compared. Result:The cure rates of the control group and the study group were 44.4% and 43.8% respectively, with no significant difference (P>0.05); the effective rates were 52.78% and 87.50% respectively, with significant difference (P<0.05). The recurrence rates of control group and study group were 8.3% and 3.1% after 2 weeks of treatment, respectively, with no significant difference (P>0.05). The recurrence rates at 3 months were 5.6% and 0 respectively, with no significant difference (P>0.05). The difference of SAS and SDS between the two groups after treatment was statistically significant (P<0.05). There was no significant difference in the residual symptoms between the two groups at the first follow-up (P>0.05), and at 1 week and 4 weeks (P<0.05). The residual symptoms of the patients after reoperation were relieved compared with those of the control group. The DHI scores of the study group between 60-70 years old and 71-85 years old group for the first time, after 1 week and 4 weeks were statistically significant (P<0.05), and the residual symptoms in the 60-70 years group were reduced compare to the 71-85-year-old group. Conclusion:Elderly people with BPPV are susceptible to anxiety and depression. Manipulation combined with psychological intervention can promote the curative effect well, but personalized treatment plan should be developed.

Independent prescriber physiotherapist led balance clinic: the Southport and Ormskirk pathway.

OBJECTIVE: To report the introduction and impact of non-medical prescribing, initiated to improve patient pathways for those presenting with dizziness and balance disorders. METHODS: The Southport and Ormskirk physiotherapy-led vestibular clinic sees and treats all patients with dizziness and balance disorders referred to the ENT department. Letters are triaged by an audiologist, who also performs an otological examination and hearing test; this is followed by an assessment with the independent prescriber physiotherapist. An ENT consultant is nearby if joint consultation is needed. Diagnoses, treatments and patient satisfaction were studied, with an analysis of the impact of medication management (stopping or starting medicines) on patients and service. RESULTS: In 12 months, 413 new patients with dizziness and balance disorders had appointments. The most common diagnoses were benign paroxysmal positional vertigo and vestibular migraine. Eighty-four per cent of patients required self-management strategies, 50 per cent exercise therapy, 48 per cent medication management and 24 per cent a particle repositioning manoeuvre. Patient satisfaction was high (99 per cent). CONCLUSION: Having an independent prescriber physiotherapist leading the balance clinic has reduced the number of hospital visits and onward referrals. Nearly half of all patients required medication management as part of their dizziness or balance treatment.

The evaluation of anxiety and panic agarophobia scores in patients with benign paroxysmal positional vertigo on initial presentation and at the follow-up visit.

CONCLUSION: Patients with BPPV experienced short but intense anxiety and/or panic disorder, especially at the initial visit, but most patients recovered without medication with successful treatment. OBJECTIVE: Recent studies have shown that people with dizziness report some psychological problems such as panic and agoraphobia and anxiety. The aim of this study was to evaluate anxiety and panic agorophobia levels in patients with benign paroxysmal positional vertigo on initial presentation and at the follow-up visit and compare the scores with the control group. METHODS: All the 32 patients in the study had a diagnosis of BPPV confirmed by their history, typical subjective symptom reports, and characteristic positional nystagmus during the Dix-Hallpike test and/or Roll test. The patients were instructed to complete the standard forms of Beck anxiety inventory and panic agoraphobia scale questionnaire before and at 7 and 14 days after the canalith repositioning treatment. RESULTS: The validity scores of panic agoraphobia were statistically significantly higher in patients with BPPV than in the control group in each period (p < .001) and the validity scores of the Beck anxiety inventory were statistically significantly higher in patients with BPPV than in the control group at the first and second evaluation (p < .001).

Reliability of an anamnestic questionnaire for the diagnosis of benign paroxysmal positional vertigo in the elderly.

BACKGROUND: There is common agreement in the literature that it can result in an underestimation of benign paroxysmal positional vertigo (BPPV) in the elderly. AIMS: The aim of this work was to analyze the role of anamnesis in the diagnosis of BPPV in patients of different ages through the development and validation of a scored questionnaire. METHODS: The questionnaire is based on the presence/absence of six typical anamnestic features of BPPV. The Mini-Mental State Exam (MMS) was also administered to patients over 65 years of age. Bedsides, examination for BPPV was then carried out, assigning the outcome of the questionnaire and eventual MMS to the final diagnosis for each patient. RESULTS: The sensitivity and specificity of the questionnaire for high scores (>8) were found to be, respectively, 86 % and 80 % in all patients, 94 and 71 % in those under 65 years of age, 78 and 90 % in patients over 65, and, in particular, 63 and 83 % in those with MMS >24 and 100 and 100 % in those with MMS ≤24. DISCUSSION: The reliability and average score of the questionnaire were statistically significantly lower in the group of elderly patients without cognitive deficits. The lower reliability of the questionnaire in the geriatric population, rather than the presence of cognitive deterioration, seems to correlate with other comorbidities or simply to a lower mobility of the head triggering positional symptoms. CONCLUSION: The use of the questionnaire could however reduce the risk of a missed diagnosis of BPPV given its good reliability across all ages.

The effects of abnormality of cVEMP and oVEMP on rehabilitation outcomes in patients with idiopathic benign paroxysmal positional vertigo.

The presence of utricular and saccular dysfunction impairs quality of life (QoL) in patients. The aims of the present study were to examine the effect of repositioning maneuvers on QoL of patients with idiopathic benign paroxysmal positional vertigo (BPPV) and to describe the effect of cervical vestibular-evoked myogenic potential (cVEMP) or ocular VEMP (oVEMP) abnormalities on patient recovery after rehabilitation. Thirty idiopathic BPPV patients with/without otolith dysfunctions (n = 15, each group) were included in this clinical trial study. Otolith dysfunction was determined using oVEMP and cVEMP abnormalities. EcochG and caloric tests were performed to rule out other causes of secondary BPPV. The QoL in groups of patients with idiopathic BPPV was assessed using a Persian version of the dizziness handicap inventory (DHI-P) before and after treatment with Epley's maneuver. Pre-treatment results showed significant handicaps in both groups. DHI-P scores were higher in BPPV patients with otolith dysfunction (total, functional, emotional, physical score: 34.13, 11.20, 7.06, 15.86, respectively) than those in patients without otolith dysfunction (total, functional, emotional, physical score: 25.46, 7.86, 6.13, 11.46, respectively, P < 0.05). After treatment, DHI-P scores decreased in both groups. However, in the otolith dysfunction group, DHI-P scores (total, functional, emotional, physical score: 9.20, 3.33, 1.33, 4.53, respectively) were higher than those in patients without otolith dysfunction (total, functional, emotional, physical score: 4.13, 0.93, 1.06, 2.00, respectively). In BPPV patients with cVEMP or oVEMP abnormalities, QoL is more compromised in comparison with that in BPPV patients without these dysfunctions. Otolith dysfunction enhances the negative effects of BPPV on QoL.

Effectiveness of the Parnes particle repositioning manoeuvre for posterior canal benign paroxysmal positional vertigo.

BACKGROUND: Benign paroxysmal positional vertigo is a common vestibular disorder that negatively affects an individual's health-related quality of life. This study aimed to examine the effectiveness of the Parnes particle repositioning manoeuvre as an intervention for individuals with posterior canal benign paroxysmal positional vertigo. METHODS: The de-identified records of 155 individuals treated with the Parnes manoeuvre were examined. Descriptive statistics were calculated, including the frequency and valid per cent of participants whose nystagmus was resolved with the Parnes manoeuvre. RESULTS: In all, nystagmus was resolved with the Parnes manoeuvre in 145 participants (93.5 per cent). The mean number of manoeuvres needed to resolve the nystagmus was 1.3. CONCLUSION: The Parnes manoeuvre proved to be as effective as the Epley canalith repositioning manoeuvre, currently the most common intervention, in treating individuals with posterior canal benign paroxysmal positional vertigo.

[Analysis of clinical features with benign paroxysmal positional vertigo in elderly patients and precautions for canalith repositioning procedure treatment].

OBJECTIVE: To analyze clinical features with benign paroxysmal positional vertigo (BPPV) and discuss the attentions in the canalith repositioning procedures. METHOD: A total of 76 male and female patients aged 80 and over with BPPV (elderly group) and 76 patients aged 60-65 years old with BPPV (older group) was retrospectively analyzed. RESULT: (1)Semicircular canal condition: in elderly group, posterior semicircular canal was involved in 72 cases, whereas the horizontal semicircular 4 cases. In older group, posterior semicircular canal was involved in 70 cases, whereas the horizontal semicircular and multiple canals in 5 cases and 1 case respectively. (2) Precipitating factors: precipitating factors of elderly were variety. Its closely related with emotion, infection, seasonal alternation surgery, and trauma. There were significant differences between the two groups (P<0. 05). (3) The symptoms of undergoing treatment and post-treatment: the duration of dizziness and carebaria were significant difference after canalith repositioning procedure treatment between two groups (P<0. 05), the duration of balance disturbance and symptoms of vegetative nerve functional disturbance like nausea and sweating were significant difference (P<0. 05). (4) Treatment and outcomes: the remission, partial remission rate were 34. 2 %, 81. 6% re- spectively, after the first or second time of repositioning treatment. The efficacy of repositioning treating at the first time was significantly different between two groups (P<0. 05). It was poor efficacy in elderly group. There is no difference in efficacy for repositioning treatment at the second or third time (P>0. 05). (5) The elderly always accompanied with other medical condition and had risk factors of cerebrovascular disease. The efficacy was not associated with the complication(P>0.05). However, it was most likely to overtreatment caused by emphasizing other medical conditions treatment. BPPV was easy to ignore and misdiagnose, meanwhile, delayed the diagnosis and increased the medical costs. (6) Many elderly were accompanied cervical spondylosis, lumbar spondylosis body stiffness and fear of vertigo which increased the difficulty of repositioning treatment. (7) Recurrence: we followed up 2 years after treatment. In older group, 11 patients (14. 5%)were relapsed. In elderly group, 29 patients (38. 2%) relapsed. There were significant differences between the two groups (P<0. 05). CONCLUSION: There are various precipitating factors in elderly patients with BPPV, the most frequent precipitating factors were related to psychological factor and overfatigue. The symptoms of the patients attack BPPV was always mask with other diseases, but do not impact on the efficacy of Canalith repositioning at the first time; Even the efficacy of repositioning is poor at the first time, it's effective and safety after multiple treatments of repositioning; It prolonged the symptoms including carenaria, dizziness and nausea after treatment.

Anxiety and depression among patients with different types of vestibular peripheral vertigo.

Numerous studies have been published on comorbid anxiety and depression in patients with vertigo. However, very few studies have separately described and analyzed anxiety or depression in patients with different types of vestibular peripheral vertigo. The present study investigated anxiety and depression among patients with 4 different types of peripheral vertigo. A total of 129 patients with 4 types of peripheral vertigo, namely, benign paroxysmal positional vertigo (BPPV, n = 49), migrainous vertigo (MV, n = 37), Menière disease (MD, n = 28), and vestibular neuritis (VN, n = 15), were included in the present study. Otological and neurootological examinations were carefully performed, and self-rating anxiety scale and self-rating depression scale were used to evaluate anxiety and depression. Patients were divided into 2 groups, according to the vestibular function: normal and abnormal vestibular function. There was no significant difference in the risk of anxiety/depression between these 2 groups. However, for patients with the 4 different vertigo types, the prevalence of anxiety (MV = 45.9%, MD = 50%) and depression (MV = 27%, MD = 28.6%) was significantly higher in the patients with MV or MD than those with BPPV or VN (P < 0.05). Vestibular function is not significantly associated with the risk of anxiety/depression. Anxiety/depression is more common in patients with MV or MD than those with BPPV or VN. This may be due to the different mechanisms involved in these 4 types of vertigo, as well as differences in the prevention and self-control of the patients against the vertigo.

Fatigue during an episode of benign paroxysmal positional vertigo.

Fatigue is characterized by weariness unrelated to exertion levels. It has been reported in chronic neurological diseases such as multiple sclerosis, Parkinson disease and stroke. Patients with benign paroxysmal positional vertigo (BPPV) often complain about fatigue during a vertigo attack. No attention has been paid to this symptom in the literature so far. We were interested to evaluate the frequency and factors influencing fatigue in BPPV. Patients treated for idiopathic BPPV during the years 2011-2012 were prospectively evaluated for the presence of fatigue. During the first visit, patients were asked to complete two questionnaires based on their experience during the last week: the Fatigue severity scale and the Hospital anxiety and depression scale. Patients' demographic data and BPPV characteristics were registered. Among 172 patients treated for BPPV, 40 (23.2 %) reported fatigue. The mean fatigue score was 4.73 ± 1.98 indicating moderate fatigue. No correlation was found between fatigue and anxiety or fatigue and depression. Fatigue scores were inversely related to age (r = -0.36, p = 0.020) and were not dependent on the type of BPPV, its recurrence, background diseases, gender, duration of vertigo or the presence of autonomic symptoms. Moderate fatigue is quite common during an attack of BPPV. It seems to be a genuine symptom of the entity that might worsen patients' distress. For severe or persistent fatigue treatment with fatigue relieving drugs such as amantadine, methylphenidate or modafinil could be tried in the future.

Prevalence of unrecognized benign paroxysmal positional vertigo in older patients.

Dizziness is a relatively common complaint which occurs more often with increasing age. Benign paroxysmal positional vertigo (BPPV) is an important cause which can easily be treated but is frequently not recognized by professionals. The aim of this study was to assess the prevalence of unrecognized BPPV in older patients. Patients ≥70 years of age (n = 989) indicated whether they experienced dizziness, and if so whether the symptoms were typical for BPPV. If affirmed, a diagnostic maneuver was performed. Positive patients were treated at once. All suspected patients completed quality of life questionnaires and were followed for 3 and 6 months. Positive BPPV patients were compared with negative (but suspected) patients. Almost one quarter of the patients (226 patients, 23 %) suffered from dizziness, among whom 101 were suspected of BPPV. Less than half (n = 45) underwent the diagnostic maneuver, of whom 13 (29 %) were positive for BPPV. At follow-up, one patient developed BPPV, leading to a total of 14 positive patients (overall prevalence 1.4 %). BPPV positive patients did not differ from BPPV negative patients. Among a large group of older patients, one quarter experiences dizziness, and 1.4 % has definite BPPV.