Onset and resolution failure of recurrent benign paroxysmal positional vertigo: the role of cervical range of motion.

PURPOSE: To explore possible associations between cervical spine mobility, measured by cervical range of motion (CROM) and a possible earlier onset of recurrent benign paroxysmal positional vertigo (BPPV), as well as an increased failure rate of canalith repositioning procedures. METHODS: Medical records of 749 patients (247, 253 and 249 patients with a CROM ≤ 45°, between 45.1° and 55° and > 55.1°, respectively) with a first-time diagnosis of non-traumatic BPPV were included in this retrospective study. Age, gender, canal involvement and CROM values were treated as prospective prognostic factors for time of BPPV recurrence onset (RO) and number of manoeuvres needed to achieve resolution (resolution rate, RR). A multiple regression analysis was performed. RESULTS: A significant increase in the incidence of recurrent BPPV was found in patients with reduced CROM (139 [56.27%;], 102 [40.31%] and 87 [34.93%], respectively, belonging to ≤ 45°, 45.1°-55° and > 55.1° subgroups; X2 = 9.42, p = 0.008). A strong association between age, CROM and recurrent BPPV RO and RR was demonstrated, respectively (multiple correlation coefficients = 0.492678 and 0.593493, respectively, p value < 10-4). Canal involvement was in line with the previous experiences. CONCLUSION: The results from this retrospective analysis unveiled the previously unexplored relation between reduction in cervical spine mobility and BPPV recurrence and treatment failure. The data from this study do not indicate the mechanisms by which this comorbidity might directly cause recurrent BPPV. However, they may suggest CROM to be evaluated, in association with other known risk factors for increased susceptibility to BPPV recurrence.

Temporomandibular disorders and cervicogenic dizziness: Relations between cervical range of motion and clinical parameters.

OBJECTIVE: To analyze the cervical range of motion (CROM) and clinical parameters in patients affected by myogenous temporomandibular disorders (TMD), cervicogenic dizziness (CGD), both TMD and CGD (TMD/CGD), and a group of healthy subjects (HS). METHODS: CROM degrees, Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia (TSK-17), Hospital Anxiety and Depression Scale (HADS), and Jaw Functional Limitation Scale 20 (JFLS-20) scores were compared between 46 TMD patients, 49 CGD subjects, 43 TMD/CGD patients, and 98 HS. RESULTS: TMD/CGD and CGD patients demonstrated significantly lower CROM degrees and higher DHI, TSK-17, and HADS values when compared to TMD patients. TMD/CGD and TMD patients demonstrated higher JFLS-20 values when compared to CGD and HS. Significant negative correlations were found in TMD/CGD and TMD patients between JFLS-20 and CROM in flexion and extension. DISCUSSION: Present findings demonstrated a relation between spine movement impairment and TMD.

Postural and clinical outcomes of sustained natural apophyseal glides treatment in cervicogenic dizziness patients: A randomised controlled trial.

OBJECTIVE: To evaluate how self-report and posturographic measures could be affected in patients with cervicogenic dizziness undergoing sustained natural apophyseal glides. DESIGN: Randomised controlled single-blind study. SETTING: Tertiary rehabilitation centre. SUBJECTS: Patients affected by cervicogenic dizziness, diagnosed by applying accepted criteria. Forty-one patients (19 male, 22 female: mean age 44.3 ± 14.8 years) receiving treatment, and 39 patients (18 male, 21 female: mean age 43.8 ± 13.9 years) receiving placebo were included in the study. INTERVENTIONS: The treatment group underwent sustained natural apophyseal glides, while the placebo was constituted by a detuned laser. Both groups received their interventions six times over 4 weeks. MAIN MEASURES: Outcomes were tested by means of self-report measures such as perceived dizziness, neck disability, anxiety and depression. Also, cervical range of motion and posturography testing with power spectra frequency were analysed. RESULTS: When compared to placebo, treated patients demonstrated a significant decrease in perceived dizziness (post-treatment total Dizziness Handicap Inventory score 20.5 ± 5.3 as compared to 26.2 ± 6 baseline), neck disability and pain (Neck Disability Index and Neck Pain Index post-treatment scores 12.5 ± 4.3 and 45.6 ± 15.1, respectively, as compared to baseline scores of 15.1 ± 4.8 and 62.5 ± 14.3), as well as significant improvement in cervical range of motion and some posturographic parameters. CONCLUSION: Sustained natural apophyseal glides may represent a useful intervention in reaching short-term beneficial effects in patients with cervicogenic dizziness, with respect to self-perceived symptoms, proprioceptive integration and cervical range of motion improvement.

Changes in body composition in unilateral vestibular hypofunction: relationships between bioelectrical impedance analysis and neuro-otological parameters.

PURPOSE: Experimental works have indicated the potential of the vestibular system to affect body composition to be mediated by its extensive connections to brainstem nuclei involved in regulating metabolism and feeding behavior. The aim of this study was to evaluate-by means of bioelectrical impedance analysis (BIA)-the body composition in a group of chronic UVH normal-weighted patients when compared with an equally balanced group of healthy participants, serving as a control group (CG). METHODS: Forty-six chronic UVH and 60 CG participants underwent otoneurological (including video Head Impulse Test [vHIT] and static posturography testing [SPT]), BIA measurements and self-report (SRM) and performance measures (PM). RESULTS: Beyond significant (p < 0.001) changes in SPT variables (surface and length) and SRM/PM (including Dizziness Handicap Inventory, Dynamic Gait Index and Activity Balance Confidence scales), UVH participants demonstrated significant (p < 0.001) higher values of fat mass and visceral fat and lower values of muscle mass (p = 0.004), when compared to CG. Significant correlations were found in UVH participants between otoneurological and BIA measurements. CONCLUSION: These study findings represent the first clinical in-field attempt at depicting, with the use of BIA parameters, changes in body composition related to chronic UVH. Since such alterations in metabolic parameters could be considered both the consequences and/or the cause of vestibular-related quality of life deficit, BIA parameters could be considered as cheap, easy to use, noninvasive assessments in case of chronic UVH.

Reciprocal roles of joint position error, visual dependency and subjective perception in cervicogenic dizziness.

AIM: Since cervical joint position error (JPE) and visual dependency (VD) may reflect altered ascending inputs from the neck receptors, the aim of the present study was to test how these parameters may be impacted by those clinical parameters in cervicogenic dizziness (CGD) patients when compared with healthy subjects participants. MATERIALS AND METHODS: 93 subjects participants fulfilling inclusion criteria for CGD and 98 age- and gender-matched healthy subjects volunteers - undergoing cervical relocation and rod and disc test to evaluate JPE and VD, respectively - were compared to each other. Cervical range of motion (CROM), Dizziness Handicap Inventory (DHI), Neck Disability Index (NDI), Neck pain intensity (NPI), Tampa Scale for Kinesiophobia (TSK-17) and Hospital Anxiety and Depression Scale (HADS) were also collected in both groups. RESULTS: When compared to healthy participants, CGD patients were found to have a higher degree of JPE in right (p = 0.008, mean difference, MD: 2.88) and left (p = 0.006, MD: 2.55) rotation as well as in extension (p = 0.011, MD: 2.31), flexion (p = 0.009, MD: 2.35) and mean value (p = 0.001, MD: 2.53) and higher degrees of error in CCW at +40° and -40° (p = 0.012, MD: 0.85 and p = 0.016, MD: 0.82, respectively) and CW at +40° and -40° (p = 0.018, MD: 0.83 and p = 0.015 MD: 0.81, respectively). CGD patients also demonstrated a significant reduction in degrees of CROM in active flexion (p = 0.011, MD: -34.63), extension (p = 0.018, MD: -21.67), left (p = 0.012, MD: -28.29) and right (p = 0.009, MD: -28.52) rotation, and left (p = 0.02, MD: -7.29) and right (p = 0.021, MD: -5.05) lateral flexion. Furthermore, these patients demonstrated higher scores in total DHI (p = 0.007, MD: 25.17) (and relative DHI-P, DHI-F, DHI-E; p = 0.009, MD: 11.4; p = 0.014, MD: 8.73 and p = 0.018, MD: 5.03, respectively), in TSK-17 (p = 0.017, MD: 17.56), and HADS, both in anxiety (p = 0.022, MD: 4.62) and depression (p = 0.02, MD: 7.31) subscale. CONCLUSIONS: A possible common physiopathological background may impact on processes involved in both the JPE and VD behaviour, entangled in a vicious circle with the impaired subjective clinical and quality of life perception.