Do single-session Epley maneuvers treat benign paroxysmal positional vertigo?

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular condition characterized by short-term vertigo attacks that significantly affect quality of life. OBJECTIVES: Examine how well a single Epley maneuver worked in an outpatient setting for people with posterior canal benign paroxysmal positional vertigo (PC-BPPV) and whether they needed a second Dix-Hallpike maneuver. DESIGN: Prospective. SETTINGS: Otorhinolaryngology department of a tertiary care center. PATIENTS AND METHODS: Sociodemographic data, body mass index (BMI), and systemic disease history of 75 patients diagnosed with PC-BPPV were recorded, and their relationship with success rates after the modified Epley maneuver was analyzed. MAIN OUTCOME MEASURES: Detect cases that could not be repositioned with the diagnostic control Dix-Hallpike test performed 20 minutes after the modified Epley reposition maneuver in the same session in PC-BPPV patients. SAMPLE SIZE: 75. RESULTS: Of the 75 patients, 31 were male (41.3%), 44 female (58.6%) with a mean (standard deviation) age of 58.6 (15.9) years age, 54.6% had one or more chronic diseases. BMI was 30 mg/kg2 and above in 31 patients (41.3%). The modified Epley maneuver was successful in 77.3%. No significant relationship was found between additional diseases or BMI in the patient group in whom the maneuver was unsuccessful. CONCLUSION: The success rates of repositioning maneuvers in treating patients diagnosed with PC-BPPV are high. However, more than a single maneuver is required in some resistant patients. Second diagnostic and repositioning maneuvers performed in the same session will reduce multiple hospital admissions. While it is helpful to repeat the maneuver in the patient group where it was unsuccessful, other factors causing the failure should be investigated. LIMITATIONS: Lack of follow-up results of patients after 7-10 days.

Different clinical course of BPPV according to the medical conditions.

Dizziness is one of the most prevalent complaints in medicine, and benign paroxysmal positional vertigo (BPPV) accounts for one-third of all cases. The present study was aimed at identifying differences in the course and prognosis of BPPV depending on the patient's medical condition during hospitalization. Patients in group 1 were hospitalized due to trauma, those in group 2 for scheduled surgery, and those in group 3 for medical treatment. The intervals from admission to symptom onset, surgery to symptom onset, and symptom onset to ENT department referral were compared. The interval from admission to symptom onset was shortest in group 1 (3.1 ± 8.0 days) and differed significantly from that in group 3 (20.0 ± 35.0 days, p < 0.001). The interval from surgery to symptom onset for group 2 was 5.6 ± 5.8 days and was significantly shorter than that from admission to symptom onset for group 3 (p = 0.014). The interval from symptom onset to ENT referral in group 3 (2.0 ± 2.8 days) was significantly shorter than in groups 1 and 2 (4.1 ± 5.1 and 4.0 ± 3.6 days, p = 0.008 and p = 0.002, respectively). The findings imply that the course of BPPV differed according to the patients' medical condition.

Management of recurrent benign paroxysmal positional vertigo.

BACKGROUND: Benign paroxysmal positional vertigo is the most common episodic vestibular disorder, although it is often quiescent by the time patients visit a specialist clinic, making the diagnosis difficult to confirm. Patients fear the consequences of a relapse and it is not clear what follow up should be provided. OBJECTIVE: This evaluation reviewed the results of an open access pathway that offered priority appointments to patients with a history of positional vertigo. RESULTS AND CONCLUSION: In total, 664 patients were included in the analysis, 52 per cent of whom had unconfirmed benign paroxysmal positional vertigo. Open follow up improved diagnostic rates by approximately 40 per cent. The rate of benign paroxysmal positional vertigo recurrence was 34 per cent in patients with follow up of at least one year, 41 per cent with follow up of one to two years, and 53 per cent with follow up of two years or more. One in five recurrences occurred in a different semi-circular canal. These results suggest that specialist follow up is required for management of recurrent benign paroxysmal positional vertigo.

Pilot study to evaluate a training programme for primary care physiotherapists in the assessment and management of benign paroxysmal positional vertigo.

OBJECTIVE: This pilot study aimed to evaluate a training programme for primary care physiotherapists focused on the assessment and management of benign paroxysmal positional vertigo. METHODS: A six-month training programme and toolkit utilising the revised Standards for Quality Improvement Reporting Excellence ('SQUIRE 2.0') guidelines was developed to facilitate the learning of new knowledge and skills in the assessment and management of benign paroxysmal positional vertigo following Gagne's model of instructional design. A pre- and post-training knowledge and confidence questionnaire evaluated the impact of the training programme. RESULTS: Eleven participants started the training programme and five completed it. On average, knowledge increased by 54 per cent (range, 41-95 per cent) and confidence increased by 45 per cent (range, 31-76 per cent). A 73 per cent improvement in practical skills acquisition was demonstrated after the initial training session. CONCLUSION: A structured approach to learning demonstrates improvements in knowledge, skills and confidence of physiotherapists in the evidence-based management of benign paroxysmal positional vertigo.

Effect of the early diastolic blood pressure response to the head-up tilt test on the recurrence of benign paroxysmal positional vertigo.

BACKGROUND: Otolith organ acts complementarily with the autonomic nervous system to maintain blood pressure. However, the effect of blood pressure variability in the autonomic nervous system on otolith organ has not yet been determined. This study aimed to verify the hypothesis that blood pressure variability in the autonomic nervous system affects the recurrence of benign paroxysmal positional vertigo (BPPV), which is the most common disease of the vestibular organs, by using the head-up tilt test (HUTT). METHODS: This study included 432 patients diagnosed with idiopathic BPPV. The follow-up period for all patients was 12 months. Age, sex, hypertension, diabetes and recurrence were analyzed. The HUTT parameters were divided into a group of patients whose average diastolic blood pressure increased in the upright position compared to supine position during the HUTT (DBP1) and a group of patients whose average diastolic blood pressure decreased in the upright position compared to supine position during the HUTT (DBP2). Model selection, general loglinear analysis, and logit loglinear analysis were performed using a hierarchically progressing loglinear analysis. RESULTS: In summary, the group with increased average diastolic blood pressure (DBP1) showed a higher tendency for BPPV recurrence compared to the group with decreased diastolic blood pressure (DBP2) in the upright position during the HUTT, although the difference was not statistically significant (p = 0.080). However, in males, the DBP1 group demonstrated a significantly higher recurrence rate of BPPV than the DBP2 group during the HUTT (95% CI, -20.021 to -16.200; p < 0.001). CONCLUSIONS: It is presumed that poor autonomic nervous system response through vestibulosympathetic reflex maintains elevated diastolic blood pressure in the upright position during the HUTT. This variability is assumed to affect the recurrence of BPPV.

Assessing the impact of migraine on benign paroxysmal positional vertigo symptoms and recovery.

BACKGROUND: During episodes of benign paroxysmal positional vertigo (BPPV), individuals with migraine, compared with individuals without migraine, may experience more severe vestibular symptoms because of their hyperexcitable brain structures, more adverse effects on quality of life, and worse recovery processes from BPPV. METHODS: All patients with BPPV were assigned to the migraine group (MG, n = 64) and without migraine group (BPPV w/o MG, n = 64) and completed the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), VDI Health-Related Quality of Life Scale (VDI-HRQoLS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) at the time of BPPV diagnosis (baseline) and on the one-month follow-up. Headache Impact Test-6 and Migraine Disability Assessment Scale were used for an assessment of headache. Motion sickness was evaluated based on the statement of each patient as present or absent. RESULTS: Compared with the BPPV w/o MG, the MG had higher VSS scores at baseline [19.5 (10.7) vs. 11.3 (8.5); p < 0.001] and on one-month follow-up [10.9 (9.3) vs. 2.2 (2.7), p < 0.001]; experienced more severe dizziness and imbalance symptoms based on the VDI-SS at baseline (61.9% vs. 77.3%; p < 0.001) and after one month (78.9% vs. 93.7%, p < 0.001); and more significantly impaired quality of life according to the VDI-HRQoLS at baseline (77.4% vs. 91.8%, p < 0.001) and after one month (86.3% vs. 97.6%, p < 0.001). On the one-month follow-up, the subgroups of patients with moderate and severe scores of the BAI were higher in the MG (39.2%, n = 24) than in the BPPV w/o MG (21.8%, n = 14) and the number of patients who had normal scores of the BDI was lower in the MG than in the BPPV w/o MG (67.1% vs. 87.5%, p = 0.038). CONCLUSION: Clinicians are advised to inquire about migraine when evaluating patients with BPPV because it may lead to more intricate and severe clinical presentation. Further studies will be elaborated the genuine nature of the causal relationship between migraine and BPPV.

Otolithic functions in patients with residual dizziness after successful repositioning manoeuvres for unilateral posterior canal BPPV.

OBJECTIVE: To evaluate otolithic functions in patients with residual dizziness after successful canalith repositioning procedures (CRPs) for unilateral posterior canal benign paroxysmal positional vertigo (BPPV), and to investigate possible risk factors. METHODS: This case-control observational study included healthy controls and patients with residual dizziness after improvement following CRP for BPPV. All participants were subjected to full history taking, otoscopy, audiological basic evaluation, Dix-Hallpike test to search for posterior canal BPPV, residual dizziness screening, and vestibular evoked myogenic potential (VEMP) testing. Between-group differences were assessed and possible factors associated with residual dizziness were identified by univariate analysis. RESULTS: A total of 50 patients with residual dizziness (mean age, 56.53 ± 7.46 years [29 female: 21 male]) and 50 healthy controls (mean age, 58.13 ± 7.57 years [20 female: 30 male]) were included. A significant difference in VEMP latencies was found between the patient and control group (delayed in the patient group), with no significant between-group difference in amplitude in both ears. Aging, female sex, long duration of BPPV, number of CRPs, cervical VEMP and ocular VEMP abnormalities, and winter onset, were significantly associated with the risk of residual dizziness. CONCLUSIONS: Residual dizziness is a frequent sequel of BPPV that may relate to otolithic dysfunction. VEMP changes were revealed in the form of delayed latencies.

Benign Paroxysmal Positional Vertigo After Use of Handheld Massage Gun.

This report describes 2 cases of benign paroxysmal positional vertigo symptoms in middle-aged patients who experienced onset after using a handheld massage gun.

[Analysis of inducement of benign paroxysmal positional vertigo].

Objective:To analyze the related factors that may affect the onset of benign paroxysmal positional vertigo（BPPV）. Methods:Fifty BPPV patients treated in Department of Otolaryngology Head and Neck Surgery, Shanxi Provincial People's Hospital from May to September 2023 were selected as the case group, and 50 healthy adults were selected as the control group. Relevant information was collected by means of questionnaire survey and medical history inquiry. The two groups were compared in terms of sleep time, night sleep duration, wake times, underlying diseases（hypertension, diabetes, coronary heart disease, etc.） and negative emotional impact. Results:The proportion of male and female in the case group was 16% and 84%, and that in the control group was 20% and 80%. The mean age of the case group was（54.66±13.39） years old, and the mean age of the control group was（54.42±12.55） years old, ranging from 27 to 80 years old. The sleeping time of the case group was significantly later than that of the healthy group, and the difference was statistically significant（P<0.05）. The night sleep duration of the case group was shorter than that of the healthy group, the difference was statistically significant（P<0.05）. There was no significant difference in awakening times between the case group and the healthy group（P>0.05）. There were more patients in the case group with underlying diseases（54%） and affected by negative emotions（70%） than in the healthy group, and the difference was statistically significant（P<0.05）. Conclusion:Late sleep time, short sleep duration at night, accompanied by underlying diseases and negative emotions can affect the onset of BPPV.

[Comparison of efficacy between personalized vestibular rehabilitation and otolith reposition for the treatment of atypical benign paroxysmal positional vertigo].

Objective: To compare the clinical efficacy of personalized vestibular rehabilitation and otolith reposition in treating atypical benign paroxysmal positional vertigo (BPPV). Methods: A randomized controlled trial was carried out. Fifty patients diagnosed with atypical BPPV in the Vertigo Clinic of the First Affiliated Hospital of Shandong First Medical University from October 2022 to September 2023 were recruited and randomly divided into manual reduction group (25 cases) and vestibular rehabilitation group (25 cases) according to the random number table. All patients were given flunarizine. Patients in the manual reduction group were treated by Epley maneuver and (or) Barbecue maneuver, while the vestibular rehabilitation group was given personalized vestibular rehabilitation therapy. After two weeks' treatment, the clinical symptoms (positional vertigo/nystagmus) and total dizziness handicap inventory (DHI) score, DHI physical (DHI-P), DHI emotional (DHI-E), and DHI functional (DHI-F) of the two groups were evaluated and compared. Results: A total of 50 patients diagnosed with atypical BPPV were included, including 23 males and 27 females, with an average age of (48.8±14.5) years. There was no statistically significant difference between the two groups in age, gender, disease severity, Romberg, position test abnormality ratio (Dix-hallpike/Roll test), temperature test, and video head impulse test baseline test results (all P>0.05). After 2 weeks of treatment, the effective rates of the treatment in the manual reduction and vestibular rehabilitation groups were 56.0% (14/25) and 88.0% (22/25), respectively, with a statistically significant difference (P=0.025). The total DHI score, DHI-P, DHI-E, and DHI-F scores in both groups were significantly decreased after treatment (all P<0.001). Compared with the manual reduction group, the total DHI score (23.2±2.7 vs 36.4±15.7, P=0.002), DHI-P (10.2±4.6 vs 13.7±5.3, P=0.016) and DHI-F (6.5±6.4 vs 13.0±7.2, P=0.002) in the vestibular group were lower, however, there was no significant difference in DHI-E score between the two groups (6.6±4.8 vs 9.6±7.3, P=0.087). Conclusion: Compared with otolith reposition, personalized vestibular rehabilitation therapy plays a better role in improving the symptoms and decreasing DHI score for patients with atypical BPPV.

The importance of Epley maneuver in posterior canal benign paroxysmal positional vertigo.

OBJECTIVE: We investigated symptom scores and quality of life in unilateral posterior canal benign paroxysmal positional vertigo (BPPV) patients. PATIENTS AND METHODS: In this retrospective and multicentric study, 78 patients with unilateral posterior canal BPPV (47 right-sided and 31 left-sided) were included. All patients have performed the Standard Epley maneuver. Features of the nystagmus [nystagmus duration (second), latent period (second)] and features of the disease [side (right or left-sided), disease duration (years), and recurrence of disease (present or absent)] were noted. Before and 1 week after the Epley maneuver, all patients were evaluated using the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), and Vertigo Dizziness Imbalance health-related quality of life scale (VDI-HQoL). RESULTS: Our results showed that VSSs of the right-sided group were significantly higher than those in the left-sided group before and 1 week after the maneuver (p<0.05). One week after the maneuver, VDI-HQoLs of the left-sided group were significantly higher than those in the right-sided group (p<0.05). In all right-sided and left-sided groups, at 1 week after the maneuver, VSSs were significantly lower, and VDI-SSs and VDI-HQoLs were significantly higher than those before the maneuver (p<0.05). As VSS values increased, VDI-SS and VDI-HQoL values decreased (p<0.05). In the left-sided group, VSS values decreased, and VDI-HQoL values increased. As disease duration increased, VSS values increased before the maneuver (p<0.05). In females, VSS values increased, and VDI-SS and VDI-HQoL values decreased before the maneuver (p<0.05). CONCLUSIONS: In posterior canal BPPV, the Epley maneuver effectively decreased VSS values and increased VDI-SS and VDI-HQoL values. In the left-sided BPPV group, there were lower VSS values and higher VDI-HQoL values that showed better quality of life of the patients. Older age and female gender are other factors related to lower quality of life with higher symptom scores.

[Discussion and analysis the value of supine median³ nystagmus in the diagnosis and treatment of HC-BPPV].

Objective:To explore the clinical value of supine median³ nystagmus in the accurate diagnosis of horizontal semicircular canal benign paroxysmal positional vertigo（HC-BPPV）. Methods:A total of 187 patients with HC-BPPV admitted to the First Affiliated Hospital of Xi'an Jiaotong University from June 2020 to March 2021 were selected. Among them 42 cases of Cupulolithiasis and 145 cases of Canalithiasis. The nystagmus parameters of patients left and right supine position and supine median³ position were recorded in detail by RART. According to the direction of supine median³ nystagmus, patients were divided into three groups: group A（nystagmus to weak side）, group B（nystagmus to strong side）, group C（negative nystagmus）. The canalith repositioning manoeuvres（CRM） was carried out by utility of an automatic vestibular function diagnosis and therapy system（SRM-IV）. The cure rate of CRM in three groups of HC-BPPV patients was compared, Multivariate logistic regression analysis was performed to analyze the influencing factors of CRM for HC-BPPV. Results:The cure rates of group A, group B and group C were 81.58%, 16.13% and 56.25%, respectively. The difference among the three groups was statistically significant. Then a pairwise comparison of group A, B and C, the difference was statistically significant（χ²A-B=40.294,P<0.001,χ²B-C=14.528, P<0.001,χ²A-C=11.606, P=0.001）; the results of multivariate logistic regression analysis showed that the direction of supine median³ nystagmus and BMI were the influencing factors of CRM for HC-BPPV. Conclusion:The direction, intensity and duration of supine median³ nystagmus play an important role in determining the responsibility semicircular canal of HC-BPPV.

Procedural skills workshops for primary care physicians in Israel: a comprehensive analysis.

BACKGROUND: Some of the most common complaints addressed by primary care physicians (PCPs) require manual procedures, such as lacerations repair, abscesses drainage, ingrown toenails removal, dry needling for myofascial pain syndrome, and Epley maneuver for treating benign paroxysmal positional vertigo (BPPV). The aim of this study was to describe the procedural skills workshops program for PCPs implemented in Maccabi Healthcare Services and to investigate how many PCPs have participated and used the skills since the program's inception in 2017. METHODS: In this observational study, we followed all participants in courses from 2017 to 2021. We extracted all procedures performed during these years by PCPs who learned the skill in MHS. RESULTS: During the study period, 620 PCPs participated in workshops for dry needling, soft-tissue and joint injections, BPPV treatment, minor surgical procedures, and spirometry. Most procedures performed were dry needling (average annual number 3,537) and minor surgical procedures (average annual number 361). The average annual use per physician was highest for dry needling (annual average use per physician who used the learned skill was 50.9), followed by soft tissue and joint injections (16.8), minor surgical procedures (14.8), and BPPV treatment (7.5). CONCLUSION: procedural skills workshops may expand PCPs' therapeutic arsenal, thus empowering PCPs and providing more comprehensive care for patients. Some manual skills, such as dry needling, soft tissue injections, and the Epley maneuver, were more likely to be used by participants than other skills, such as spirometry and soft tissue injections.

Association between vitamin D deficiency and benign paroxysmal positional vertigo (BPPV) incidence and recurrence: a systematic review and meta-analysis.

OBJECTIVES: The objective of this study is to determine the relationship between serum vitamin D level and the risk of developing benign paroxysmal positional vertigo (BPPV) incidence and recurrence in countries in the Northern Hemisphere. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Scopus and Web of Science databases were searched for studies published between January 2000 and February 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Participants located in the Northern Hemisphere aged 18 or over with at least one episode of BPPV, serum 25-hydroxyvitamin D levels measured and reported, no comorbidities or history of vitamin D supplementation. DATA EXTRACTION AND SYNTHESIS: Data extraction and synthesis were performed by a single reviewer and checked by a second reviewer. Inclusion and exclusion criteria and risk of bias were assessed by two independent reviewers using the Newcastle Ottawa Tool for Cohort studies and Risk of Bias Assessment Tool for Nonrandomised Studies checklist for case-control studies. Meta-analysis was conducted using random effects models. Standard mean difference with a 95% CI was used to measure the relationship between vitamin D level and BPPV. RESULTS: The 35 articles identified by the literature search reported data of 9843 individuals. 19 studies (7387 individuals) were included in the BPPV incidence meta-analysis while 7 studies (622 individuals) were included in the BPPV recurrence meta-analysis. Lower serum vitamin D levels were found in BPPV incidence compared with controls, but the relationship between vitamin D levels in recurrent BPPV compared with non-recurrent disease remained uncertain. CONCLUSION: Results of this systematic review and meta-analysis demonstrated a negative correlation between serum vitamin D and BPPV incidence, while any relationship between serum vitamin D and BPPV recurrence remained uncertain. Risk of bias analysis revealed evidence of variable quality. There were insufficient data available to evaluate seasonal relationships between serum vitamin D and BPPV. Given the potential for this as a confounding factor, future research should aim to investigate this further. PROSPERO REGISTRATION NUMBER: CRD42021271840.

Prospective diagnostic accuracy study of history taking and physical examination for adults with vertigo in general practice: study protocol.

INTRODUCTION: Vertigo is a prevalent and burdensome symptom. More than 80% of patients with vertigo are primarily treated by their general practitioner (GP) and are never referred to a medical specialist. Despite this therapeutic responsibility, the GP's diagnostic toolkit has serious limitations. All recommended tests lack empirical evidence, because a diagnostic accuracy study on vestibular disorders ('How well does test x discriminate between patients with or without target condition y?') has never been performed in general practice. The VERtigo DIagnosis study aims to fill this gap. METHODS AND ANALYSIS: We will perform a diagnostic accuracy study on vertigo of primary vestibular origin in general practice to assess the discriminative ability of history taking and physical examination. We will compare all index tests with a respective reference standard. We will focus on five target conditions that account for more than 95% of vertigo diagnoses in general practice: (1) benign paroxysmal positional vertigo, (2) vestibular neuritis, (3) Ménière's disease, (4) vestibular migraine (VM) and (5) central causes other than VM. As these five target conditions have a different pathophysiology and lack one generally accepted gold standard, we will use consensus diagnosis as a construct reference standard. Data for each patient, including history, physical examination and additional tests as recommended by experts in an international Delphi procedure, will be recorded on a standardised form and independently reviewed by a neurologist and otorhinolaryngologist. For each patient, the reviewers have to decide about the presence/absence of each target condition. We will calculate sensitivity, specificity, predictive values, likelihood ratios and diagnostic ORs, followed by decision rules for each target condition. ETHICS AND DISSEMINATION: The study obtained approval from the Vrije Universiteit Medical Center Medical Ethical Review Committee (reference: 2022.0817-NL83111.029.22). We will publish our findings in peer-reviewed international journals. TRIAL REGISTRATION NUMBER: ISRCTN97250704.

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.

Individualized repositioning with a mechanical rotational chair facilitates successful treatment of patients with very retractable benign paroxysmal positional vertigo.

BACKGROUND: About 12.5 % of patients diagnosed with benign paroxysmal positional vertigo (BPPV), experience persistent BPPV where it is unknown why some BPPV cases are very refractory (vrBPPV) to treatment. OBJECTIVES: The primary objective was to investigate if patients with vrBPPV could be successfully treated with a mechanical rotation chair (MRC) adjusted to the exact vertical semicircular canal (SCC) angles of the individual patient. Secondary endpoint was to determine if inner ear anomalies were predominant in these patients. METHODS: This prospective clinical trial included 20 patients (main group) who underwent computed tomography (CT) with measurements of the bony island and the width between the SCC walls of the posterior leg of the lateral SCCs. The inter-SCC angles, the angles between the sagittal plane and the vertical SCCs were compared to the presumed mean standard angles of the SCCs. Of these, 14 patients (subgroup) underwent individualized treatment with the Rotundum® repositioning chair according to their measured SCC angles. RESULTS: All measured SCC angles differed significantly (p < 0.05) from the presumed mean standard SCC angles, except the angle between the sagittal plane and the left posterior SCC (p-SCC). Three out of 14 patients experienced subjective and objective remission after treatment with this MRC. Six out of 14 patients experienced either subjective remission or objective remission. CONCLUSIONS: Patients with vrBPPV have vertical SCC angles that differ significantly from the presumed mean standard SCC angles. Individualized treatment with this MRC successfully treated 21.4 % of the patients with vrBPPV and provided subjective relief for 42.9 %.

A new roll test to diagnose posterior semicircular canal benign paroxysmal positional vertigo.

BACKGROUND: The Dix-Hallpike (DH) test is a gold standard for diagnosing benign paroxysmal positional vertigo (BPPV). However, lateral semicircular canal BPPV is not rare. We have been performing the new roll test that begins from the sitting position and contains a head-hanging position, in order not to overlook lateral canal BPPV. We noticed that transient vertical/torsional nystagmus sometimes occurs during the new roll test. OBJECTIVE: To clarify the value of the new roll test in diagnosing posterior canal BPPV and elucidate the position that elicits nystagmus. MATERIALS AND METHODS: The subjects were 100 consecutive patients (79 were female, 21 were male) with posterior canal BPPV. We classified the patients into four types based on a position that induced nystagmus. RESULTS: The patient's position that elicited nystagmus varied. The supine type accounted for 24 %, the lateral type accounted for 62 %, the head-hanging type accounted for 9 %, and the DH type accounted for 5 %. CONCLUSION: The new roll test is valuable for diagnosing posterior canalolithiasis cases. Most patients reveal vertical/torsional nystagmus in the supine or lateral position. Therefore, performing the new roll test first is efficient at the initial visit.

Vitamin D Supplementation and Recurrence of Benign Paroxysmal Positional Vertigo.

Positional vertigo manifests as a spinning sensation triggered by changes in head position relative to gravity. Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder characterized by recurrent episodes of positional vertigo. The connection between vitamin D insufficiency/deficiency and the onset and recurrence of BPPV is established. This study aims to assess vitamin D as a recurring factor in BPPV and the efficacy of vitamin D supplementation in preventing its recurrence. A comprehensive literature review on the relationship between vitamin D and BPPV recurrence was conducted, searching PubMed, Embase, Web of Science, and article reference lists for studies published from 2020 to 2023. A total of 79 articles were initially identified through the search, with 12 of them being utilized in the study. Recurrence rates for BPPV varied from 13.7% to 23% for studies with follow-up less than 1 year and 13.3% to 65% for studies with follow-up equal to or exceeding 2 years. Risk factors for BPPV recurrence include advanced age, female sex, hypertension, diabetes mellitus, hyperlipidemia, osteoporosis, and vitamin D deficiency. While earlier studies did not establish a link between low vitamin D levels and initial BPPV occurrence, they did associate recurrent episodes with low vitamin D levels. Recent research indicates that vitamin D supplementation in BPPV patients with deficiency or insufficiency decreases both the numbers of relapsing patients and relapses per patient. To validate these findings across diverse populations, further randomized controlled studies with larger cohorts and extended follow-up durations are essential.