Vértigo posicional paroxístico benigno: factores de riesgo asociados y eficacia de las maniobras de reposición / Benign paroxysmal positional vertigo: associated risk factors and efficacy of particle repositioning maneuvers

INTRODUCCIÓN: El vértigo posicional paroxístico benigno (VPPB) es el vértigo periférico más frecuente. El tratamiento depende del compromiso de los canales semicirculares (CSC) y/o cúpulas, y consiste en maniobras de reposición de partículas. OBJETIVO: Evaluar los factores de riesgo asociados al VPPB en pacientes atendidos en el Servicio de Otorrinolaringología de la Red de Salud UC Christus. Evaluar la tasa de éxito de las maniobras de reposición. MATERIAL Y MÉTODO: Estudio retrospectivo. Se revisaron casos de VPPB con indicación de maniobras de reposición durante los años 2016-2017. Se obtuvo información demográfica, antecedentes médicos, la maniobra realizada y su éxito. Se evaluaron comorbilidades y temporada del año. RESULTADOS: Se incluyeron 195 consultas, realizándose 293 maniobras. La mayoría de los pacientes fueron mujeres (74%) con edad promedio de 63 años. Comorbilidades más frecuentes fueron hipertensión, dislipidemia y diabetes mellitus. El 20% presentó una hipofunción vestibular concomitante, 23% presentó antecedentes de VPPB y 8% compromiso bilateral. Canalolitiasis del CSC posterior fue predominante (90%). En el 77,3% se resuelve el caso con una maniobra. Los casos fueron más frecuentes en primavera y otoño. CONCLUSIONES: El VPPB fue más frecuente en mujeres, con una edad promedio de 63 años. La mayoría presentó canalolitiasis unilateral lográndose resolución con una maniobra de reposición.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. The treatment depends on the semicircular canal (SCC) and/or cupula involved and consists of particle repositioning maneuvers. AIM: Analyze risk factors associated with BPPV for patients seen at the otorhinolaryngology department of the UC Christus health center. Evaluate the success rate of the repositioning maneuvers. MATERIAL AND METHODS: Retrospective study. All cases of BPPV for which a repositioning maneuver was prescribed during the years 2016-2017 were reviewed. Data obtained includes demographics, medical history, maneuver performed, and its success rate. Comorbidities and seasonality were evaluated. RESULTS: 195 cases were included; with 293 maneuvers. The majority were women (74%), and the average age was 63 years. Common comorbidities were hypertension, dyslipidemia and diabetes mellitus. Concurrently, 20% had unilateral vestibular hypofunction, 23% had a history of BPPV, and 8% had bilateral involvement. Posterior SCC canalithiasis was most common (90%). In 77.3%, the case was resolved with one maneuver. Cases were most frequent in the spring and autumn season. CONCLUSION: BPPV was more common in women with an average age of 63 years. The majority of patients presented with unilateral canalithiasis obtaining a complete recovery with a single maneuver.

Video Head Impulse Test to Preoperatively Identify the Nerve of Origin of Vestibular Schwannomas.

BACKGROUND: Identification of the nerve of origin in vestibular schwannoma (VS) is an important prognostic factor for hearing preservation surgery. Thus far, vestibular functional tests and magnetic resonance imaging have not yielded reliable results to preoperatively evaluate this information. The development of the video head impulse test (vHIT) has allowed a precise evaluation of each semicircular canal, and its localizing value has been tested for some peripheral vestibular diseases, but not for VS. OBJECTIVE: To correlate patterns of semicircular canal alteration on vHIT to intraoperative identification of the nerve of origin of VSs. METHODS: A total 31 patients with sporadic VSs were preoperatively evaluated with vHIT (gain of vestibule-ocular reflex, overt and covert saccades on each semicircular canal) and then the nerve of origin was surgically identified during surgical resection via retrosigmoid approach. vHIT results were classified as normal, isolated superior vestibular nerve (SVN) pattern, isolated inferior vestibular nerve (IVN) pattern, predominant SVN pattern, and predominant IVN pattern. Hannover classification, cystic component, and distance between the tumor and the end of the internal auditory canal were also considered for analysis. RESULTS: Three patients had a normal vHIT, 12 had an isolated SVN pattern, 5 had an isolated IVN pattern, 7 had a predominant SVN pattern, and 4 had a predominant IVN pattern. vHIT was able to correctly identify the nerve of origin in 89.7% of cases (100% of altered exams). CONCLUSION: The pattern of semicircular canal dysfunction on vHIT has a localizing value to identify the nerve of origin in VSs.

Tumarkin-like phenomenon as a sign of therapeutic success in benign paroxysmal positional vertigo.

OBJECTIVES: To describe an unusual patient reaction to maneuvers used in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV) that we termed the "Tumarkin-like phenomenon". METHODS: At a private practice, 221 outpatients were diagnosed and treated for PC-BPPV. The treatment consisted of performing the Epley or Semont maneuvers. At the end of these maneuvers, when assuming the sitting position, the patients' reactions were recorded. RESULTS: Thirty-three patients showed a Tumarkin-like phenomenon described by a self-reported sensation of suddenly being thrown to the ground. In the follow-up, this group of patients remained without PC-BPPV symptoms up to at least 72 hours after the maneuvers. CONCLUSION: The occurrence of a Tumarkin-like phenomenon at the end of Epley and Semont maneuvers for PC-BPPV may be linked with treatment success.

Tumarkin-like phenomenon as a sign of therapeutic success in benign paroxysmal positional vertigo / Fenômeno Tumarkin-like como sinal de sucesso terapêutico na vertigem posicional paroxística benigna

ABSTRACT Objective: To describe an unusual patient reaction to maneuvers used in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV) that we termed the "Tumarkin-like phenomenon". Methods: At a private practice, 221 outpatients were diagnosed and treated for PC-BPPV. The treatment consisted of performing the Epley or Semont maneuvers. At the end of these maneuvers, when assuming the sitting position, the patients' reactions were recorded. Results: Thirty-three patients showed a Tumarkin-like phenomenon described by a self-reported sensation of suddenly being thrown to the ground. In the follow-up, this group of patients remained without PC-BPPV symptoms up to at least 72 hours after the maneuvers. Conclusion: The occurrence of a Tumarkin-like phenomenon at the end of Epley and Semont maneuvers for PC-BPPV may be linked with treatment success.

RESUMO Objetivo: Descrever uma reação incomum dos pacientes às manobras utilizadas no tratamento da vertigem posicional paroxística benigna do canal posterior (VPPB-CP), a qual denominamos de fenômeno Tumarkin-like. Métodos: Em uma clínica privada, 221 pacientes ambulatoriais foram diagnosticados e tratados para VPPB-CP. O tratamento consistiu em realizar as manobras de Epley ou de Semont. Ao término da manobra, ao serem colocados na posição sentado, as reações dos pacientes foram filmadas. Resultados: Trinta e três pacientes apresentaram o fenômeno de Tumarkin-like, descrito como uma sensação súbita de ser jogado no chão. O acompanhamento mostrou que todos eles permaneceram sem sintomas de VPPB até pelo menos 72 horas após as manobras. Conclusão: A ocorrência do fenômeno Tumarkin-like no final das manobras de Epley e Semont para VPPB-CP pode estar associado ao sucesso terapêutico.

Dehiscencia del canal semicircular superior como causa de tinnitus pulsátil / Superior semicircular canal dehiscence as cause of pulsatile tinnitus

RESUMEN El tinnitus se presenta en forma crónica en alrededor del 10% de los adultos, siendo el 4% de estos casos tinnitus pulsátil (TP). El TP se caracteriza por ser rítmico y sincrónico al latido cardiaco. Existen múltiples causas descritas, pero en un grupo importante de casos, no se logra objetivar su origen. Nuestro objetivo es presentar casos de dehiscencia del canal semicircular superior (DCSS) como causa de tinnitus pulsátil y su estudio. Se presentan dos pacientes evaluadas por tinnitus pulsátil. En ambos casos se descartan causas sistémicas, ECO doppler carotídeo sin alteración, angio TAC y RNM sin hallazgos. En reconstrucción de Pöschl se sospecha DCSS, por lo que se estudia con potenciales miogénicos evocados cVEMP y oVEMP con disminución de umbral y respuesta aumentada en oído afectado. En los casos expuestos el tinnitus aparece como síntoma único asociado a la presencia de DCSS, que fue confirmada con estudio imagenológico y VEMPs. El estudio con angio TAC permite pesquisar diversas causas asociadas. Los VEMPs confirman el diagnóstico, teniendo el oVEMP mayor sensibilidad. Como conclusión la DCSS es una entidad a tener presente como diagnóstico diferencial del tinnitus pulsátil y ante su sospecha se debe explorar con VEMPs.

ABSTRACT Tinnitus occurs chronically in about 10% of adults, being pulsatile tinnitus a 4% of these cases (TP). TP is characterized by being rythmic and sychronous to the heart beat. There are many described causes, but in a significant group of cases it is not possible to determine its origin. Our aim is present clinical cases of superior semicircular canal dehiscence (SSCD) as the cause of pulsatile tinnitus and its study. Clinical cases: Two patients present pulsatile tinnitus in her right ear. System causes were discarded, normal Carotid Doppler ultrasonography, Anglo CT scan and MRI without findings. In Pöschl reconstruction SSCD can be observed. Evoked myogenic potentials (VEMPs) by suspicion of SSCD Syndrome, cVEMP and oVEMP with a elevated amplitudes and lower thresholds ipsilateral response. In the cases exposed, tinnitus appears as a single symptom associated with the presence of SSCD which was confirmed with imaging studies and VEMPs. The AngioTAC allows to investigate several associated causes. The VEMPs confirm the diagnosis, with oVEMP having a greater sensitivity. The SSCD is an entity to have in my mind as a differential diagnosis of pulsatile tinnitus and, if suspected, should be explored with VEMPs.

Subjective visual vertical after treatment of benign paroxysmal positional vertigo / Vertical visual subjetiva após tratamento da vertigem posicional paroxística benigna

Abstract Introduction: Otolith function can be studied by testing the subjective visual vertical, because the tilt of the vertical line beyond the normal range is a sign of vestibular dysfunction. Benign paroxysmal positional vertigo is a disorder of one or more labyrinthine semicircular canals caused by fractions of otoliths derived from the utricular macula. Objective: To compare the subjective visual vertical with the bucket test before and immediately after the particle repositioning maneuver in patients with benign paroxysmal positional vertigo. Methods: We evaluated 20 patients. The estimated position where a fluorescent line within a bucket reached the vertical position was measured before and immediately after the particle repositioning maneuver. Data were tabulated and statistically analyzed. Results: Before repositioning maneuver, 9 patients (45.0%) had absolute values of the subjective visual vertical above the reference standard and 2 (10.0%) after the maneuver; the mean of the absolute values of the vertical deviation was significantly lower after the intervention (p < 0.001). Conclusion: There is a reduction of the deviations of the subjective visual vertical, evaluated by the bucket test, immediately after the particle repositioning maneuver in patients with benign paroxysmal positional vertigo.

Resumo Introdução: A função do otólito pode ser estudada por meio de testes da vertical visual subjetiva, porque a inclinação da linha vertical além da faixa normal é um sinal de disfunção vestibular. A vertigem postural paroxística benigna é um distúrbio de um ou mais canais semicirculares labirínticos causado por frações de otólitos derivados da mácula utricular. Objetivo: Comparar a vertical visual subjetiva com o teste do balde antes e imediatamente após a manobra de reposicionamento de partículas em pacientes com vertigem posicional paroxística benigna. Método: Foram avaliados 20 pacientes. A posição estimada, onde uma linha de fluorescência dentro de um balde atingia a posição vertical, foi medida antes e imediatamente após a manobra de reposicionamento de partículas. Os dados foram tabulados e analisados estatisticamente. Resultados: Antes da manobra de reposicionamento, nove pacientes (45%) apresentaram valores absolutos de vertical visual subjetiva acima da referência padrão e dois (10%) depois da manobra; a média dos valores absolutos do desvio vertical foi significativamente mais baixa depois da intervenção (p < 0,001). Conclusão: Há uma redução dos desvios da vertical visual subjetiva, avaliada pelo teste do balde, imediatamente após a manobra de reposicionamento de partículas em pacientes com vertigem posicional paroxística benigna.

Sensitivity of caloric test and video head impulse as screening test for chronic vestibular complaints.

OBJECTIVE:: This study compared the results of the caloric test with those of the video head impulse test obtained during the same session and evaluated whether the former can be used to screen for non-acute vestibular dysfunction. METHODS:: A total of 157 participants complaining of dizziness with vestibular characteristics of varying durations and clinical courses completed the caloric test and video head impulse test. RESULTS:: Significantly more caloric test results than video head impulse test results were abnormal. CONCLUSIONS:: The results of the caloric test and video head impulse test are distinct but complement each other. Within our sample, the caloric test was more sensitive for vestibular dysfunction. Therefore, the video head impulse test is not a suitable screening tool of the vestibular system in patients with chronic complaints.

Revisión sobre los conocimientos actuales de dehiscencia del canal semicircular posterior / Review of current knowledge of the dehiscence in the semicircular posterior canal

La dehiscencia del canal semicircular posterior es una patología rara y con baja incidencia, por ello hemos realizado una revisión de los conocimientos actuales de esta entidad. Se ha realizado una búsqueda bibliográfica desde 1998 hasta diciembre de 2016 de toda la literatura publicada sobre la misma en las bases de datos Allied and Complementary Medicine Database and the Embase, Health Management Information Consortium, Scopus, Consortium, Medline, PsycINFO y Scielo. Se han encontrado y revisado 53 trabajos relacionados con el tema. La dehiscencia del canal semicircular posterior presenta una prevalencia variable; 0,3%-4,5% en adultos y 1,2%-20% en niños. Su localización puede ser hacia el golfo de la yugular o fosa cerebral posterior. Los pacientes pueden ser asintomáticos o presentar clínica auditiva y/o vestibular. La tomografía computarizada y la prueba de potenciales vestibulares miogénicos evocados permiten establecer el diagnóstico de certeza. En el tratamiento quirúrgico la vía de abordaje de elección es la transmastoidea y las técnicas del cierre del canal son el "plugging" y el "resurfacing".

The posterior semicircular canal dehiscence is a rare pathology and it has a low incidence. We have realized a review about the current knowledge of this entity. We have performed a bibliographic research from 1998 to 2016 December about the literature published in this subject, in the data basis Allied and Complementary Medicine Database and the Embase, Health Management Information Consortium, Scopus, Consortium, Medline, PsycINFO y Scielo. I thas been found and reviewed 53 papers about the topic. The posterior semicircular canal dehiscence has a variable prevalence: 0,3%-4-5% in adults and 1,2%-20% in children. The location can be in the jugular bulb or in the posterior brain fossa. Some patients can be asymptomatic, whereas others can have auditory and/or vestibular signs and symptoms. Computed tomography and test of vestibular evoked myogenic potentials allow the diagnosis of certainty. In the surgical treatment the approach of choice is transmastoid and techniques to close the canal are plugging and resurfacing.

Sensitivity of caloric test and video head impulse as screening test for chronic vestibular complaints

OBJECTIVE: This study compared the results of the caloric test with those of the video head impulse test obtained during the same session and evaluated whether the former can be used to screen for non-acute vestibular dysfunction. METHODS: A total of 157 participants complaining of dizziness with vestibular characteristics of varying durations and clinical courses completed the caloric test and video head impulse test. RESULTS: Significantly more caloric test results than video head impulse test results were abnormal. CONCLUSIONS: The results of the caloric test and video head impulse test are distinct but complement each other. Within our sample, the caloric test was more sensitive for vestibular dysfunction. Therefore, the video head impulse test is not a suitable screening tool of the vestibular system in patients with chronic complaints.

Subjective visual vertical after treatment of benign paroxysmal positional vertigo.

INTRODUCTION: Otolith function can be studied by testing the subjective visual vertical, because the tilt of the vertical line beyond the normal range is a sign of vestibular dysfunction. Benign paroxysmal positional vertigo is a disorder of one or more labyrinthine semicircular canals caused by fractions of otoliths derived from the utricular macula. OBJECTIVE: To compare the subjective visual vertical with the bucket test before and immediately after the particle repositioning maneuver in patients with benign paroxysmal positional vertigo. METHODS: We evaluated 20 patients. The estimated position where a fluorescent line within a bucket reached the vertical position was measured before and immediately after the particle repositioning maneuver. Data were tabulated and statistically analyzed. RESULTS: Before repositioning maneuver, 9 patients (45.0%) had absolute values of the subjective visual vertical above the reference standard and 2 (10.0%) after the maneuver; the mean of the absolute values of the vertical deviation was significantly lower after the intervention (p<0.001). CONCLUSION: There is a reduction of the deviations of the subjective visual vertical, evaluated by the bucket test, immediately after the particle repositioning maneuver in patients with benign paroxysmal positional vertigo.

Síndrome de dehiscencia del canal semicircular superior: a propósito de un caso / Canal dehiscence syndrome of the superior semicircular: in a case purpose

El síndrome de dehiscencia de canal semicircular superior (DCSS) es una patología descrita en 1998 por Minor y cols, presenta síntomas diversos incluido vértigo inducido por el sonido, hipoacusia y autofonía por la falta de cobertura ósea en dicho canal. El diagnóstico se basa en la clínica y la confirmación se obtiene mediante la tomografía computarizada de peñasco. El tratamiento será expectante o reparación quirúrgica de la continuidad si la clínica es incapacitante. En este artículo se presenta un caso clínico de DCSS con síntomas auditivos y vestibulares al emitir el fonema "mmm".

The superior semicircular dehiscence síndrome is a pathology described en 1998 by Minor et al. Which presents several symptoms incluid sound induced vértigo, hearing loss and autophony due to bone dehiscense of this semicircular canal. The diagnosis was based on clinical and confirmation is given by the temporal bone CT. Treatment is expectant or surgical repair of continuity if the clinic is disabling. In this paper we present a case of DCSS with auditory and vestibular symptoms in issuing the phoneme "mmm".

Horizontal canal benign paroxysmal positional vertigo: diagnosis and treatment of 37 patients.

Benign paroxysmal positional vertigo (BPPV), the most frequent cause of vertigo is associated with high morbidity in the elderly population. The most common form is linked to debris in the posterior semicircular canal. However, there has been an increasing number of reported BPPV cases involving the horizontal canals. The purpose of this article is to highlight the clinical features, diagnosis, and treatment in 37 patients with horizontal canal BPPV; twenty-six with geotropic nystagmus, and eleven with the apogeotropic form. Treatment consisted of the Gufoni manoeuver in eighteen patients (48.6%), the barbecue 360° maneuver in twelve patients (32.4%), both manoeuvers in four patients (10.8%), both manoeuvers plus head shaking in one patient (2.7%), and the Gufoni maneuver plus head shaking in two patients. Cupulolithiasis patients were asked to sleep in a forced prolonged position. We obtained a complete resolution of vertigo and nystagmus in 30 patients (81.0%) on the initial visit.

Horizontal canal benign paroxysmal positional vertigo: diagnosis and treatment of 37 patients / Vertigem posicional paroxística benigna do canal horizontal: diagnóstico e tratamento de 37 pacientes

Benign paroxysmal positional vertigo (BPPV), the most frequent cause of vertigo is associated with high morbidity in the elderly population. The most common form is linked to debris in the posterior semicircular canal. However, there has been an increasing number of reported BPPV cases involving the horizontal canals. The purpose of this article is to highlight the clinical features, diagnosis, and treatment in 37 patients with horizontal canal BPPV; twenty-six with geotropic nystagmus, and eleven with the apogeotropic form. Treatment consisted of the Gufoni manoeuver in eighteen patients (48.6%), the barbecue 360° maneuver in twelve patients (32.4%), both manoeuvers in four patients (10.8%), both manoeuvers plus head shaking in one patient (2.7%), and the Gufoni maneuver plus head shaking in two patients. Cupulolithiasis patients were asked to sleep in a forced prolonged position. We obtained a complete resolution of vertigo and nystagmus in 30 patients (81.0%) on the initial visit.

Vertigem posicional paroxística benigna (VPPB) é a causa mais frequente de vertigem e promove alta morbidade na população idosa. A forma mais comum está relacionada com otoconias no canal semicircular posterior. Entretanto, nos últimos anos identifica-se cada vez mais casos de VPPB dos canais horizontais. Os principais objetivos deste artigo são destacar as características clínicas, diagnóstico e tratamentos aplicados em 37 pacientes com VPPB do canal horizontal; vinte e seis com nistagmo geotrópico, e onze com nistagmo apogeotrópico. O tratamento consistiu na manobra de Gufoni em dezoito pacientes (48,6%) manobra do churrasco 360° em doze pacientes (32,4%) ambas as manobras em quatro pacientes (10,8%) ambas as manobras mais a manobra de sacudir a cabeça (MSC) em um paciente (2,7%), e manobra de Gufoni mais MSC em dois pacientes (2,7%). Pacientes com cupulolitíase dormiram uma noite na posição forçada prolongada. Em 30 pacientes (81,0%) o sucesso terapêutico ocorreu na primeira consulta.

Is it important to repeat the positioning maneuver after the treatment for benign paroxysmal positional vertigo? / É importante realizar o reteste da manobra de posicionamento após o tratamento da vertigem postural paroxística benigna?

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular dysfunction. OBJECTIVE: To assess whether the performance of the Dix-Hallpike maneuver after the Epley positioning maneuver has prognostic value in the evolution of unilateral ductolithiasis of posterior semicircular canal. METHODS: A prospective cohort study in monitored patients at otoneurology ambulatory with a diagnosis of BPPV; they were submitted to the therapeutic maneuver and then to a retest in order to evaluate the treatment effectiveness; all cases were reassessed one week later and the retest prognostic value was evaluated. RESULTS: A sample of 64 patients which 47 belonging to negative retest group and 17 belonging to positive retest. Performed the maneuver in all patients, the retest presented 51.85% sensitivity, 91.89% specificity, 82.35% positive predictive value and 72.34% negative predictive value. CONCLUSION: The study shows that doing the retest after repositioning maneuver of particles in BPPV is effectual, since it has high specificity. .

INTRODUÇÃO: A vertigem posicional paroxística benigna (VPPB) é a causa mais comum de disfunção vestibular periférica. OBJETIVO: Avaliar se a realização do reteste de Dix-Hallpike após a manobra de posicionamento de Epley tem valor prognóstico na evolução da vertigem posicional da ductolitíase paroxística benigna de canal semicircular posterior unilateral. MÉTODO: Estudo prospectivo do tipo coorte de pacientes em acompanhamento no ambulatório de otoneurologia com diagnóstico de VPPB; foram submetidos a manobra terapêutica e posteriormente ao reteste para avaliar a eficácia do tratamento; todos os casos foram reavaliados em uma semana e analisado o valor prognostico do reteste. RESULTADOS: Amostra de 64 pacientes, 47 do grupo reteste negativo e 17 do reteste positivo; realizada manobra de Epley em todos os pacientes. O reteste apresentou sensibilidade de 51,85%; especificidade de 91,89%; valor preditivo positivo de 82,35% e valor preditivo negativo de 72,34%. CONCLUSÃO: O estudo mostra que é válido realizar o reteste após a manobra de reposicionamento de partículas na VPPB, visto que possui alta especificidade. .

Is it important to repeat the positioning maneuver after the treatment for benign paroxysmal positional vertigo?

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular dysfunction. OBJECTIVE: To assess whether the performance of the Dix-Hallpike maneuver after the Epley positioning maneuver has prognostic value in the evolution of unilateral ductolithiasis of posterior semicircular canal. METHODS: A prospective cohort study in monitored patients at otoneurology ambulatory with a diagnosis of BPPV; they were submitted to the therapeutic maneuver and then to a retest in order to evaluate the treatment effectiveness; all cases were reassessed one week later and the retest prognostic value was evaluated. RESULTS: A sample of 64 patients which 47 belonging to negative retest group and 17 belonging to positive retest. Performed the maneuver in all patients, the retest presented 51.85% sensitivity, 91.89% specificity, 82.35% positive predictive value and 72.34% negative predictive value. CONCLUSION: The study shows that doing the retest after repositioning maneuver of particles in BPPV is effectual, since it has high specificity.

A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo.

OBJECTIVE: Primary objective of this study was to find a statistical link between the most worldwide comorbidities affecting the elderly population (hypertension, diabetes, osteoarthrosis, osteoporosis and depression) and recurrent episodes of BPPV. Secondary objective was defining possible "groups of risk" for people suffering recurrent positional vertigo related to the presence of a well documented comorbidity. METHODS: This was an observational, cross-sectional, multicenter, spontaneous, non-pharmacological study. The data of 1092 patients suffering BPPV evaluated in 11 different Departments of Otolaryngology, Otoneurology and Neurology, referring Centers for positional vertigo evaluation, were retrospectively collected. RESULTS: Regarding evaluated comorbidities (hypertension, diabetes, osteoarthrosis, osteoporosis and depression), data analysis showed the presence of at least one comorbid disorder in 216 subjects (19.8%) and 2 or more in 408 subjects (37.4%). Moreover there was a statistical significant difference between the number of comorbidities and the number of recurrences, otherwise said as comorbidity disorders increased the number of relapses increased too. CONCLUSION: The presence of a systemic disease may worsen the status of the posterior labyrinth causing a more frequent otolith detachment. This condition increases the risk for patients suffering BPPV to have recurrent episodes, even if correctly managed by repositioning maneuvers. The combination of two or more of aforementioned comorbidities further increases the risk of relapsing BPPV, worsened by the presence of osteoporosis. On the basis of this results it was possible to define "groups of risk" useful for predicting BPPV recurrence in patients with one or more comorbidity.

Benign paroxysmal positional vertigo: diagnosis and treatment.

Benign paroxysmal positional vertigo is a common disorder in Neurotology. This vestibular syndrome is characterized by transient attacks of vertigo, caused by change in head position, and associated with paroxysmal characteristic nystagmus. The symptoms result from movement of the free floating otoconia particles in the endolymph or their attachment to the cupulae of the semicircular canal. The diagnosis is essentially clinical and should be confirmed by performing diagnostic maneuvers. Treatment is based on the identification of the affected semicircular canal and performance of liberatory maneuvers or repositioning of free floating particles of otoliths. The effectiveness varies from 70 to 100%.

Results from the balance rehabilitation unit in benign paroxysmal positional vertigo.

UNLABELLED: Posturography is a useful new tool to study the influence of vestibular diseases on balance. AIM: to compare the results from the Balance Rehabilitation Unit (BRU) static posturography in elderly patients with Benign Paroxysmal Positional Vertigo (BPPV), before and after Epley's maneuver. MATERIALS AND METHODS: a prospective study of 20 elderly patients with a diagnosis of BPPV. The patients underwent static posturography and the limit of stability (LE) and ellipse area were measured. We also applied the Dizziness Handicap Inventory (DHI) questionnaire to study treatment effectiveness. RESULTS: 80% were females, with a mean age of 68.15 years. After the maneuver, the LE increased significantly (p=0.001). The elliptical area of somatosensory, visual and vestibular conflicts (2,7,8,9 situations) in BRU and the DHI scores decreased significantly (p<0.05) after treatment. CONCLUSION: the study suggests that elderly patients with BPPV may present static postural control impairment and that the maneuver is effective for the remission of symptoms, to increase in the stability and improvement in postural control in situations of visual, somatosensory and vestibular conflicts.

Resultados do Balance Rehabilitation Unit na Vertigem Posicional Paroxística Benigna / Results from the Balance Rehabilitation Unit in Benign Paroxysmal Positional Vertigo

A posturografia é um instrumento útil e novo para o estudo da influência das doenças vestibulares no equilíbrio corporal. OBJETIVO: Comparar os resultados da posturografia estática do Balance Rehabilitation Unit (BRU) em idosos com Vertigem Postural Paroxística Benigna (VPPB) pré e pós a manobra de Epley. MATERIAL E MÉTODO: Estudo prospectivo de 20 pacientes idosos com diagnóstico de VPPB. Os pacientes foram submetidos à posturografia estática do BRU, e o limite de estabilidade (LE) e a área de elipse foram medidos. Aplicou-se também o questionário "Dizziness Handicap Inventory" versão brasileira (DHI) para verificar a eficácia do tratamento. RESULTADOS: 80 por cento pacientes eram do gênero feminino, com a média etária de 68,15 anos. Após a manobra, o LE aumentou significantemente (p=0,001). A área de elipse nas condições de conflitos sensoriais, visuais e vestibulares da BRU (condições 2,7,8,9) e o escore do DHI diminuíram significantemente (p<0,05) após o tratamento. CONCLUSÃO: O estudo sugere que idosos com VPPB apresentam prejuízo no controle postural estático e que a manobra de Epley é eficiente para a remissão dos sintomas, para o aumento do limite de estabilidade e para a melhora do controle postural em situações de conflitos visuais, somatossensoriais e vestibulares.

Posturography is a useful new tool to study the influence of vestibular diseases on balance. AIM: to compare the results from the Balance Rehabilitation Unit (BRU) static posturography in elderly patients with Benign Paroxysmal Positional Vertigo (BPPV), before and after Epley's maneuver. MATERIALS AND METHODS: a prospective study of 20 elderly patients with a diagnosis of BPPV. The patients underwent static posturography and the limit of stability (LE) and ellipse area were measured. We also applied the Dizziness Handicap Inventory (DHI) questionnaire to study treatment effectiveness. RESULTS: 80 percent were females, with a mean age of 68.15 years. After the maneuver, the LE increased significantly (p=0.001). The elliptical area of somatosensory, visual and vestibular conflicts (2,7,8,9 situations) in BRU and the DHI scores decreased significantly (p<0.05) after treatment. CONCLUSION: the study suggests that elderly patients with BPPV may present static postural control impairment and that the maneuver is effective for the remission of symptoms, to increase in the stability and improvement in postural control in situations of visual, somatosensory and vestibular conflicts.

Elderly falls associated with benign paroxysmal positional vertigo.

UNLABELLED: Benign Paroxysmal Positional Vertigo (BPPV) can cause falls, especially in the elderly. AIM: to study whether or not elderly patients with BPPV have a reduction on their falls after the particle repositioning maneuver (PRM). MATERIALS AND METHODS: retrospective study including elderly with BPPV who had fall(s) during the last year. All patients were submitted to the PRM according to the affected semicircular canal (SCC). After the abolition of positioning vertigo and nystagmus, the patients were submitted to a 12 month follow-up and were investigated about the number of fall(s). Wilcoxon's test was performed to compare the number of fall(s) before and after 12 months of the PRM. RESULTS: One hundred and twenty one patients were included in the study. One hundred and one patients presented involvement of the posterior SCC, 16 of the lateral and four of the anterior. We noticed a reduction on the number of falls, with statistically significant difference when all the patients were analyzed together (p<0.001), the posterior canal BPPV patients (p<0,001) and the lateral canal VPPB patients (p=0.002). We also found a tendency of statistically significant difference for the anterior canal BPPV patients (p=0.063). CONCLUSION: BPPV elderly patients had indeed a reduction on the number of falls after the PRM.