Benign Positional Paroxysmal Vertigo Treatment: a Practical Update

Mandalà, Marco; Salerni, Lorenzo; Nuti, Daniele

doi:10.1007/s11940-019-0606-x

Cited by 37 publications

(23 citation statements)

References 80 publications

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“…We are fully aware that the natural variations in the orientation and morphology have a substantial impact on the validity of the extrapolation to the individual patient. Like various publication describing repositioning maneuvers for BPPV (15,16,21,22), these simulations do not represent the physics of the otoconia. The ideal would be to optimally visualize the otolith movement of each patient, however at present, there are many unknown variables.…”

Section: Resultsmentioning

confidence: 99%

“…For PC-BPPV, the maneuvers described by Epley (11) and Semont et al (12) are most commonly used. The Epley's maneuver uses the effect of gravity on the otolith particle to move it toward the utricle while Semont's maneuver works on the principal of acceleration and gravity (21)(22)(23)(24). This paper describes the simulation of Semont's maneuver along with variations for posterior canal.…”

Section: Maneuversmentioning

confidence: 99%

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BPPV Simulation: A Powerful Tool to Understand and Optimize the Diagnostics and Treatment of all Possible Variants of BPPV

Bhandari¹,

Kingma

Bhandari³

2021

Front. Neurol.

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BPPV is a mechanical disorder caused by the displacement of otolith debris into the semicircular canals. The treatment involves different repositioning maneuvers to bring the debris back into the utricle. This study aims to show how dynamic simulation models based on fluid dynamics and MRI, can help to visualize and understand the movement of the debris within the canals during head movement in 3D as a function of time. The user can define the rotation angle and plane at each step of the maneuver and then the model visualizes the canal and the otoconial movement in 3D. The simulation developed also allows alteration of various parameters like the rotational head acceleration, the duration of each step of the maneuver, the initial position of the otoconial debris in the canal, the size and the number of the particles and fluid dynamics of endolymph. The clod movement is visualized in such a way that it allows a better understanding of the impact and efficacy of various liberation maneuvers and why certain maneuvers might fail when not applied properly in the clinic. The model allows simulation of multi-canal BPPV. In this paper we demonstrate the power of the model applied on the maneuvers of Semont and Yacovino when executed in different ways. The model aims to provide a visual explanation for the need of specific maneuvers for each type of BPPV. The simulator presented here can be used to test the efficacy of existing maneuvers and help in the development of new maneuvers to treat different BPPV variants.

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Section: Resultsmentioning

confidence: 99%

Section: Maneuversmentioning

confidence: 99%

BPPV Simulation: A Powerful Tool to Understand and Optimize the Diagnostics and Treatment of all Possible Variants of BPPV

Bhandari¹,

Kingma

Bhandari³

2021

Front. Neurol.

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“…According to clinical practice guidelines, canalith repositioning maneuvers are recommended as the first approach to treat BPPV. Observation or "watchful waiting" is also a therapeutic option for BPPV (1,6). Thus, the unnecessary examination and test of BPPV may result in increased costs for patients.…”

Section: Introductionmentioning

confidence: 99%

Increased Otolin-1 in Serum as a Potential Biomarker for Idiopathic Benign Paroxysmal Positional Vertigo Episodes

Wu¹,

Wei²,

Lu³

et al. 2020

Front. Neurol.

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Objective: Otolin-1, a main specific otoconia matrix protein, passes through the labyrinth-blood barrier and is detectable in peripheral blood. Serum otolin-1 levels differ between patients with benign paroxysmal positional vertigo (BPPV) and healthy controls and are significantly age-related, increasing in healthy controls with age, suggesting that serum otolin-1 levels reflect otolith status. The aim of this study was to determine whether otolin-1 levels change during vertigo episodes in patients with BPPV and whether any change is specific and sensitive enough for BPPV episodes. Method: Patients diagnosed with de novo idiopathic BPPV during an acute episode were included in the study from May 2017 to May 2018. Blood samples were drawn before patients were treated with canalith-repositioning maneuvers. Serum otolin-1 levels were compared between 78 patients and 121 age-and sex-matched healthy individuals. Results: There were no significant differences between the groups in the age distribution, sex ratio, body mass index, clinical history, routine blood parameters, or total protein, albumin, uric acid, creatinine, blood urea nitrogen and lipid profiles (P > 0.05). Serum levels of otolin-1 were significantly higher in BPPV patients than in healthy controls (P < 0.001). Receiver operating characteristic analysis revealed that a serum otolin-1 value of 299.45 pg/ml was the optimal cutoff value to discriminate patients with BPPV from healthy controls (area under the curve 0.757, 95% CI 0.687∼0.826) with a sensitivity of 67.9% and a specificity of 72.7%. Conclusion: Serum levels of otolin-1 may be a potential biomarker for BPPV episodes.

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“…Horizontal positional nystagmus has a short latency and prolonged duration with poor fatigability. [4][5][6][7] This test is the best method of diagnosing LC-BPPV.…”

Section: Introductionmentioning

confidence: 99%

Double‐Blind Randomized Trial on the Efficacy of the Forced Prolonged Position for Treatment of Lateral Canal Benign Paroxysmal Positional Vertigo

et al. 2020

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Objectives/Hypothesis: The need for class I and II studies on the efficacy of liberatory maneuvers in the treatment of lateral canal benign paroxysmal positional vertigo (LC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of the forced prolonged position (FPP). Study Design: Double-blind, randomized controlled trial. Methods: Two hundred twenty-one patients with unilateral LC-BPPV met the inclusion criteria for a multicentric study. Patients were randomly assigned to treatment by FPP (116 subjects) or sham treatment (105 subjects). Subjects were followed up at 24 hours with the supine roll test by blinded examiners. Results: Among the sample, 67.4% and 32.6% of the patients showed respectively geotropic and apogeotropic variant of LC-BPPV. At the 24-hour follow-up, the effectiveness of FFP compared to the sham maneuver was, respectively, 57.8% versus 12.4% (P < .0001) in the total sample, 76.9% versus 11.3% (P < .0001) in the geotropic variant group, and 60.5% versus 17.6% (P = .0003) in the apogeotropic variant group, including resolution or transformation to geotropic variant. Conclusions: FPP proved highly effective compared to the sham maneuver. The present class 2 study of the efficacy of the FPP changes the level of recommendation of the method for treating LC-BPPV into a strong one.

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Benign Positional Paroxysmal Vertigo Treatment: a Practical Update

Cited by 37 publications

References 80 publications

BPPV Simulation: A Powerful Tool to Understand and Optimize the Diagnostics and Treatment of all Possible Variants of BPPV

BPPV Simulation: A Powerful Tool to Understand and Optimize the Diagnostics and Treatment of all Possible Variants of BPPV

Increased Otolin-1 in Serum as a Potential Biomarker for Idiopathic Benign Paroxysmal Positional Vertigo Episodes

Double‐Blind Randomized Trial on the Efficacy of the Forced Prolonged Position for Treatment of Lateral Canal Benign Paroxysmal Positional Vertigo

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