Benign positional vertigo, its diagnosis, treatment and mimics

Argaet, Emma C; Bradshaw, Andrew P.; Welgampola, Miriam S.

doi:10.1016/j.cnp.2019.03.001

Cited by 47 publications

(47 citation statements)

References 87 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The treatment of BPPV is based on the detection of these characteristic nystagmus patterns to decide the appropriate maneuver required to reposition the otolith debris back into the utricle. The precise debris movements in the canals have been studied and clarified by physics using various models based on the fluid dynamics of BPPV (3)(4)(5)(6)(7)(8)(9). These studies form the basis for our current understanding of the latency, direction, reversal, and fatiguability of the nystagmus as a function of time, the size and number of otoconial particles.…”

Section: Introductionmentioning

confidence: 99%

“…It is very likely that these issues will vary among patients and by that limits an exact application of the models (fluid dynamics) at current. Nevertheless, the physics models based on the fluid dynamics of BPPV (3)(4)(5)(6)(7)(8)(9) form the basis for our current understanding of the latency, direction, reversal, and fatiguability of the nystagmus as a function of time. The ideal would be to optimally visualize the otolith movement in any individual patient real time.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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.

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

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.

View full text Add to dashboard Cite

show abstract

“…Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the peripheral vestibular system and characterised by episodes of vertigo associated with head movements 4445 . Although BPPV generally responds well to treatment, there is a significant rate of recurrence after the initial resolution 46 .…”

Section: Resultsmentioning

confidence: 99%

Clinical application of cVEMPs and oVEMPs in patients affected by Ménière’s disease, vestibular neuritis and benign paroxysmal positional vertigo: a systematic review

Scarpa

Gioacchini

Cassandro

et al. 2019

Acta Otorhinolaryngol Ital

View full text Add to dashboard Cite

Vestibular evoked myogenic potentials (VEMPs) are increasingly used for different pathologies with new clinical insights. Although the study of otolithic function selectively in both its saccular (cervical VEMPs) and utricular (ocular VEMPs) parts does not represent a recent achievement, the clinical utility of this tool is still emerging. The aim of the present report is to define advances in application of VEMPs in diagnosis and clinical study of vestibular neuritis, Ménière's disease and benign paroxysmal positional vertigo. To perform a systematic review of the literature, three appropriate strings were run in PubMed to retrieve dedicated articles. A double cross-check was performed on citations and two independent investigators independently reviewed all full-text articles and performed a comprehensive quality assessment. Of 140 articles identified, 26 articles were included, comprising a total of 1,181 patients affected by vestibular neuritis (296 subjects), Ménière's disease (378 patients) and benign paroxysmal positional vertigo (507 patients). Overall, the use of both cVEMP and oVEMP appeared particularly useful in improving the topographic diagnosis of vestibular neuritis. Most (n = 8) of the studies dedicated to Ménière's disease and benign paroxysmal positional vertigo (10 overall) also reported significantly abnormal VEMP values compared to healthy controls. Although further reports will be necessary to better define normal threshold levels of VEMPs for each pathology, our review suggests that VEMPs may represent a useful aid in improving the diagnostic accuracy for these three common vestibular pathologies.

show abstract

“…Cervical dysfunction was treated with manual therapy and exercise, 12 followed by canalith repositioning procedure for BPPV when present. 28 Vision therapy included vision exercises for smooth pursuits, saccades, complex motor tasks including divided attention and laterality, and vergences. 29 Vestibular rehabilitation therapy was integrated for substitution (dynamic balance exercises with visual restriction and on compliant surfaces), vestibular ocular reflex training for gaze stability to address adaptation and ex- ercises for habituation were added on or after the 3 rd week of vision therapy.…”

Section: Interventionsmentioning

confidence: 99%

Sequencing and Integration of Cervical Manual Therapy and Vestibulo-oculomotor Therapy for Concussion Symptoms: Retrospective Analysis

Wong

Ziaks

Vargas

et al. 2021

International Journal of Sports Physical Therapy

View full text Add to dashboard Cite

Background BackgroundAfter concussion many people have cervicogenic headache, visual dysfunction, and vestibular deficits that can be attributed to brain injury, cervical injury, or both. While clinical practice guidelines outline treatments to address the symptoms that arise from the multiple involved systems, no preferred treatment sequence for post-concussion syndrome has emerged. Purpose PurposeThis study sought to describe the clinical and patient-reported outcomes for people with post-concussion symptoms after a protocol sequenced to address cervical dysfunction and benign paroxysmal positional vertigo within the first three weeks of injury, followed by integrated vision and vestibular therapy. Study Design Study DesignRetrospective longitudinal cohort analysis Methods MethodsRecords from a concussion clinic for 38 patients (25 male 13 female, aged 26.9±19.7 years) with post-concussion symptoms due to sports, falls, assaults, and motor vehicle accident injuries were analyzed. Musculoskeletal, vision, and vestibular system functions were assessed after pragmatic treatment including early cervical manual therapy and canalith repositioning treatment-when indicated-integrated with advanced vision and vestibular rehabilitation. Patient-reported outcomes included the Post-Concussion Symptom Scale (PCSS) for general symptoms; and for specific symptoms, the Dizziness Handicap Index (DHI), Convergence Insufficiency Symptom Scale (CISS), Activities-specific Balance Confidence scale (ABC), and the Brain Injury Vision Symptom Survey (BIVSS). Paired t-tests with Bonferroni correction to minimize familywise error (p<0.05) were used to analyze the clinical and patient-reported outcomes. Results ResultsAfter 10.4±4.8 sessions over 57.6±34.0 days, general symptoms improved on the PCSS (p=0.001, 95%CI=12.4-30.6); and specific symptoms on the DHI (p<0.001, 95%CI=14.5-33.2), CISS (p<0.002, 95%CI=7.1-18.3), ABC (p<0.024, 95%CI=-.3 --.1), and BIVSS (p<0.001, 95%CI=13.4-28.0). Clinical measures improved including cervical range-of-motion (55.6% fully restored), benign paroxysmal positional vertigo symptoms (28/28, fully resolved), Brock string visual convergence (p<0.001, 95%CI=3.3-6.3), and score on the Balance Error Scoring System (p<0.001, 95%CI=5.5-11.6).

show abstract

Benign positional vertigo, its diagnosis, treatment and mimics

Abstract: Highlights History and nystagmus profile paramount to diagnosis of benign positional vertigo. Randomised controlled trials demonstrate effectiveness of repositioning manoeuvres. Atypical positional nystagmus warrants vestibular function assessment and imaging.

Cited by 47 publications

References 87 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

Clinical application of cVEMPs and oVEMPs in patients affected by Ménière’s disease, vestibular neuritis and benign paroxysmal positional vertigo: a systematic review

Sequencing and Integration of Cervical Manual Therapy and Vestibulo-oculomotor Therapy for Concussion Symptoms: Retrospective Analysis

Contact Info

Product

Resources

About