Is Posttraumatic Benign Paroxysmal Positional Vertigo Different From the Idiopathic Form?

Gordon, Carlos R.; Levite, Ronen; Joffe, Vitaly; Gadoth, Natan

doi:10.1001/archneur.61.10.1590

Cited by 152 publications

(150 citation statements)

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“…For dizziness occurring at times other than in bed, cervicogenic vertigo must be considered after a whiplash trauma. Head injury may equally affect both labyrinths; thus, bilateral BPPV is expected to occur more frequently in the posttraumatic cases [35,39], although we have not noted a high incidence of bilateral cases in our series.…”

Section: Discussioncontrasting

confidence: 54%

Benign paroxysmal positional vertigo following whiplash injury: a myth or a reality?

Dispenza

Stefano

Mathur

et al. 2011

American Journal of Otolaryngology

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Objective: The aim of the study was to evaluate the true incidence, diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV) arising after whiplash injury and to distinguish this type of posttraumatic vertigo from other types of dizziness complained after trauma.Methods: This was a retrospective study comprising patients referred to our center after whiplash injury. The patients were evaluated with neurotologic examination including bedside and instrumental tests. A Dizziness Handicap Inventory evaluating the symptoms of patients was submitted before and after treatment and was evaluated. The BPPV patients were separately evaluated from those with cervicogenic vertigo, and a comparison between our data about idiopathic BPPV was done.Results: Eighteen patients of whiplash who had BPPV were evaluated. The mean age was 38.2 years. BPPV was the cause of vertigo in 33.9% of total whiplash patients. In 16 cases, the posterior semicircular canal was involved; the lateral semicircular canal was involved in 2 cases. The instrumental neurotologic assessment did not show any alteration of either vestibulospinal reflexes or dynamic ocular movements. Duration of symptoms before treatment ranged from 3 to 26 days. A total of 55.5% of patients had relief from their symptoms after first repositioning maneuver. The Dizziness Handicap Inventory score improved in all patients treated with repositioning maneuvers, but no difference emerged with idiopathic BPPV data. Conclusion: BPPV after whiplash injury could be unveiled with a simple bedside examination of peripheral vestibular system, and a treatment could be done in the same session. The diagnosis of posttraumatic BPPV is not different from the idiopathic form, but the treatment may require more maneuvers to achieve satisfactory results.

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Section: Discussioncontrasting

confidence: 54%

Benign paroxysmal positional vertigo following whiplash injury: a myth or a reality?

Dispenza

Stefano

Mathur

et al. 2011

American Journal of Otolaryngology

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“…In a recent prospective study with 247 patients, Gordon et al reported that trauma resulting BPPV cases are much less frequent than idiopathic origin BPPV cases (8.5% in this study are trauma-related), they are, however, more difficult to treat, requiring repeated treatment sessions to completely resolve the symptoms (77% vs 14%, respectively, p<0.001), besides having greater recurrence trends (57% vs 19%, respectively, p<0.004) 37 .…”

Section: Discussionmentioning

confidence: 47%

Manobras para o tratamento da vertigem posicional paroxística benigna: revisão sistemática da literatura

Teixeira

Machado

2006

Rev. Bras. Otorrinolaringol.

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Beni gn Paroxysmal Positional Vertigo (BPPV) is one of the most frequent diseases of the vestibular system and it is characterized by episodes of recurrent vertigo triggered by head movements or position changes. There are several approaches for treatment, but efficacy is still being discussed. Aim: To asses the effectiveness of the specific maneuvers available to the treatment of BPPV. Methodology: An electronic search at the main databases, including MEDLINE, LILACS, PEDro, Cochrane Collaborations Database was performed, and we selected only randomized clinical trials studying adults with diagnosis of BPPV confirmed by the Dix-Hallpike test. The trials should have included physical maneuvers such as Epley and Semont. The main outcome was Dix-Hallpike negative test and the changes to subjective complaints. The trials were assessed using Jadad's scale and only studies with quality scores equal or above 3 were pooled on a meta-analyses to assess their effectiveness. Results: We found five controlled clinical trials phase I comparing the Epley's maneuver with controls or placebo. The metaanalysis showed positive evidence of Epley's maneuver to the posterior semicircular canal (effect size = 0.11 [CI 95% 0.05, 0.26]

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“…173 Patients with BPPV after trauma are likely to demonstrate an even higher recurrence rate of their BPPV. 132 Thus, clinicians should be aware of the recurrence risk of BPPV and should counsel patients accordingly. Counseling will likely have several benefits.…”

Section: Action Statement Profile For Statementmentioning

confidence: 99%

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Bhattacharyya¹,

Gubbels

Schwartz

et al. 2017

Otolaryngol.--head neck surg.

588

776

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Objective. This update of a 2008 guideline from the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV.Purpose. The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV.Action Statements. The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. The update group made a strong recommendation against postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. The update group made recommendations that the clinician should (1) perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate...

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Is Posttraumatic Benign Paroxysmal Positional Vertigo Different From the Idiopathic Form?

Abstract: The nature and severity of the traumas causing t-BPPV are diverse, ranging from minor head injuries to more severe head and neck trauma with brief loss of consciousness. It appears that t-BPPV is more difficult to treat than i-BPPV, and also has a greater tendency to recur.

Cited by 152 publications

References 23 publications

Benign paroxysmal positional vertigo following whiplash injury: a myth or a reality?

Benign paroxysmal positional vertigo following whiplash injury: a myth or a reality?

Manobras para o tratamento da vertigem posicional paroxística benigna: revisão sistemática da literatura

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

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