Less common forms of posterior canal benign paroxysmal positional vertigo

Califano, Luigi; Mazzone, Salvatore; Salafia, Francesca; Melillo, Maria Grazia; Manna, Giuseppe

doi:10.14639/0392-100x-n1032

Cited by 28 publications

(44 citation statements)

References 24 publications

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“…Fifty-two studies of the 179 titles and abstracts were selected for full-text analysis. After reviewing articles in full-text, a total of six studies met our eligibility criteria and were included in the qualitative assessment, consisting of five non-RCTs (12,13,19–21) and one RCT (17).…”

Section: Resultsmentioning

confidence: 99%

Vitamin D Supplementation for Benign Paroxysmal Positional Vertigo: A Systematic Review

et al. 2022

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Objective: Benign paroxysmal positional vertigo (BPPV) is commonly attributed to displaced otoconia. These have been shown to have biomineralization close to that of bone, and vitamin D deficiency has been associated with BPPV. We aim to systematically review the available literature on vitamin D supplementation and BPPV intensity and recurrence in adults. Databases Reviewed: PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Current Controlled Trials, and ClinicalTrials.gov. Methods: We systematically reviewed the available literature from 1947 to April 2020. The study protocol was registered in the PROS-PERO database (trial registration: CRD42020183195). Results: A total of 179 abstracts were identified and screened by two independent reviewers. Based on inclusion and exclusion criteria, six studies were selected and subjected to a quality assessment. In one randomized clinical trial (RCT), vitamin D supplementation was found to reduce annual recurrence rate of vertigo in patient with BPPVand subnormal serum vitamin D levels compared with placebo (odds ratio, 0.69; 95% confidence interval, 0.54-0.90). Non-RCTs demonstrated the possibility of a null effect in the random effects model (odds ratio, 0.08; 95% confidence interval, 0.00-1.56). The RCT considered as low risk of bias. All of the nonrandomized studies were assessed as serious risk of bias. Conclusions: The intervention studies identified consistently demonstrated a decrease in BPPV recurrence with supplementation of vitamin D in patients with subnormal vitamin D levels. Although there is a paucity of high-quality studies, the present literature does highlight a role for optimization of vitamin D levels in patients with BPPV.

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Section: Resultsmentioning

confidence: 99%

Vitamin D Supplementation for Benign Paroxysmal Positional Vertigo: A Systematic Review

et al. 2022

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“…Recent evidence increasingly acknowledges the presence of atypical posterior semicircular canal BPPV variants with various nystagmus presentations. Califano21 found a 5% (25/498) rate of apogeotropic posterior canal BPPV in a cohort of acute posterior canal BPPV cases, which was much more common than anterior canal BPPV (4 cases). These variants should be considered by clinicians when patient’s signs and symptoms are not following typical responses to canalith repositioning attempts.…”

Section: Discussionmentioning

confidence: 96%

Resolution of atypical posterior semicircular canal BPPV: evidence for putative short-arm location

Ludwig

Schubert

2023

BMJ Case Rep

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This case demonstrates the successful identification and treatment of atypical posterior semicircular canal benign paroxysmal positional vertigo (BPPV) based on a unique presentation of positional nystagmus, the resultant nystagmus from repositioning manoeuvers, and restored function of the affected semicircular canal. This case illustrates the importance of completing a comprehensive clinical examination and the value for incorporating the video head impulse test as well as adjusting treatment based on testing and patient response when managing variant cases of BPPV.

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“…10 , 13 , 22 , 55 In contrast, the majority of papers on apogeotropic H‐BPPV (89/146 [61%]) equate all apogeotropic nystagmus with cupulolithiasis. 56 However, particles moving freely in the periampullary canal have also been shown to cause apogeotropic nystagmus 13 , 14 , 16 , 22 , 57 , 58 , 59 , 60 , 61 and it is included in the Barany Society H‐BPPV definition. 22 As recently as 2021, 15 articles discussed apogeotropic nystagmus, but 1/3 failed to discuss periampullary otoconia as a possible cause.…”

Section: Discussionmentioning

confidence: 99%

Cupulolithiasis: A Critical Reappraisal

Kalmanson¹,

Foster²

2023

OTO Open

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Objective To review the history and pathophysiologic theories for cupulolithiasis and canalith jam in benign paroxysmal positional vertigo. Data Sources PubMed, Google Scholar. Review Methods Three PubMed and Google Scholar searches were performed, keywords: “cupulolithiasis,” “apogeotropic [and] benign,” and “canalith jam,” resulting in 187 unique full‐text articles in English or with English translation. Figures—Labyrinthine photographs were obtained of fresh utricles, ampullae, and cupulae of a 37‐day‐old mouse. Conclusions Freely moving otoconial masses explain most cases (>98%) of benign paroxysmal positional vertigo. Evidence that otoconia adhere strongly or persistently to the cupula is lacking. Apogeotropic nystagmus in the horizontal canal form is often attributed to cupulolithiasis; however, periampullary canalithiasis explains self‐limited nystagmus, and reversible canalith jam explains prolonged apogeotropic nystagmus. Treatment‐resistant cases can be explained by entrapment of particles in the canals or ampullae, but persistent adherence to the cupula remains theoretical. Implications for Practice Apogeotropic nystagmus is usually due to freely moving particles and should not be used in studies of horizontal canal benign paroxysmal positional vertigo as the sole method to define entrapment or cupulolithiasis. Caloric testing and imaging may help differentiate jam from cupulolithiasis. Treatment for apogeotropic benign paroxysmal positional vertigo should include maneuvers that rotate the head through 270° to fully clear the canal of mobile particles, using mastoid vibration or head shaking if entrapment is suspected. Canal plugging can be used for treatment failures.

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Less common forms of posterior canal benign paroxysmal positional vertigo

Cited by 28 publications

References 24 publications

Vitamin D Supplementation for Benign Paroxysmal Positional Vertigo: A Systematic Review

Vitamin D Supplementation for Benign Paroxysmal Positional Vertigo: A Systematic Review

Resolution of atypical posterior semicircular canal BPPV: evidence for putative short-arm location

Cupulolithiasis: A Critical Reappraisal

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