Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo

Abstract

A prospective cohort study was designed to evaluate the long-term outcome and health-related quality of life (HRQoL) in patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV) treated by the particle repositioning maneuver (PRM) in the outpatient clinic of a general community hospital. Fifty individuals with PC-BPPV were included, and 45 (90%) completed the study. The diagnosis was based on the history of short episodes of vertigo and a positional nystagmus during the Dix-Hallpike test (DHT). All patients were treated by a single PRM, and relapses were evaluated by DHT at 30, 180 and 360 days post-treatment; a new PRM was performed if the DHT was positive. The main outcome measures were: percentage of patients with a negative DHT after treatment, scores obtained on the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Dizziness Handicap Inventory Short Form (DHI-S) before and 30, 180 and 360 days post-treatment. The DHT was found negative in 80% (40/50) of individuals at 30 days. Ten, seven and five patients presented a positive DHT at 30, 180 and 360 days, respectively. Persistent BPPV was observed in 5% (2/50) of patients at 360 days, despite repeated PRM. Relapses (DH+ after successful PRM) were observed in 7.5% (3/50) at 180 days and 360 days. Both questionnaires showed a reliability Cronbach's alpha >0.7. The average standardized score for each SF-36 scale was compared with the reference population normative data, showing differences with norms for all scales except for vitality. After PRM, patients improved their scores with both instruments, indicating a restoration of HRQoL at 30 days. Physical dimension scores of the SF-36 improved from day 30 to 360. DHI-S scores were statistically better after PRM (P < 0.001). Our results show that the effectiveness of PRM is 88% after 1 year of follow-up. Patients with BPPV experienced a decrease in HRQoL, which was restored after PRM. Although relapses were observed in 7.5% of individuals, they did not affect HRQoL.

The social impact of dizziness in London and Siena

“…Furthermore, when assessed with questionnaires [4,7,23], dizziness is known to generate emotional distress and handicap, features that can persist even after vertiginous symptoms decrease [11,14,22,24]. Questionnaire assessment of dizzy patients, however, has mostly been carried out in order to make comparisons between different diagnostic groups, for follow up and to assess the effects of treatment [10][11][12]24]. …”

Feasibility and Effects of a Nursing Intervention for Patients with Peripheral Vestibular Disorders

“…Benign paroxysmal positional vertigo is mainly treated with the Epley Maneuver, in which series of head positions, loose debris in the posterior semicircular canal of the inner ear is repositioned into the utriculus (Lopez-Escamez, Gamiz, Fernandez-Perez, & Gomez-Fiñana, 2005). The most common treatment for M eni ere's disease (MD) is to reduce the fluid pressure (endolymphatic hydrops) in the inner ear by diuretic pharmaceuticals (Sajjadi & Paparella, 2008), and VN is treated symptomatically (e.g., with antiemetics) and with encouragement to balance training.…”

Effects of balance Vestibular Rehabilitation Therapy in elderly with Benign Paroxysmal Positional Vertigo: a randomized controlled trial

“…[2] Consequently, these balance deficits contribute to several physical and emotional impairments in this population. [6] There is strong scientific evidence that supports Canalith Repositioning Maneuver (CRM) for improvement in vertigo and nystagmus in BPPV patients. [2,5,[7][8][9] Studies also affirm short-term balance improvement in patients with BPPV after CRM intervention.…”