Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

Maia, Francisco Zuma e; Ramos, Bernardo Faria; Cal, Renato Valério Rodrigues; Brock, Camila Martins; Albernaz, Pedro Luiz Mangabeira; Strupp, Michael

doi:10.3389/fneur.2020.01040

Cited by 35 publications

(28 citation statements)

References 64 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: Discussionmentioning

confidence: 99%

“…In most publications about liberation maneuvers (11)(12)(13)(14)(15)(16), therefore 2D pictures are shown of the canal with the clod in different phases of the maneuvers, without any hard supporting evidence, simply because it is not available: only indirect evidence exists based on the observation of nystagmus. These papers are very useful and made to help clinicians to understand the sequence of otolith movements occurring during each step of the maneuvers.…”

Section: Introductionmentioning

confidence: 99%

“…Types of BPPV and therapeutic maneuvers (PC-BPPV, Posterior canal BPPV; HC-BPPV, Horizontal canal BPPV; AC-BPPV, Anterior canal BPPV; QLR, Quick liberatory rotation); FPP, Forced Prolonged Positioning(11)(12)(13)(14)(15)(16)25).…”

mentioning

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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…New techniques to avoid difficulties in localizing the otolithic debris in apogeotropic h-BPPV were recently introduced and analyzed. Zuma et al described a repositioning maneuver comparable to the modified Gufoni maneuver for apogeotropic cupulolithiasis and canalolithiasis ( 33 ). They added two more steps which should detach the debris from the utricular side of the cupula.…”

Section: Discussionmentioning

confidence: 99%

Treatment Results of Geotropic and Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo in a Tertiary Dizziness Clinic

et al. 2021

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Purpose: To determine the effectiveness of our treatment protocol for geotropic and apogeotropic horizontal canal benign paroxysmal positional vertigo (h-BPPV).Methods: We retrospectively evaluated patients with newly diagnosed geotropic and apogeotropic h-BPPV who visited our clinic between July 2017 and December 2019. Patients were treated according to our treatment protocol, which was implemented in 2017. Patients with geotropic h-BPPV were preferably treated with the Gufoni maneuver. In patients with apogeotropic h-BPPV we executed the modified Gufoni maneuver to achieve conversion to the geotropic type. We looked at the number of successful treatments and the number of recurrences within 1 year.Results: We included 102 patients with h-BPPV, 62 (61%) of whom were treated for geotropic h-BPPV. The ratio of apogeotropic to geotropic h-BPPV was 0.65. After the first visit, we observed resolution of horizontal canal BPPV in 71 and 63% of the geotropic and the apogeotropic group, respectively. After the second visit, this percentage increased to 92% for geotropic h-BPPV and 78% for apogeotropic h-BPPV. After 1 year of follow-up we determined a recurrence rate of 32 and 24% for the geotropic and apogeotropic group, respectively.Conclusion: With our treatment protocol we managed to achieve high rates of symptom resolution in the geotropic and apogeotropic type of h-BPPV with acceptable recurrence rates. We observed a relatively high ratio of apogeotropic h-BPPV to geotropic h-BPPV.

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“…The past few decades have increased our knowledge about BPPV; however, some aspects are still not understood or are controversial (34)(35)(36). Perhaps, answers will come when we can image the material in the semicircular canals and see its motion (2).…”

Section: "Short Canal Repositioning Maneuver"mentioning

confidence: 99%

Diagnostic and Therapeutic Maneuvers for Anterior Canal BPPV Canalithiasis: Three-Dimensional Simulations

Bhandari¹,

Bhandari²,

Kingma

et al. 2021

Front. Neurol.

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Background and Objectives: Anterior canal BPPV is a rare BPPV variant. Various diagnostic and therapeutic maneuvers have been described for its management. The aim of this study was to use three-dimensional simulation models to visualize otoconial debris movement within the anterior canal during diagnostic tests and different liberatory maneuvers. This can help to optimize existing treatment maneuvers and help in the development of better management protocols.Methods: Based on reconstructed MRI images and fluid dynamics, a 3D dynamic simulation model (as a function of time) was developed and applied. Simulations of the supine head-hanging test for diagnosis of ac-BPPV were studied. Three repositioning maneuvers were simulated: 1) the Yacovino maneuver and its modifications, 2) the reverse Epley maneuver and 3) the short canal repositioning (CRP) maneuver.Results: The simulation showed that the supine head-hanging test is a good test for diagnosis of ac-BPPV affecting both labyrinths and demonstrated why there is no inversion of nystagmus on sitting up. The Yacovino maneuver was seen to be an effective treatment option for ac-BPPV without having to determine the side involved. However, simulations showed that the classical Yacovino maneuver carried a risk of canal switch to the posterior canal. To overcome this risk, a modified Yacovino maneuver is suggested. The reverse Epley maneuver was not an effective treatment. Short CRP is useful in ac-BPPV treatment; however, it requires determination of side of involvement.Conclusion: The 3D simulator of the movement of the otoconial debris presented here can be used to test the mechanism of action and the theoretical efficacy of existing diagnostic tests and maneuvers as well as to develop new treatment maneuvers to optimize BPPV treatment.

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Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

Cited by 35 publications

References 64 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

Treatment Results of Geotropic and Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo in a Tertiary Dizziness Clinic

Diagnostic and Therapeutic Maneuvers for Anterior Canal BPPV Canalithiasis: Three-Dimensional Simulations

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