Research in Vestibular Science

Volume 12 (3); September 2011

Review

Diagnosis of Benign Paroxysmal Positional Vertigo: Sun Young Oh; Res Vestib Sci. 2013;12(3):73-78.

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Abstract: Benign paroxysmal positional vertigo (BPPV) is a clinical syndrome characterized by brief recurrent episodes of vertigo triggered by changes in head position with respect to gravity. BPPV is the most common cause of recurrent vertigo, with a lifetime prevalence of 2.4%. In this review article, the diagnosis of BPPV involving the posterior, horizontal and anterior semicircular canal are described.

Original Articles

Multicenter Study on the Clinician’s Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea: Eun Ju Jeon, Won Ho Chung, Jeong Hwan Choi, Eui Cheol Nam, Hong Ju Park, Jong Dae Lee, Won Sang Lee, Kyu Sung Kim, Eui Kyung Goh, Ja Won Koo, Min Bum Kim, Min Beom Kim, Se Hyung Kim, Young Jin Kim, Chang Hee Kim, Sung Il Nam, Seog Kyun Mun, Ga Young Park, Sang Yoo Park, Shi Nae Park, Chang Hoon Bae, Sung Hyun Boo, Myung Whan Suh, Jae Hyun Seo, Eun Jin Son, Jae Jun Song, Jae Jin Song, Joong Wook Shin, Dae Bo Shim, Seong Ki Ahn, Hye Youn Youm, Shin Young Yoo, Dong Hee Lee, Seung Hwan Lee, Chang Ho Lee, Hyun Seok Lee, Hwan Ho Lee, Hyo Jeong Lee, Yun Hoon Choung, Seung Hyo Choi, Jee Sun Choi, Seok Min Hong, Sung Kwang Hong; Res Vestib Sci. 2013;12(3):79-92.

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Abstract: Background and Objectives: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician’s diagnostic and therapeutic approaches for BPPV. Materials and Methods: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. Results: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). Conclusion: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.

Clinical Characteristics and Natural Course of Benign Paroxysmal Vertigo of Childhood: A Long-Term Follow-Up Study: Eun Jae Lee, Seong Ki Ahn, Dong Gu Hur, Joon Seok Ko; Res Vestib Sci. 2013;12(3):93-98.

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Abstract: Background and Objectives: It is suggested that some patients with benign paroxysmal vertigo of childhood (BPVC) go on to develop migraine. However, neither the natural course nor the clinical features of BPVC have been determined, and therefore, the aim of this study was to investigate the clinical characteristics and the natural course of BPVC. Materials and Methods: During the period January 2002 to December 2009, we reviewed the clinical records of 58 patients diagnosed with BPVC. All patients were approached by telephone and using a questionnaire. The clinical characteristics of vertigo, such as sex and age distribution, duration and frequency of vertigo, associated symptoms, development of migraine, and neurologic abnormalities, were analyzed. Results: Mean follow- up duration was 73.2 months (range, 31-119 months). Patients had a mean age at onset of 11.8 years and a mean duration of 6.1 years. An obvious female predilection was found, and 40% of BPVC developed to migraine had a family history of migraine. Of the 32 patients, symptoms resolved in 68.7% but were unchanged in five patients (15.6%). BPVC developed to migraine in five patients (15.6%). Conclusion: This study suggests that vertigo spontaneously resolves in the majority of cases. However, the incidence of development to migraine in the BPVC patients is higher than that in general population.

The Efficacy of DizzyFIX for Residual Dizziness after Successful Repositioning Maneuvers in Posterior Benign Paroxysmal Positional Vertigo: Nam Guk Kim, Hyun Myung O, Joo Young Kim, Jang Soo Lee, Wee Hwang Kim; Res Vestib Sci. 2013;12(3):99-105.

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Abstract: Background and Objectives: Benign paroxysmal positional vertigo (BPPV) is one of the critical life events that can affect physical, emotional, and functional aspects of quality of life. Canalith repositioning procedure (CRP) provides rapid and long lasting relief of symptoms in most patients with BPPV. However, some patients express nonspecific symptoms such as anxiety or discomfort after treatment, The purpose of this study was to assess the residual symptoms after CRP in patients with BPPV using Dizziness Handicap Inventory (DHI) in a questionnaire format and to evaluate the therapeutic efficacy of CRP according to accompanying the DizzyFIX device. Materials and Methods: We performed a prospective investigation in 135 consecutive patients with confirmed posterior semicircular canal BPPV. CRP was performed until nystagmus and vertigo disappeared. Patients were divided into three group using the DizzyFIX (group A), not using the DizzyFIX (group B) and closed observation (group C) after treatment. Then patients were asked to complete the questionnaire for Korean form DHI before treatment, 1, 2, 3, 4, 8 week after treatment. Results: There was a significant improvement in DHI scores when comparing the pre CRP and post CRP three groups (p<0.05), although emotional items showed incomplete improvement at 1 week. But at 2 week after treatment, there were statistically significant differences between group A and other groups in DHI scores specially in emotional items. Conclusion: Even after successful CRP, DHI scores indicated incomplete recovery and residual subjective symptoms may remain. For these patients additional follow up and management are necessary and using of the DizzyFIX will be helpful to reduce the incidence of residual dizziness especially emotional aspect.

The Assumption of Diagnosis and Site of Lesion in Benign Paroxysmal Positional Vertigo Using a Questionnaire: Sungmin Park, Chang Deok Han, Kyu Sung Kim, Wookey Lee; Res Vestib Sci. 2013;12(3):106-109.

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Abstract: Background and Objectives: Diagnosis of patients with dizziness requires detailed history taking. Using a questionnaire may be helpful for accurate and rapid diagnosis. However, no reliable questionnaire was developed yet. The purpose of this study is to know if authors’ questionnaire is reliable for diagnosing of benign paroxysmal positional vertigo (BPPV) and deciding affected canal. Materials and Methods: We evaluated 45 patients presenting with positional vertigo from January 2012 to September 2012. We developed a questionnaire by extracting specific questions on positional vertigo from the Dizziness Handicap Inventory and the activities-specific balance confidence scale. All the patients answered the questionnaire, followed by Dix-Hallpike test and head rolling test. Affected canal suspected by the questionnaire was analyzed and compared with affected canal confirmed by positioning test. Results: Among 45 patients, 24 (53%) was diagnosed with BPPV by positioning test. Patients with posterior canal BPPV (p-BPPV) answered positive of dizziness in pitch axis movement more frequently than roll and yaw, but it was not statistically significant (p>0.05). In the patients with lateral canal BPPV (l-BPPV), no significant difference was observed among three axes. Concordance rate of suspected canal by the questionnaire and positioning test was 36% in p-BPPV and 39% in l-BPPV. Conclusion: Diagnosis of BPPV and affected canal by the questionnaire based on movement axis is limited in this study. Development of more reliable questionnaire is necessary.

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