Clinical Manifestation And Maneuver Repositioning Therapy For Benign Paroxysmal Positional Vertigo

Part 1Clinical manifestation and maneuver repositioning therapy for benign paroxysmal positional vertigoObjective:To describe clinical manifestation and maneuver repositioning therapy for benign paroxysmal positional vertigo(BPPV).Methods:Retrospectively analysis the clinical manifestation and maneuver repositioning therapy results of patients with BPPV from January 2003 to December 2007.Results:Four hundred thirty-eight patients with BPPV(290 women,148 men) observed,age from 16 to 84(mean 54.98±2.27) years.One hundred eighty-six patients had left semicircular canals BPPV as well as 244 patients had right problems.Two hundred fifty-three patients were considered as idiopathic BPPV and the rest patients were considered as secondary BPPV that might because of head trauma, infection,various otologic illnesses,hypertension,diabetes,operation,oral calcium pills, and so on.Three hundred eleven patients(71.01%) were found to have posterior semicircular canal involvement,there were 89 patients(20.32%) with horizontal semicircular canal,13 patients(2.97%) with anterior semicircular canal,13 patients(2.97%) with combined semicircular canals and 12 patients(2.74%) with subjective BPPV.Most patients experienced brief violent vertigo attack induced by head position changes,which is characterized by such characters as positioning,latency,transience,fatigability, reversibility and associated with a characteristic nystagmus.The mean latency were 3.40±3.35 seconds,1.88±1.70 seconds and 4.80±4.21 seconds,the mean duration of vertigo attack were13.35±10.63 seconds,26.11±22.13 seconds and 9.20±3.70 seconds in posterior,horizontal and anterior semicircular canal BPPV,respectively,posterior semicircular canal BPPV showed longer latency and shorter duration of vertigo attack compared with horizontal semicircular canal BPPV.Two hundred thirty-five patients with posterior semicircular canal BPPV were treated with particle repositioning maneuver (PRM) and the initial success rate was 84.3%,the total success rate was 98.3%.Eighty patients with posterior semicircular canal BPPV were treated with Semont maneuver and the two success rates were 82.5%and 97.5%respectively.Eighty-nine patients with horizontal semicircular canal BPPV were received Barbecue rolling maneuver therapy,the initial and total success rates were 74.2%and 97.8%.The symptom relieved only in 1 patient after reversed PRM therapy and the symptoms all disappeared after the therapy of Semont maneuver in 13 patients with anterior semicircular canal BPPV.Three-dimensional reconstruction MRI showed 2 patients had stegnotic semicircular canals in 4 repositioning failure patients.One hundred sixty-five patients(38%) experienced dizziness and unbalance after successful repositioning maneuvers.Eighty-one patients recurred during follow-up and the recurrent rate was 18.5%,recurrences were seen significantly more often in secondary BPPV patients compared with idiopathic BPPV patients.Although the reourrencing involved semicircular canals might be different from those first attack,it was also effective for another maneuver repositioning therapy.Conclusions:BPPV is a common clinical entity characterized by brief violent vertigo attack induced by head position changes,which is characterized by such characters as positioning,latency, transience,fatigability,reversibility and associated with a characteristic nystagmus.The most common cases are of posterior semicircular canal BPPV that shows longer latency and shorter duration compare with horizontal semicircular canal BPPV.Most BPPV patients become asymptomatic after corresponding repositioning maneuver therapy according to the involved semicircular canals,repositioning failure patients may be relatived to abnormalities of semicircular canals.BPPV has a tendcy to recurrence,but it is also effective for another maneuver repositioning therapy.Part 2Clinical manifestation and maneuver repositioning therapy for subjective benign paroxysmal positional vertigoObjective:To evaluate clinical manifestation and maneuver repositioning therapy for subjective benign paroxysmal positional vertigo(S-BPPV).Methods:Retrospectively analysis the clinical manifestation and maneuver repositioning therapy results of 12 patients with S-BPPV from January 2003 to December 2007,the results were compared with 24 patients with objective benign paroxysmal positional vertigo(O-BPPV).Results:S-BPPV patients suffered from attack of transient vertigo with sudden onset triggered by changes in head position and no concomitant nystagmus in Dix-Hallpike test, The latency and duration of vertigo attack in S-BPPV were 4.42±2.02 seconds and 8.67±4.31seconds,but those in O-BPPV were 3.2±1.18 seconds and 14.75±4.97 seconds, There were significant differences between the two results(t=2.3,P＜0.05 and t=3.61,P＜0.01).The symptoms disappeared in 11 patients after a single therapy of particular repositioning maneuver(PRM) and 1 patient after 2 PRMs,the initial success rate was 91.7%in S-BPPV and 79.2%in O-BPPV,the difference wasn't significant(χ~2 =0.23,P＞0.5);the number of circulation in initial therapy was 1.75±1.08 times in S-BPPV and 3.38±1.06 times in O-BPPV,the difference was significant(t=4.32,P＜0.01).2 patients recurred during follow-up in S-BPPV and 7 patients in O-BPPV,the difference wasn't significant(χ~2 =0.17,P＞0.5 ).Conclusions:Longer latency,shorter duration and less circulation are seen in S-BPPV compare to O-BPPV,S-BPPV seems to be more favorable than O-BPPV.Part 3Clinical manifestation and maneuver repositioning therapy for traumatic benign paroxysmal positional vertigoObjective:To evaluate clinical manifestation and maneuver repositioning therapy for traumatic benign paroxysmal positional vertigo(T-BPPV).Methods:Retrospectively analysis the clinical manifestation and maneuver repositioning therapy results of 19 patients with T-BPPV from January 2003 to December 2007,the results were compared with 51 patients with idiopathic benign paroxysmal positional vertigo(I-BPPV)Results:There were significant difference between T-BPPV group and I-BPPV group (t=2.57,P＜0.05) just with the mean onset ages of 51.3±19.1 years and 63.2±16.5 years, 2 or more than 2 semicircular canals involved were seen in 9 patients in T-BPPV group and 4 patients in I-BPPV group,the difference was significant(χ~2 =6.74,P＜0.01),The latency and duration of vertigo attack were 2.64±2.01 seconds and 16.73±10.92seconds in T-BPPV group and 2.87±0.92 seconds and12.57±10.03 seconds in I-BPPV group,the differences were not significant(P＞0.2 and P＞0.05).the one-stage success rates were 62.5%in T-BPPV group and 83.6%in I-BPPV group,the difference was significant(χ~2=4.94,P＜0.05);the numbers of circulation in first management were 3.91±3.11 times in T-BPPV group and 2.58±1.47 times in I-BPPV group,the difference was significant(t=2.70,P＜0.01).the rates of residual symptom were 42.1%in T-BPPV group and 17.6%in I-BPPV group,the difference was significant(χ~2 =4.50,P＜0.05).There were 11 patients recurred in T-BPPV group and 12 patients recurred in I-BPPV group during follow-up,the difference was also significant(χ~2=7.41,P＜0.01).Conclusion:The mean onset age of T-BPPV patients was younger than that of I-BPPV patients,more semicircular canals involved,more circulation therapy and higher rates of residual symptom and recurrence are seen in T-BPPV patients compare with I-BPPV patients,which indicate T-BPPV seems to be more unfavorable than I-BPPV.