Treatment Of Benign Paroxysmal Positional Vertigo

Objective:The purposes of this study were to demonstrate the current status ofbenign paroxysmal positional vertigo (BPPV) management and the advantages ofrepositioning maneuvers as well as to facilitate the accurate and efficient diagnosisand management of BPPV.Methods: Between December2012and May2013at the Otolaryngology VertigoClinic,the Affiliated Sixth People’s Hospital of Shanghai Jiao Tong University,.of1213participants with severe dizziness/vertigo who were examined and treated,331(27.3%) fulfilled the diagnostic criteria for BPPV at first visit. All patients in thestudy had a diagnosis of BPPV confirmed by their history, typical subjectivesymptom reports, and characteristic positional nystagmus during the Dix–Hallpiketest and/or roll test. And218patients,who were local citizen and diagnosed withBPPV for the first time, could cooperated and finished our interview regarding theirapproach to vetigo clinc, their medical history, characteristics of the first attack ofvertigo, associated symptoms, associated fall， number of hospital visits,initialdepartment they visits,hospital admission and financial costs.Results: The average duration from the appearance of the first symptoms until afinal diagnostic positional maneuver was905days. On average, patients visitedhospitals more than six times before the final diagnosis due to initial visits toinappropriate departments, including neurology,emergency, generalmedicine,ENT,rehabilitation, Traditional Chinese Medicine, orthopaedic surgery, andcardiology with a corresponding average financial cost of2,862RMB. The patientswho had the history of falls accounted for9%.21patients(10%) had hospitaladmission for BPPV.According to the ways approaching our clinc, The218BPPV patients were dividedinto two groups, Group Ⅰ，From TV show （famous doctors in consultation）, afriend recommendation, newspapers or online information, patients who got to know BPPV accounted for66.94%(n=146)；Group Ⅱ，patients who were suspected withBPPV and referred by other doctors to vetigo clinc accounted for33.03%(n=72), Theaverage duration from the appearance of the first symptoms until a final diagnosticpositional maneuver were794days,326days (P=0.220), the average number ofhospital visits were6.62times,3.21times (P=0.004),, a corresponding averagefinancial cost were3,638￥,1,288￥(P=0.001), hospitalization rates were13%,3%(P=0.003).The canalith repositioning procedure (CRP) was effective in88.68%ofpatients after the first repositioning maneuver.Conclusion：Our data demonstrated that despite the significant prevalence ofBPPV, delays in diagnosis and treatment frequently occur, which have both cost andquality-of-life impacts on patients, also caused a serious waste of medical resources.Generalizing the awareness of BPPV of doctors, can reduce BPPV proportion ofpatients hospitalized, save medical cost, can make BPPV patients more likely get fast,effective CRP.The CRP is very effective for patients with BPPV. It would be of greatimportance to popularize the knowledge of BPPV among doctors. Objective:To examine the value of self-treatment for Posterior canal benignparoxysmal positional vertigo(PC-BPPV)，we compared the results from patientstreated with modified Epley in an outpatient clinic in combination with self-treatmentat home with those in patients treated by modified Epley alone.Methods:We carried out a randomized controlled trial between December2012andMay2013at the Department of Otolaryngology Head and Neck Surgery, theAffiliated Sixth People’s Hospital of Shanghai Jiao Tong University. We enrolled150patients with unilateral idiopathic BPPV-PSC, which met the diagnosis，at last,of147patientscould complete the follow-up. Among them，73patients were allocted tomodified Epley-alone group and74were allocted to slef-treatment group.Results:The success rate after1week,was53.4%in modified Epley-alone group vs83.8%in self-treatment group（p<0.001）.In the modified Epley-alone group,thesuccess rate of hand repositioning group and chair-assisted repositioning group is45.9%vs61.1%（p=0.194），the risk rate is0.752,95%CI（0.486-1.163）；In theself-treatment group, the success rate of hand repositioning group and chair-assistedrepositioning group is87.5%vs81.0%（p=0.449）,the risk rate is1.081，95%CI（0.888-1.316）；Serious complications occurred in0%of the modified Epley-alonegroup and in1.3%of the self-treatment group (p=0.322).Conclusion:Compared to modified Epley maneuver alone, complementary self-treatment with modified Epley maneuver treated PC-BPPV sooner and moreeffectively, and its serious complications didn’t increase significantly. It coulddecrease the frequency of visit. Chair-assisted repositioning showed better result thanhand repositioning alone, and self-treatment at home can reduce the effect of the gap. It was available for patients with PC-BPPV who could follow the medical directions.Our study suggested that complementary self-treatment with modified Epleymaneuver had more benefits for patients with PC-BPPV. Objective：To compare the clinical presentation and outcome between patientswith secondary BPPV and idiopathic BBPV．Methods: We reviewed the medical records of32patients with secondary BPPV，including17post-traumatic BPPV cases and15BPPV cases with additionalvestibular pathology, between December2012and October2013at the Department ofOtolaryngology Head and Neck Surgery, the Affiliated Sixth People’s Hospital ofShanghai Jiao Tong University. The outcome was compared with the outcome of189patients with idiopathic BPPV who were treated during December2012and October2013.Results: The rate of2or more than2semicircular canals involved were5/17inpost-traumatic BPPV group and23/189in idiopathic BPPV group, the difference wassignificant(p=0.047); the rate of2or more than2semicircular canals involved were2in BPPV with additional vestibular pathology group,which was similar withidiopathic BPPV group (p=1).When only treated in Outpatient department,the short-term success rate was16.67%in post-traumatic BPPV group and64.94%inidiopathic BPPV group(p=0.057);with self-treatment, the short-term success rate was67.64%in post-traumatic BPPV group and84.82%in idiopathic BPPVgroup(p=0.173). The long-term success rate was also similar(p=0.074).The recurrencerate was47.06%in post-traumatic BPPV group and17.99%in idiopathic BPPVgroup(p=0.004),5in8patients who recurred in post-traumatic BPPV group couldtreat BPPV successfully at home. Compared with idiopathic BPPV self-treatmentgroup，the short-term success rate in BPPV with additional vestibular pathology self-treatment group was similar(71.43%vs84.82%，p=0.375),the long-term success ratewas also similar(p=1). The recurrence rate between two group wassimilar(13.33%vs17.99%，p=0.754).Conclusion：Compared with idiopathic BPPV patients, post-traumatic BPPV patientshave more semicircle canals involved, need more times therapy, higher recurrence, and self- treatment could deal with it; The therapeutic efficacy and recurrence of BPPV with additionalvestibular pathology were similar to that of idiopathic BPPV.