Efficacy Observation In The Treatment Of Benign Paroxysmal Positional Vertigo Using Multiaxial Rotating Canalith Repositioning System

ObjectiveBy comparing one-off cure rate, total cure rate and recurrence rate etc. of simplex benign paroxysmal positional vertigo(BPPV) between two different canalith repositioning procedures, manual manoeuvres vs. automatic rotatory chair for canalith repositioning maneuver, evaluation of clinical efficacy and value of multiaxial rotating canalith repositioning system in the treatment of all kinds of simplex BPPV was conducted to further summarize treatment experience of BPPV and find possible causes for treatment failure. MethodsA total of 245 patients with simplex BPPV treated in the department of otolaryngology-head and neck surgery of the second hospital of Tianjin medical university, were randomly divided into manual manoeuvres group(n=121) and repositioning chair group(n=124). Manual manoeuvres and the 360°multiaxial rotating canalith repositioning procedures were applied for patients with various types of BPPV in the manual manoeuvres group and repositioning chair group, respectively, till vertigo and positional nystagmus disappearing. The two groups of patients undergone reexamination within 1 week after treatment to check improvement degree of vertigo and whether there was a positional nystagmus in Dix-Hallpike test and Roll test. Patients still with symptoms of vertigo and positional nystagmus accepted corresponding repositioning treatment again according to the grouping. Symptoms of vertigo and positional nystagmus in patients cannot be improved after 4 times treatment, which was defined as treatment failure. Follow-up was conducted in both groups after 6 months since repositioning treatment finished to record cases of recurrence. Data of one-off cure rate, total cure rate and recurrence rate etc. of various types of BPPV were statistically analyzed. Inter-group comparison was performed with chi-square test or Fisher exact test. P<0.05 was considered a significant difference. Results1. In the treatment of posterior semicircular canal canalithiasis, 74 patients accepted manual manoeuvres and its one-off cure rate and total cure rate was 86.49%(64/74) and 91.89%(68/74), respectively, while 71 patients accepted multiaxial rotating canalith repositioning procedures and its one-off cure rate and total cure rate was 92.96%(66/71)and 95.77%(68/71) respectively. There was no significant difference between the two groups in the cure rate via Chi-square test.2. In the treatment of horizontal semicircular canal canalithiasis, the one-off cure rate and total cure rate of the manual manoeuvres group(n=23) was 52.17%(12/23) and 65.22%(15/23) respectively, while the one-off cure rate and total cure rate of the repositioning chair group(n=29) was 79.31%(23/29) and 93.10%(27/29) respectively. There were significant differences in the cure rate by Chi-square test(P<0.05), the cure rate differences between two groups have statistical significance.3. In the treatment of horizontal semicircular canal canalithiasis, the one-off cure rate and total cure rate of the manual manoeuvres group(n=12) was 16.67%(2/12) and 58.33%(7/12) respectively, while the one-off cure rate and total cure rate of the repositioning chair group(n=10) was 70.00%(7/10) and 90.00%(9/10) respectively. There was a significant difference in the one-off cure rate by Fisher exact test, while there was no statistical significant difference in the total cure rate between the two groups.4. In the treatment of horizontal semicircular canal cupulolithiasis, the one-off cure rate and total cure rate of the manual manoeuvres group(n=12) was 16.67%(2/12) and 41.67%(5/12) respectively, while the one-off cure rate and total cure rate of the repositioning chair group(n=14) was 64.29%(9/14) and 85.71%(12/14) respectively. There was significant differences in the one-off cure rate and total cure rate by Fisher exact test between the two groups.5. Follow-up results showed a total of 15 cases of recurrence after 6 months since repositioning treatment finished, including 8 cases in the manual manoeuvres group(8/121, 6.61%) and 7 cases in the repositioning chair group(7/124, 5.65%). There was no significant difference in the recurrence rate by Chi-square test between the two groups. Conclusions1. In the treatment of canalithiasis, the total cure rate of multiaxial rotating canalith repositioning system was equivalent to the manual manoeuvres in treating posterior semicircular canal canalithiasis, but the one-off cure rate and total cure rate of which was superior to the manual manoeuvres in treating horizontal semicircular canal canalithiasis. At the same time the advantage of multiaxial rotating canalith repositioning system such as accurate operation, alleviating suffering of patients, economize on manpower, etc. made it be available for clinical application.2. In the treatment of cupulolithiasis, the one-off cure rate of multiaxial rotating canalith repositioning system was higher than that of the manual manoeuvres by reducing frequency of repositioning treatment and it obtained a good total cure rate in treating horizontal semicircular canal cupulolithiasi.3. Reasons for failure treatment of canalithiasis were mainly due to anatomic abnormality and otolith blocking semicircular canal, therefore otolith adhesion in side wall of ampulla may be related to failure treatment of cupulolithiasis.4. There were certain recurrent events in patients with BPPV, thus it was beneficial for preventing recurrence by controlling complications actively.