Research in Vestibular Science

Reviews

Treatment in Benign Paroxysmal Positional Vertigo: Factors that Affect Successful Treatment Outcome: Dae Bo Shim; Res Vestib Sci. 2023;22(1):1-6. Published online March 13, 2023; DOI: https://doi.org/10.21790/rvs.2023.22.1.1

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most common etiology of benign vestibulopathy. Various treatments for BPPV have been developed, and appropriate treatments for each subtype of BPPV have been provided and used in accordance with clinical practice guidelines published by the American Academy of Otorhinolaryngology-Head and Neck Surgery in 2008 and 2017. Although many therapeutic maneuvers have been reported to show high success rates in the treatment of BPPV patients, some cases are not effective even by appropriate therapeutic maneuvers. This article reviews various factors affecting the successful treatment of BPPV patients.

Medical Treatment of Nonvascular Central Vertigo: Seo-Young Choi, Kwang-Dong Choi; Res Vestib Sci. 2021;20(3):75-80. Published online September 15, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.3.75

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Abstract PDF: Central vertigo is the common symptom resulting from abnormalities in the central nervous system, caused by various diseases, which include neurodegenerative, vascular, inflammation, infection, tumor, paraneoplastic, toxic, or metabolic disorders. Since the treatment of central vertigo depends on the causes, an accurate diagnosis should be preceded the treatment through a detailed neurotologic examination and laboratory evaluation. Also, it is important to identify and document the neurologic findings accompanied by central vertigo, because some medication focuses on the ocular motor abnormalities as nystagmus or saccadic intrusion. Here, we will review the medical treatment for central vertigo.

Update of Treatment for Horizontal Canal Benign Paroxysmal Positional Vertigo: Evidence-Based Approach: Dae Bo Shim; Res Vestib Sci. 2017;16(2):47-52. Published online June 15, 2017; DOI: https://doi.org/10.21790/rvs.2017.16.2.47

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Abstract PDF: Horizontal canal benign paroxysmal positional vertigo (HC-BPPV) can be classified as either the geotropic or apogeotropic subtype by the pattern of nystagmus triggered by supine head roll test. Most studies have reported the geotropic subtype as a more common pathophysiology in HC-BPPV than the apogeotropic subtype. According to the BPPV clinical practice guideline provided by the American Academy of Otolaryngology-Head and Neck Surgery and American Academy of Neurology in 2008, variations of the roll maneuver (Lempert maneuver of barbecue roll maneuver) are the most widely published treatments for HC-BPPV. In addition, various treatment techniques including Gufoni maneuver, Vannuchi-Asprella liberatory maneuver and forced prolonged positioning have been applied for HC-BPPV. However, the guideline failed to provide specific treatment guidelines for HC-BPPV based on evidence-based researches since only Class IV data on HC-BPPV treatment were available at the point of 2008 when the BPPV clinical practice guideline was published. This review article focused on the evidences of the efficacy of various maneuvers in the treatment of HC-BPPV published after the BPPV clinical practice guidelines of 2008.

Symposium IIIs

Diagnosis and Treatment of Vertical Canal Benign Paroxysomal Positional Vertigo: Min Gu Lee, Sung Kwang Hong; Res Vestib Sci. 2013;12:S73-S76. Published online June 1, 2013

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is inner ear disorder caused by a displacement by otoconia from the utricle into semicircular canal (SCC). It is usually present as a definite vertigo spell induced by change in head position. Even though the posterior canal is by far most frequent, BPPV can involve any SCC. The diagnosis is confirmed by typical clinical presentation and positional tests. The aim of the review article was to provide a current opinion regarding vertical canal BPPV.

Treatment of Horizontal Canal Benign Paroxysmal Positional Vertigo: Sun-Young Oh; Res Vestib Sci. 2013;12:S77-S81. Published online June 1, 2013

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Abstract PDF: Several methods of physiotherapy have been advanced for benign paroxysmal positional vertigo involving horizontal semicircular canal (HC-BPPV). In this review article, the diagnosis and therapeutic maneuvers for HC-BPPV including recently published several randomized controlled trials 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.

Prediction of Successful Repositioning of Horizontal Canal Benign Positional Vertigo in Gufoni’s Maneuver: A Preliminary Study: Jeong Soo Moon, Jong Wook Shin, Hyun Jung Kim, In Chul Baek, Eung Seok Oh, Ji Eun Oh, Kyung Jae Lee, Ji Hee Lee, Jae Moon Kim, Seong Hae Jeong; Res Vestib Sci. 2010;9(3):108-113.

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Abstract PDF: Background and Objectives: Although several methods of repositioning maneuver have been introduced for the benign paroxysmal positional vertigo involving horizontal canal (HC-BPPV), no study has investigated the nystagmus pattern during the repositioning maneuver and its correlation with the repositioning results. Therefore, we evaluated the predictive value of the nystagmus for successful repositioning by studying the nystagmus pattern during the position of the Gufoni’s maneuver. Materials and Methods: Seventeen consecutive patients (age range=36~76 years, median age=64), with a diagnosis of HC-BPPV were recruited between July and August 2010. The Gufoni's maneuver for apogeotropic and geotropic nystagmus was performed. After 30 minutes, the treatment outcome was evaluated according to the nystagmus pattern at the individual stage of Gufoni’s maneuver. Successful treatment was defined by the resolution of positional vertigo in geotropic HC-BPPV and nystagmus shifted from apogeotropic to geotropic in apogeotropic HC-BPPV. Results: In the successfully treated patients, 4 of 6 patients had the contralesional nystagmus between 1st and 2nd position of Gufoni’s maneuver. Ipsilesional nystagmus in 1st position of Gufoni’s maneuver was observed in 1 patient with apogeotropic nystagmus. And the other 1 patient with Geotropic HC-BPPV showed no nystagmus in 2nd position after contralesional nystagmus in 1st position of Gufoni’s maneuver. Unsuccessfully treated 11 patients had a conversion of nystagmus direction in 2nd position after 1st step. Conclusion: During the 2nd position of the Gufoni’s maneuver, a nystagmus toward unaffected side predicts a successful repositioning, whereas reversed nystagmus is suggestive of poor response to repositioning.

A Clinical Significance of AAO-HNS guidelines for Meniere's Disease: Jun Ho Lee, Yun Hoon Choung, Keehyun Park, Min Jung Cho, Jinseok Lee, Yong Ro Yoon, Yun Tae Kim; J Korean Bal Soc. 2005;4(1):26-32.

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Abstract PDF: Background
and Objectives :The guidelines for Meniere's disease recommended from the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 1995, provided a basis for reporting results of the treatment used in Meniere's disease. However, these guidelines are sometimes not all inclusive and appropriate for management and reporting for some patients clinically considered having Meniere's disease. The objectives of this study is to review and analyze the symptoms, vertiginous episodes, audiometry, vestibular function test and results of the treatment in Meniere's disease and to evaluate the significance of AAO-HNS guidelines. Materials and Method : This study consisted of the patients with Meniere symptoms who visited the Dizziness Clinic of Ajou University Hospital between 1994 and 2001 were included in this study. The characteristics of dizziness (duration, frequency, and episodes), pure tone audiometry, vestibular function tests, and treatment results were carefully analyzed according to AAO-HNS guidelines.
Results
: Of 550 patients with Meniere symptoms, 198 patients were in the criteria for Meniere's disease. They were classified to 75 (37.9%) of the “definite”, 120 (60.6%) of the “possible”, and only 3 (1.5%) of the “probable”. In the “definite” group, the pure tone average (PTA) was 54.3 dB and canal paresis (CP) was showed in 33 patients (44%) with a mean CP of 53.6%, and the peak and descending types of the pure tone audiogram were dominant (62%). In the “possible” group, the PTA was 19.4dB and CP was found in 30 patients (25%) with mean CP of 50.1%.
Conclusion
: Even though AAO-HNS guidelines for Meniere's disease are helpful for communication between doctors, they should be considered to have limitations for the diagnosis and treatment in clinical practices.

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