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      Vértigo posicional paroxístico benigno: Factores de riesgo asociados y eficacia de las maniobras de reposición Translated title: Benign paroxysmal positional vertigo: Associated risk factors and efficacy of particle repositioning maneuvers

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          Abstract

          RESUMEN Introducción: El vértigo posicional paroxístico benigno (VPPB) es el vértigo periférico más frecuente. El tratamiento depende del compromiso de los canales semicirculares (CSC) y/o cúpulas, y consiste en maniobras de reposición de partículas. Objetivo: Evaluar los factores de riesgo asociados al VPPB en pacientes atendidos en el Servicio de Otorrinolaringología de la Red de Salud UC Christus. Evaluar la tasa de éxito de las maniobras de reposición. Material y método: Estudio retrospectivo. Se revisaron casos de VPPB con indicación de maniobras de reposición durante los años 2016-2017. Se obtuvo información demográfica, antecedentes médicos, la maniobra realizada y su éxito. Se evaluaron comorbilidades y temporada del año. Resultados: Se incluyeron 195 consultas, realizándose 293 maniobras. La mayoría de los pacientes fueron mujeres (74%) con edad promedio de 63 años. Comorbilidades más frecuentes fueron hipertensión, dislipidemia y diabetes mellitus. El 20% presentó una hipofunción vestibular concomitante, 23% presentó antecedentes de VPPB y 8% compromiso bilateral. Canalolitiasis del CSC posterior fue predominante (90%). En el 77,3% se resuelve el caso con una maniobra. Los casos fueron más frecuentes en primavera y otoño. Conclusiones: El VPPB fue más frecuente en mujeres, con una edad promedio de 63 años. La mayoría presentó canalolitiasis unilateral lográndose resolución con una maniobra de reposición.

          Translated abstract

          ABSTRACT Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. The treatment depends on the semicircular canal (SCC) and/or cupula involved and consists of particle repositioning maneuvers. Aim: Analyze risk factors associated with BPPV for patients seen at the otorhinolaryngology department of the UC Christus health center. Evaluate the success rate of the repositioning maneuvers. Material and methods: Retrospective study. All cases of BPPV for which a repositioning maneuver was prescribed during the years 2016-2017 were reviewed. Data obtained includes demographics, medical history, maneuver performed, and its success rate. Comorbidities and seasonality were evaluated. Results: 195 cases were included; with 293 maneuvers. The majority were women (74%), and the average age was 63 years. Common comorbidities were hypertension, dyslipidemia and diabetes mellitus. Concurrently, 20% had unilateral vestibular hypofunction, 23% had a history of BPPV, and 8% had bilateral involvement. Posterior SCC canalithiasis was most common (90%). In 77.3%, the case was resolved with one maneuver. Cases were most frequent in the spring and autumn season. Conclusion: BPPV was more common in women with an average age of 63 years. The majority of patients presented with unilateral canalithiasis obtaining a complete recovery with a single maneuver.

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          Most cited references31

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          The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo.

          J M Epley (1992)
          The Canalith Repositioning Procedure (CRP) is designed to treat benign paroxysmal positional vertigo (BPPV) through induced out-migration of free-moving pathological densities in the endolymph of a semicircular canal, using timed head maneuvers and applied vibration. This article describes the procedure and its rationale, and reports the results in 30 patients who exhibited the classic nystagmus of BPPV with Hallpike maneuvers. CRP obtained timely resolution of the nystagmus and positional vertigo in 100%. Of these, 10% continued to have atypical symptoms, suggesting concomitant pathology; 30% experienced one or more recurrences, but responded well to retreatment with CRP. These results also support an alternative theory that the densities that impart gravity-sensitivity to a semicircular canal in BPPV are free in the canal, rather than attached to the cupula. CRP offers significant advantages over invasive and other noninvasive treatment modalities in current use.
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            Repositioning maneuver for the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo.

            The purpose of this study was to determine the effectiveness of a new physical maneuver in the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. Case review. Outpatient clinic. The diagnosis of apogeotropic horizontal canal benign paroxysmal positional vertigo was based on the history of recurrent sudden crisis of vertigo associated with bursts of horizontal apogeotropic paroxysmal nystagmus provoked by turning the head from the supine to either lateral position. The patients were three men and five women ranging in age from 31 to 73 years (average, 49.2 yr). All patients were treated with a repositioning maneuver based on the hypothesis that the syndrome is caused by the presence of free-floating dense particles inside the endolymph of the anterior arm of the horizontal canal. The maneuver favors their shifting into the posterior arm of the canal. Patients were reexamined immediately after the treatment and underwent Gufoni's liberatory maneuver for the geotropic variant of horizontal canal benign paroxysmal positional vertigo. The treatment outcome was considered as responsive when, after one repositioning maneuver, nystagmus shifted from apogeotropic to geotropic. The repositioning maneuver resulted in a transformation from the apogeotropic variant into a geotropic variant of horizontal canal benign paroxysmal positional vertigo in all patients. This maneuver represents a simple and effective approach to the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. It favors the shifting of the canaliths from the anterior into the posterior arm of the horizontal canal from where they can migrate into the utricle with Gufoni's maneuver.
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              Vértigo posicional paroxístico benigno: criterios diagnósticos. Documento de consenso del Comité para la Clasificación de los Trastornos Vestibulares de la Bárány Society

              This article presents operational diagnostic criteria for benign paroxysmal positional vertigo (BPPV), formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society. The classification reflects current knowledge of clinical aspects and pathomechanisms of BPPV and includes both established and emerging syndromes of BPPV. It is anticipated that growing understanding of the disease will lead to further development of this classification.
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                Author and article information

                Journal
                orl
                Revista de otorrinolaringología y cirugía de cabeza y cuello
                Rev. Otorrinolaringol. Cir. Cabeza Cuello
                Sociedad Chilena de Otorrinolaringología, Medicina y Cirugía de Cabeza y Cuello (Santiago, , Chile )
                0718-4816
                March 2020
                : 80
                : 1
                : 19-27
                Affiliations
                [1] Santiago Santiago de Chile orgnamePontificia Universidad Católica de Chile orgdiv1Departamento de Otorrinolaringología Chile
                Article
                S0718-48162020000100019 S0718-4816(20)08000100019
                60c72ccb-d3fe-4e15-988a-15c91bfada9e

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 17 August 2019
                : 21 November 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 31, Pages: 9
                Product

                SciELO Chile

                Categories
                ARTÍCULOS DE INVESTIGACIÓN

                benign,paroxístico,maniobras,paroxysmal,maneuvers,posicional,benigno,Vértigo periférico,Peripheral vertigo,positional

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