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      Residual Dizziness after Successful Repositioning Maneuver for Idiopathic Benign Paroxysmal Positional Vertigo: A Review

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          Abstract

          The benign paroxysmal positional vertigo (BPPV) is a vestibular disorder cause of vertigo. The BPPV may be corrected mechanically by repositioning maneuvers but even after successful maneuvers, some patients report residual dizziness for a certain period afterward. Early recognition and treatment might decrease the incidence of residual dizziness in patients with BPPV, especially in those patients with psychiatric comorbidities and in the elderly, lowering the risk of falling. Many pathogenetic hypotheses for residual dizziness are under debate.

          The purpose of this review was to identify, evaluate and review recent researches about possible causal factors involved in residual dizziness and the implications on clinical practice. A literature search was performed using different databases such as Pubmed and Scopus. The following search terms were used: residual dizziness, otolithic membrane and BPPV. The search found a total of 1192 titles, which were reduced to 963 after a procedure of de-duplication of the found titles. The research was then restricted to an interval of time comprised between 2000 and 2016 for a total of 800 titles. Among these titles, only those including the terms benign paroxysmal positional vertigo were considered eligible for this review. Only publications in English language were taken into consideration and we excluded those with not available abstract. Finally, 90 abstracts were obtained and critically evaluated by two different Authors, and additional studies were identified by hand searching from the references of artiche of interest. Only 53 were included in this work.

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          Most cited references52

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          Epidemiology of benign paroxysmal positional vertigo: a population based study.

          To examine the prevalence and incidence, clinical presentation, societal impact and comorbid conditions of benign paroxysmal positional vertigo (BPPV) in the general population. Cross-sectional, nationally representative neurotological survey of the general adult population in Germany with a two stage sampling design: screening of 4869 participants from the German National Telephone Health Interview Survey 2003 (response rate 52%) for moderate or severe dizziness or vertigo, followed by validated neurotological interviews (n = 1003; response rate 87%). Diagnostic criteria for BPPV were at least five attacks of vestibular vertigo lasting <1 min without concomitant neurological symptoms and invariably provoked by typical changes in head position. In a concurrent validation study (n = 61) conducted in two specialised dizziness clinics, BPPV was detected by our telephone interview with a specificity of 92% and a sensitivity of 88% (positive predictive value 88%, negative predictive value 92%). BPPV accounted for 8% of individuals with moderate or severe dizziness/vertigo. The lifetime prevalence of BPPV was 2.4%, the 1 year prevalence was 1.6% and the 1 year incidence was 0.6%. The median duration of an episode was 2 weeks. In 86% of affected individuals, BPPV led to medical consultation, interruption of daily activities or sick leave. In total, only 8% of affected participants received effective treatment. On multivariate analysis, age, migraine, hypertension, hyperlipidaemia and stroke were independently associated with BPPV. BPPV is a common vestibular disorder leading to significant morbidity, psychosocial impact and medical costs.
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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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              Diagnosis and management of benign paroxysmal positional vertigo (BPPV).

              There is compelling evidence that free-floating endolymph particles in the posterior semicircular canal underlie most cases of benign paroxysmal positional vertigo (BPPV). Recent pathological findings suggest that these particles are otoconia, probably displaced from the otolithic membrane in the utricle. They typically settle in the dependent posterior canal and render it sensitive to gravity. Well over 90% of patients can be successfully treated with a simple outpatient manoeuvre that moves the particles back into the utricle. We describe the various techniques for this manoeuvre, plus treatments for uncommon variants of BPPV such as that of the lateral canal. For the rare patient whose BPPV is not responsive to these manoeuvres and has severe symptoms, posterior canal occlusion surgery is a safe and highly effective procedure.
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                Author and article information

                Journal
                Audiol Res
                Audiol Res
                AUDIO
                Audiology Research
                PAGEPress Publications, Pavia, Italy
                2039-4330
                2039-4349
                09 May 2017
                01 February 2017
                : 7
                : 1
                : 178
                Affiliations
                [1 ] Section of Otolaryngology-Head and Neck Surgery, Department of Surgical and Biomedical Sciences, University of Perugia , Corciano (PG), Italy
                [2 ] Department of Experimental Medicine, University of Perugia , Corciano (PG), Italy
                [3 ] Section of Otorhinolaryngology, Gubbio-Gualdo Tadino Hospital, ASL Umbria 1, Perugia; and Association “Naso Sano” Onlus, Umbria Regional Registry of Volunteer Activities , Corciano (PG), Italy
                Author notes
                Clinica di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Ospedale Santa Maria della Misericordia -Sant'Andrea delle Fratte, Perugia, Italy. +39.075.5783236. giorgia.giommetti@ 123456libero.it

                Contributions: GG, research strategy design, data acquisition; GG, RL, FL, GR, MF, data analysis and interpretation, critical revise for important intellectual content, final approval of the version to be published; RP, data analysis and interpretation, language revise, critical revise for important intellectual content; PDM, data acquisition, data analysis and interpretation, language revise; MF, work conception.

                Article
                10.4081/audiores.2017.178
                5452628
                28603599
                6c08c4ee-4666-4d98-8204-afded21322da
                ©Copyright G. Giommetti et al, 2017

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 07 March 2017
                : 19 April 2017
                Page count
                Figures: 1, Tables: 0, Equations: 0, References: 57, Pages: 7
                Categories
                Review

                residual dizziness,benign paroxysmal positional vertigo,repositioning maneuver

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