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Erschienen in: European Archives of Oto-Rhino-Laryngology 10/2016

29.02.2016 | Otology

Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis

verfasst von: Mario Faralli, Ruggero Lapenna, Giorgia Giommetti, Cristina Pellegrino, Giampietro Ricci

Erschienen in: European Archives of Oto-Rhino-Laryngology | Ausgabe 10/2016

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Abstract

Residual dizziness (RD) following the resolution of a benign paroxysmal positional vertigo (BBPV) episode is frequently reported by patients. Possible causes are still under debate in the literature. This study discusses the possible role of otolithic function and of elapsed time from onset of symptoms to diagnosis in the genesis of RD. In total, 116 patients younger than 65 years with their first episode of BPPV and without any other comorbidities were enrolled in the study. Before a bedside examination, subjective visual vertical (SVV) was determined in the case of a history suggestive of BPPV. SVV was tested 1 week later in those patients with BPPV of the posterior semicircular canal, and in whom positioning maneuvers showed resolution of BPPV. At 1 week control, reported RD and Dizziness Handicap Inventory (DHI) were recorded. Diagnosis and treatment of BPPV occurred within 4 days in 43 patients (group A), between 5 and 8 days in 38 patients (group B) and in more than 9 days in 35 patients (group C). Higher values of reported RD and DHI were recorded in group C, while higher values of SVV deviation were recorded in group A with an inverse relationship between SVV and DHI. Initial peripheral vestibular function asymmetry due to BPPV can induce a new central adaptation. This adaptation becomes better established the longer otoconia remain floating in the endolymph. Because of these changes, the brain is unable to quickly readapt to the old pattern after resolution resulting in more persistent RD.
Literatur
1.
Zurück zum Zitat Brandt T, Steddin S (1993) Current view of the mechanisms of benign paroxysmal positioning vertigo: cupulolithiasis or canalolithiasis? J Vestib Res 3:373–382PubMed Brandt T, Steddin S (1993) Current view of the mechanisms of benign paroxysmal positioning vertigo: cupulolithiasis or canalolithiasis? J Vestib Res 3:373–382PubMed
2.
Zurück zum Zitat Epley JM (1992) The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 107:399–404PubMed Epley JM (1992) The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 107:399–404PubMed
3.
Zurück zum Zitat Semont A, Freyss G, Vitte E (1988) Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 42:290–293PubMed Semont A, Freyss G, Vitte E (1988) Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 42:290–293PubMed
4.
Zurück zum Zitat Di Girolamo S, Paludetti G, Briglia G et al (1998) Postural control in benign paroxysmal positional vertigo before and after recovery. Acta Otolaryngol 118:289–293CrossRefPubMed Di Girolamo S, Paludetti G, Briglia G et al (1998) Postural control in benign paroxysmal positional vertigo before and after recovery. Acta Otolaryngol 118:289–293CrossRefPubMed
5.
Zurück zum Zitat Lee NH, Kwon HJ, Ban JH (2008) Analysis of residual symptoms after treatment in benign paroxysmal positional vertigo using questionnaire. Otolaryngol Head Neck Surg 14(2):232–236 Lee NH, Kwon HJ, Ban JH (2008) Analysis of residual symptoms after treatment in benign paroxysmal positional vertigo using questionnaire. Otolaryngol Head Neck Surg 14(2):232–236
6.
Zurück zum Zitat Di Girolamo S, Ottaviani F, Scarano E, Picciotti P, Di Nardo W (2000) Postural control in horizontal benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 257(7):372–375CrossRefPubMed Di Girolamo S, Ottaviani F, Scarano E, Picciotti P, Di Nardo W (2000) Postural control in horizontal benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 257(7):372–375CrossRefPubMed
7.
Zurück zum Zitat Giacomini PG, Alessandrini M, Magrini A (2002) Long-term postural abnormalities in benign paroxysmal positional vertigo. ORL J Otorhinolaryngol Relat Spec 64(4):237–241CrossRefPubMed Giacomini PG, Alessandrini M, Magrini A (2002) Long-term postural abnormalities in benign paroxysmal positional vertigo. ORL J Otorhinolaryngol Relat Spec 64(4):237–241CrossRefPubMed
8.
Zurück zum Zitat Von Brevern M, Schmidt T, Schonfeld U, Lempert T, Clarke AH (2005) Utricular dysfunction in patients with benign paroxysmal positional vertigo. Otol Neurotol 27:92–96CrossRef Von Brevern M, Schmidt T, Schonfeld U, Lempert T, Clarke AH (2005) Utricular dysfunction in patients with benign paroxysmal positional vertigo. Otol Neurotol 27:92–96CrossRef
9.
Zurück zum Zitat Dix MR, Hallpike CS (1952) The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Proc Soc Med 45:341–354 Dix MR, Hallpike CS (1952) The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Proc Soc Med 45:341–354
10.
Zurück zum Zitat Cawthorne TE, Hallpike CS (1957) A study of the clinical features and pathologic changes within the temporal bones, brain stem and cerebellum of an early case of positional nystagmus of the so called benign paroxysmal type. Acta Otolaryngol 48:89–105CrossRefPubMed Cawthorne TE, Hallpike CS (1957) A study of the clinical features and pathologic changes within the temporal bones, brain stem and cerebellum of an early case of positional nystagmus of the so called benign paroxysmal type. Acta Otolaryngol 48:89–105CrossRefPubMed
11.
Zurück zum Zitat Lindsay JR, Hemenway WG (1956) Postural vertigo due to unilateral sudden partial loss of vestibular function. Ann Otol 65:692–708 Lindsay JR, Hemenway WG (1956) Postural vertigo due to unilateral sudden partial loss of vestibular function. Ann Otol 65:692–708
12.
Zurück zum Zitat Seok JI, Lee HM, Yoo JH, Lee DK (2008) Residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo. J Clin Neurotol 4:107–110CrossRef Seok JI, Lee HM, Yoo JH, Lee DK (2008) Residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo. J Clin Neurotol 4:107–110CrossRef
13.
Zurück zum Zitat Gresty MA, Bronstein AM, Brandt T et al (1992) Neurology of otolith function: peripheral and central disorders. Brain 115:647–673CrossRefPubMed Gresty MA, Bronstein AM, Brandt T et al (1992) Neurology of otolith function: peripheral and central disorders. Brain 115:647–673CrossRefPubMed
14.
Zurück zum Zitat Headache Classification Committee of the International Headache Society (2004) The international classification of headache disorders. Cephalalgia 24(Suppl 1):1–60 Headache Classification Committee of the International Headache Society (2004) The international classification of headache disorders. Cephalalgia 24(Suppl 1):1–60
15.
16.
Zurück zum Zitat Faralli M, Ricci G, Molini E et al (2007) Determining subjective visual vertical: dynamic versus static testing. Otol Neurotol 28:1069–1071CrossRefPubMed Faralli M, Ricci G, Molini E et al (2007) Determining subjective visual vertical: dynamic versus static testing. Otol Neurotol 28:1069–1071CrossRefPubMed
17.
Zurück zum Zitat Faralli M, Longari F, Ricci G, Ibba MC, Frenguelli A (2009) Influence of extero- and proprioceptive afferents of the plantar surface in determining subjective visual vertical in patients with unilateral vestibular dysfunction. Acta Otorhinolaryngol Ital 29:245–250PubMedPubMedCentral Faralli M, Longari F, Ricci G, Ibba MC, Frenguelli A (2009) Influence of extero- and proprioceptive afferents of the plantar surface in determining subjective visual vertical in patients with unilateral vestibular dysfunction. Acta Otorhinolaryngol Ital 29:245–250PubMedPubMedCentral
18.
Zurück zum Zitat Böhmer A, Rickenmann J (1995) The subjective visual vertical as a clinical parameter of vestibular function in peripheral vestibular diseases. J Vestib Res 5:35–45CrossRefPubMed Böhmer A, Rickenmann J (1995) The subjective visual vertical as a clinical parameter of vestibular function in peripheral vestibular diseases. J Vestib Res 5:35–45CrossRefPubMed
19.
Zurück zum Zitat Jacobson GP, Newman CW (1990) The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 116(4):424–427CrossRefPubMed Jacobson GP, Newman CW (1990) The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 116(4):424–427CrossRefPubMed
20.
Zurück zum Zitat Nola G, Mostardini C, Salvi C, Ercolani AP, Ralli G (2010) Validity of Italian adaptation of the Dizziness Handicap Inventory (DHI) and evaluation of the quality of life in patients with acute dizziness. Acta Otorhinolaryngol Ital 30(4):190PubMedPubMedCentral Nola G, Mostardini C, Salvi C, Ercolani AP, Ralli G (2010) Validity of Italian adaptation of the Dizziness Handicap Inventory (DHI) and evaluation of the quality of life in patients with acute dizziness. Acta Otorhinolaryngol Ital 30(4):190PubMedPubMedCentral
21.
Zurück zum Zitat Faralli M, Manzari L, Panichi R, Botti F, Ricci G, Longari F, Pettorossi VE (2011) Subjective visual vertical before and after treatment of BPPV episode. Auris Nasus Larynx 38:307–311CrossRefPubMed Faralli M, Manzari L, Panichi R, Botti F, Ricci G, Longari F, Pettorossi VE (2011) Subjective visual vertical before and after treatment of BPPV episode. Auris Nasus Larynx 38:307–311CrossRefPubMed
22.
Zurück zum Zitat Bremova T, Bayer O, Agrawal Y, Kremmyda O, Brandt T, Teufel J, Strupp M (2013) Ocular VEMPs indicate repositioning of otoconia to the utricle after successful liberatory maneuvers in benign paroxysmal positioning vertigo. Acta Otolaryngol 133(12):1297–1303CrossRefPubMedPubMedCentral Bremova T, Bayer O, Agrawal Y, Kremmyda O, Brandt T, Teufel J, Strupp M (2013) Ocular VEMPs indicate repositioning of otoconia to the utricle after successful liberatory maneuvers in benign paroxysmal positioning vertigo. Acta Otolaryngol 133(12):1297–1303CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Faralli M, Cipriani L, Del Zompo MR, Panichi R, Calzolaro L, Ricci G (2014) Benign paroxysmal positional vertigo and migraine. Analysis of 186 cases. B-ENT 10(2):133–139PubMed Faralli M, Cipriani L, Del Zompo MR, Panichi R, Calzolaro L, Ricci G (2014) Benign paroxysmal positional vertigo and migraine. Analysis of 186 cases. B-ENT 10(2):133–139PubMed
24.
Zurück zum Zitat Lindsay JR, Hemeneway WG (1956) Postural vertigo due to unilateral sudden partial loss of vestibular function. Ann Otol Rhino Laryngol 65:692–708CrossRef Lindsay JR, Hemeneway WG (1956) Postural vertigo due to unilateral sudden partial loss of vestibular function. Ann Otol Rhino Laryngol 65:692–708CrossRef
25.
Zurück zum Zitat Treleaven J (2008) Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther 13(1):2–11CrossRefPubMed Treleaven J (2008) Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther 13(1):2–11CrossRefPubMed
26.
Zurück zum Zitat Faralli M, Ricci G, Ibba MC, Crognoletti M, Longari F, Frenguelli A (2009) Dizziness in patients with recent episodes of benign paroxysmal positional vertigo: real otolithic dysfunction or mental stress? J Otolaryngol Head Neck Surg 38(3):375–380PubMed Faralli M, Ricci G, Ibba MC, Crognoletti M, Longari F, Frenguelli A (2009) Dizziness in patients with recent episodes of benign paroxysmal positional vertigo: real otolithic dysfunction or mental stress? J Otolaryngol Head Neck Surg 38(3):375–380PubMed
27.
Zurück zum Zitat Teggi R, Giordano L, Bondi S, Fabiano B, Bussi M (2011) Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo in the elderly. Eur Arch Otorhinolaryngol 268(4):507–511CrossRefPubMed Teggi R, Giordano L, Bondi S, Fabiano B, Bussi M (2011) Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo in the elderly. Eur Arch Otorhinolaryngol 268(4):507–511CrossRefPubMed
28.
Zurück zum Zitat Gall RM, Ireland DJ, Robertson DD (1999) Subjective visual vertical in patients with benign paroxysmal positional vertigo. J Otolaryngol 28:162–165PubMed Gall RM, Ireland DJ, Robertson DD (1999) Subjective visual vertical in patients with benign paroxysmal positional vertigo. J Otolaryngol 28:162–165PubMed
29.
Zurück zum Zitat Vannucchi P (2003) La verticale e/o orizzontale visiva soggettiva. Acta Otorhinolaryngol Ital 5(Suppl 75):74–79 Vannucchi P (2003) La verticale e/o orizzontale visiva soggettiva. Acta Otorhinolaryngol Ital 5(Suppl 75):74–79
30.
Zurück zum Zitat Pollak L, Davies RA, Luxon LL (2002) Effectiveness of the particle repositioning maneuver in benign paroxysmal positional vertigo with and without additional vestibular pathology. Otol Neurotol 23:79–83CrossRefPubMed Pollak L, Davies RA, Luxon LL (2002) Effectiveness of the particle repositioning maneuver in benign paroxysmal positional vertigo with and without additional vestibular pathology. Otol Neurotol 23:79–83CrossRefPubMed
31.
Zurück zum Zitat Jung HJ, Koo JW, Kim CS, Kim JS, Song JJ (2013) Anxiolytics reduce residual dizziness after successful canalith repositioning maneuvers in benign paroxysmal positional vertigo. Acta Otolaryngol 27(5):259–263 Jung HJ, Koo JW, Kim CS, Kim JS, Song JJ (2013) Anxiolytics reduce residual dizziness after successful canalith repositioning maneuvers in benign paroxysmal positional vertigo. Acta Otolaryngol 27(5):259–263
32.
Zurück zum Zitat Kim HA, Lee H (2014) Autonomic dysfunction as a possible cause of residual dizziness after successful treatment in benign paroxysmal positional vertigo. Clin Neurophysiol 125(3):608–614CrossRefPubMed Kim HA, Lee H (2014) Autonomic dysfunction as a possible cause of residual dizziness after successful treatment in benign paroxysmal positional vertigo. Clin Neurophysiol 125(3):608–614CrossRefPubMed
33.
Zurück zum Zitat Teggi R, Quaglieri S, Gatti O, Benazzo M, Bussi M (2013) Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo. ORL J Otorhinolaryngol Relat Spec 75(2):74–81CrossRefPubMed Teggi R, Quaglieri S, Gatti O, Benazzo M, Bussi M (2013) Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo. ORL J Otorhinolaryngol Relat Spec 75(2):74–81CrossRefPubMed
Metadaten
Titel
Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis
verfasst von
Mario Faralli
Ruggero Lapenna
Giorgia Giommetti
Cristina Pellegrino
Giampietro Ricci
Publikationsdatum
29.02.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
European Archives of Oto-Rhino-Laryngology / Ausgabe 10/2016
Print ISSN: 0937-4477
Elektronische ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-016-3947-z

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