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

  • Otology
  • Published:
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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.

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References

  1. Brandt T, Steddin S (1993) Current view of the mechanisms of benign paroxysmal positioning vertigo: cupulolithiasis or canalolithiasis? J Vestib Res 3:373–382

    CAS  PubMed  Google Scholar 

  2. Epley JM (1992) The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 107:399–404

    CAS  PubMed  Google Scholar 

  3. Semont A, Freyss G, Vitte E (1988) Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 42:290–293

    CAS  PubMed  Google Scholar 

  4. Di Girolamo S, Paludetti G, Briglia G et al (1998) Postural control in benign paroxysmal positional vertigo before and after recovery. Acta Otolaryngol 118:289–293

    Article  PubMed  Google Scholar 

  5. 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

    Google Scholar 

  6. 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):372–375

    Article  PubMed  Google Scholar 

  7. Giacomini PG, Alessandrini M, Magrini A (2002) Long-term postural abnormalities in benign paroxysmal positional vertigo. ORL J Otorhinolaryngol Relat Spec 64(4):237–241

    Article  PubMed  Google Scholar 

  8. Von Brevern M, Schmidt T, Schonfeld U, Lempert T, Clarke AH (2005) Utricular dysfunction in patients with benign paroxysmal positional vertigo. Otol Neurotol 27:92–96

    Article  Google Scholar 

  9. Dix MR, Hallpike CS (1952) The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Proc Soc Med 45:341–354

    CAS  Google Scholar 

  10. 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 48:89–105

    Article  CAS  PubMed  Google Scholar 

  11. Lindsay JR, Hemenway WG (1956) Postural vertigo due to unilateral sudden partial loss of vestibular function. Ann Otol 65:692–708

    Google Scholar 

  12. 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 4:107–110

    Article  Google Scholar 

  13. Gresty MA, Bronstein AM, Brandt T et al (1992) Neurology of otolith function: peripheral and central disorders. Brain 115:647–673

    Article  PubMed  Google Scholar 

  14. Headache Classification Committee of the International Headache Society (2004) The international classification of headache disorders. Cephalalgia 24(Suppl 1):1–60

    Google Scholar 

  15. Zung WWK (1971) A rating instrument for anxiety disorders. Psychosomatics 12:371–379

    Article  CAS  PubMed  Google Scholar 

  16. Faralli M, Ricci G, Molini E et al (2007) Determining subjective visual vertical: dynamic versus static testing. Otol Neurotol 28:1069–1071

    Article  PubMed  Google Scholar 

  17. 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 29:245–250

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Böhmer A, Rickenmann J (1995) The subjective visual vertical as a clinical parameter of vestibular function in peripheral vestibular diseases. J Vestib Res 5:35–45

    Article  PubMed  Google Scholar 

  19. Jacobson GP, Newman CW (1990) The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 116(4):424–427

    Article  CAS  PubMed  Google Scholar 

  20. 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):190

    CAS  PubMed  PubMed Central  Google Scholar 

  21. 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 38:307–311

    Article  PubMed  Google Scholar 

  22. 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):1297–1303

    Article  PubMed  PubMed Central  Google Scholar 

  23. 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):133–139

    CAS  PubMed  Google Scholar 

  24. Lindsay JR, Hemeneway WG (1956) Postural vertigo due to unilateral sudden partial loss of vestibular function. Ann Otol Rhino Laryngol 65:692–708

    Article  Google Scholar 

  25. Treleaven J (2008) Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther 13(1):2–11

    Article  PubMed  Google Scholar 

  26. 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):375–380

    PubMed  Google Scholar 

  27. 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):507–511

    Article  PubMed  Google Scholar 

  28. Gall RM, Ireland DJ, Robertson DD (1999) Subjective visual vertical in patients with benign paroxysmal positional vertigo. J Otolaryngol 28:162–165

    CAS  PubMed  Google Scholar 

  29. Vannucchi P (2003) La verticale e/o orizzontale visiva soggettiva. Acta Otorhinolaryngol Ital 5(Suppl 75):74–79

    Google Scholar 

  30. 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 23:79–83

    Article  PubMed  Google Scholar 

  31. 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

    Google Scholar 

  32. 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):608–614

    Article  PubMed  Google Scholar 

  33. 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):74–81

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Otolaryngology-Head and Neck Surgery, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy

    Mario Faralli, Ruggero Lapenna, Giorgia Giommetti, Cristina Pellegrino & Giampietro Ricci

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  1. Mario Faralli
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  2. Ruggero Lapenna
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  3. Giorgia Giommetti
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  4. Cristina Pellegrino
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  5. Giampietro Ricci
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Correspondence to Ruggero Lapenna.

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Faralli, M., Lapenna, R., Giommetti, G. et al. Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis. Eur Arch Otorhinolaryngol 273, 3157–3165 (2016). https://doi.org/10.1007/s00405-016-3947-z

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  • DOI: https://doi.org/10.1007/s00405-016-3947-z

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