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Dizziness handicap and clinical characteristics of posterior and lateral canal BPPV

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Benign paroxysmal positional vertigo (BPPV) is diagnosed and divided into subtypes based on positioning vertigo and nystagmus. Whether these subtypes entail any significant differences in patient-reported symptoms; is yet not known. Such differences may have clinical and therapeutic consequences. Our aim was to assess dizziness handicap and clinical characteristics of posterior and lateral canal BPPV.

Methods

This prospective observational multicentre study analysed consecutive patients with BPPV, confirmed by standardized procedures including videonystagmography under diagnostic manoeuvres in a biaxial rotational chair. Patients were screened for other neurological and otological disorders.

Outcomes

Dizziness handicap inventory (DHI), posterior vs. lateral canal involvement. Factors: age, gender, positional nystagmus intensity (maximum slow-phase velocity), symptom duration, 25-hydroxyvitamin D-level and traumatic aetiology.

Results

132 patients aged 27–90 (mean 57, SD 13) years were included. Higher DHI scores were associated with lateral canal BPPV [95% CI (1.59–13.95), p = 0.01] and female gender [95% CI (0.74–15.52), p = 0.03]. Lateral canal BPPV was associated with longer symptom duration [OR 1.10, CI (1.03–1.17), p = 0.01] and lower 25-hydroxyvitamin D-levels [OR 0.80, CI (0.67–0.95), p = 0.03]. There was no correlation between DHI scores and nystagmus intensity.

Conclusions

This study suggests that patients with lateral canal BPPV have increased patient-perceived disability, lower vitamin D-levels and longer duration of symptoms. This subtype might therefore require closer follow-up. Patient-perceived disability is not related to positional nystagmus intensity.

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References

  1. Neuhauser HK (2016) The epidemiology of dizziness and vertigo. Handb Clin Neurol 137:67–82. https://doi.org/10.1016/B978-0-444-63437-5.00005-4

    Article  CAS  Google Scholar 

  2. D'Silva LJ, Whitney SL, Santos M, Dai H, Kluding PM (2017) The impact of diabetes on mobility, balance, and recovery after repositioning maneuvers in individuals with benign paroxysmal positional vertigo. J Diabetes Complicat 31(6):976–982. https://doi.org/10.1016/j.jdiacomp.2017.03.006

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lopez-Escamez JA, Gamiz MJ, Fernandez-Perez A, Gomez-Finana M (2005) Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo. European Arch Oto-rhino-laryngol 262(6):507–511. https://doi.org/10.1007/s00405-004-0841-x

    Article  Google Scholar 

  4. Obermann M, Bock E, Sabev N, Lehmann N, Weber R, Gerwig M, Frings M, Arweiler-Harbeck D, Lang S, Diener HC (2015) Long-term outcome of vertigo and dizziness associated disorders following treatment in specialized tertiary care: the Dizziness and Vertigo Registry (DiVeR) Study. J Neurol 262(9):2083–2091. https://doi.org/10.1007/s00415-015-7803-7

    Article  PubMed  Google Scholar 

  5. Roberts RA, Abrams H, Sembach MK, Lister JJ, Gans RE, Chisolm TH (2009) Utility measures of health-related quality of life in patients treated for benign paroxysmal positional vertigo. Ear Hear 30(3):369–376. https://doi.org/10.1097/AUD.0b013e31819f316a

    Article  PubMed  Google Scholar 

  6. Kao WT, Parnes LS, Chole RA (2017) Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo. Laryngoscope 127(3):709–714. https://doi.org/10.1002/lary.26115

    Article  PubMed  Google Scholar 

  7. Moriarty B, Rutka J, Hawke M (1992) The incidence and distribution of cupular deposits in the labyrinth. Laryngoscope 102(1):56–59. https://doi.org/10.1288/00005537-199201000-00011

    Article  CAS  PubMed  Google Scholar 

  8. Schuknecht HF, Ruby RR (1973) Cupulolithiasis. Adv Otorhinolaryngol 20:434–443

    CAS  PubMed  Google Scholar 

  9. Kahraman SS, Ozcan O, Arli C, Ustun I, Erduran R, Akoglu E, Gokce C (2016) Calcium homeostasis during attack and remission in patients with idiopathic benign paroxysmal positional vertigo. Otol Neurotol 37(9):1388–1392. https://doi.org/10.1097/MAO.0000000000001167

    Article  PubMed  Google Scholar 

  10. Talaat HS, Abuhadied G, Talaat AS, Abdelaal MS (2015) Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo. Eur Arch Oto-rhino-laryngol 272(9):2249–2253. https://doi.org/10.1007/s00405-014-3175-3

    Article  Google Scholar 

  11. Cohen HS, Sangi-Haghpeykar H (2010) Nystagmus parameters and subtypes of benign paroxysmal positional vertigo. Acta Otolaryngol 130(9):1019–1023. https://doi.org/10.3109/00016481003664777

    Article  PubMed  Google Scholar 

  12. Hain TC, Squires TM, Stone HA (2005) Clinical implications of a mathematical model of benign paroxysmal positional vertigo. Ann N Y Acad Sci 1039:384–394. https://doi.org/10.1196/annals.1325.036

    Article  PubMed  Google Scholar 

  13. Kao WT, Parnes LS, Chole RA (2016) Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo. Laryngoscope. https://doi.org/10.1002/lary.26115

    Article  PubMed  PubMed Central  Google Scholar 

  14. von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D (2015) Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res Equilibr Orientat 25(3–4):105–117. https://doi.org/10.3233/VES-150553

    Article  Google Scholar 

  15. Johansson MS, Arlinger SD (2002) Hearing threshold levels for an otologically unscreened, non-occupationally noise-exposed population in Sweden. Int J Audiol 41(3):180–194

    Article  PubMed  Google Scholar 

  16. Martens C, Goplen FK, Nordfalk KF, Aasen T, Nordahl SH (2016) Prevalence and characteristics of positional nystagmus in normal subjects. Otolaryngol Head Neck Surg. https://doi.org/10.1177/0194599816629640

    Article  PubMed  Google Scholar 

  17. Tamber AL, Wilhelmsen KT, Strand LI (2009) Measurement properties of the dizziness handicap inventory by cross-sectional and longitudinal designs. Health Qual Life Outcomes 7:101. https://doi.org/10.1186/1477-7525-7-101

    Article  PubMed  PubMed Central  Google Scholar 

  18. Whitney SL, Wrisley DM, Brown KE, Furman JM (2004) Is perception of handicap related to functional performance in persons with vestibular dysfunction? Otol Neurotol 25(2):139–143

    Article  PubMed  Google Scholar 

  19. Muthén LK, Muthén BO (1998–2017) Mplus user’s guide, 8th edn. Muthén & Muthén, Los Angeles, CA

  20. Handa PR, Kuhn AM, Cunha F, Schaffleln R, Gananca FF (2005) Quality of life in patients with benign paroxysmal positional vertigo and/or Meniere's disease. Braz J Otorhinolaryngol 71(6):776–782

    Article  PubMed  Google Scholar 

  21. Saxena A, Prabhakar MC (2013) Performance of DHI score as a predictor of benign paroxysmal positional vertigo in geriatric patients with dizziness/vertigo: a cross-sectional study. PLoS ONE 8(3):e58106. https://doi.org/10.1371/journal.pone.0058106

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Shim DB, Ko KM, Lee JH, Park HJ, Song MH (2015) Natural history of horizontal canal benign paroxysmal positional vertigo is truly short. J Neurol 262(1):74–80. https://doi.org/10.1007/s00415-014-7519-0

    Article  PubMed  Google Scholar 

  23. Imai T, Takeda N, Ito M, Inohara H (2011) Natural course of positional vertigo in patients with apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. Auris Nasus Larynx 38(1):2–5. https://doi.org/10.1016/j.anl.2010.05.011

    Article  PubMed  Google Scholar 

  24. Imai T, Ito M, Takeda N, Uno A, Matsunaga T, Sekine K, Kubo T (2005) Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology 64(5):920–921. https://doi.org/10.1212/01.wnl.0000152890.00170.da

    Article  CAS  PubMed  Google Scholar 

  25. Kitahara T, Ota I, Horinaka A, Ohyama H, Sakagami M, Ito T, Shiozaki T, Wada Y, Yamanaka T (2018) Idiopathic benign paroxysmal positional vertigo with persistent vertigo/dizziness sensation is associated with latent canal paresis, endolymphatic hydrops, and osteoporosis. Auris Nasus Larynx. https://doi.org/10.1016/j.anl.2018.05.010

    Article  PubMed  Google Scholar 

  26. Kim MJ, Kim K-S, Joo YH, Park SY, Han GC (2012) The dizziness handicap inventory and its relationship with vestibular diseases. J Int Adv Otol 8(1):69–77

    Google Scholar 

  27. Yoo MH, Yang CJ, Kim SA, Park MJ, Ahn JH, Chung JW, Park HJ (2017) Efficacy of steroid therapy based on symptomatic and functional improvement in patients with vestibular neuritis: a prospective randomized controlled trial. Eur Arch Oto-rhino-laryngol 274(6):2443–2451. https://doi.org/10.1007/s00405-017-4556-1

    Article  Google Scholar 

  28. Soto-Varela A, Huertas-Pardo B, Gayoso-Diz P, Santos-Perez S, Sanchez-Sellero I (2016) Disability perception in Meniere's disease: when, how much and why? Eur Arch Oto-rhino-laryngol 273(4):865–872. https://doi.org/10.1007/s00405-015-3638-1

    Article  Google Scholar 

  29. Jeong SH, Choi SH, Kim JY, Koo JW, Kim HJ, Kim JS (2009) Osteopenia and osteoporosis in idiopathic benign positional vertigo. Neurology 72(12):1069–1076. https://doi.org/10.1212/01.wnl.0000345016.33983.e0

    Article  PubMed  Google Scholar 

  30. Jeong SH, Kim JS, Shin JW, Kim S, Lee H, Lee AY, Kim JM, Jo H, Song J, Ghim Y (2013) Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol 260(3):832–838. https://doi.org/10.1007/s00415-012-6712-2

    Article  CAS  PubMed  Google Scholar 

  31. Lee SB, Lee CH, Kim YJ, Kim HM (2017) Biochemical markers of bone turnover in benign paroxysmal positional vertigo. PLoS ONE 12(5):e0176011. https://doi.org/10.1371/journal.pone.0176011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Gordon CR, Levite R, Joffe V, Gadoth N (2004) Is posttraumatic benign paroxysmal positional vertigo different from the idiopathic form? Arch Neurol 61(10):1590–1593. https://doi.org/10.1001/archneur.61.10.1590

    Article  PubMed  Google Scholar 

  33. Baloh RW, Honrubia V, Jacobson K (1987) Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology 37(3):371–378

    Article  CAS  PubMed  Google Scholar 

  34. Gucluturk MT, Unal ZN, Ismi O, Cimen MB, Unal M (2016) The role of oxidative stress and inflammatory mediators in benign paroxysmal positional vertigo. J Int Adv Otol 12(1):101–105. https://doi.org/10.5152/iao.2015.1412

    Article  PubMed  Google Scholar 

  35. Tsai KL, Cheng YY, Leu HB, Lee YY, Chen TJ, Liu DH, Kao CL (2015) Investigating the role of Sirt1-modulated oxidative stress in relation to benign paroxysmal positional vertigo and Parkinson's disease. Neurobiol Aging 36(9):2607–2616. https://doi.org/10.1016/j.neurobiolaging.2015.05.012

    Article  CAS  PubMed  Google Scholar 

  36. Dal T, Ozluoglu LN, Ergin NT (2000) The canalith repositioning maneuver in patients with benign positional vertigo. Eur Arch Oto-rhino-laryngol 257(3):133–136

    Article  CAS  Google Scholar 

  37. Asawavichianginda S, Isipradit P, Snidvongs K, Supiyaphun P (2000) Canalith repositioning for benign paroxysmal positional vertigo: a randomized, controlled trial. Ear Nose Throat J 79(9):732–734 (736–737)

    Article  CAS  PubMed  Google Scholar 

  38. von Brevern M, Seelig T, Neuhauser H, Lempert T (2004) Benign paroxysmal positional vertigo predominantly affects the right labyrinth. J Neurol Neurosurg Psychiatry 75(10):1487–1488. https://doi.org/10.1136/jnnp.2003.031500

    Article  Google Scholar 

  39. Nuti D, Masini M, Mandala M (2016) Benign paroxysmal positional vertigo and its variants. Handb Clin Neurol 137:241–256. https://doi.org/10.1016/B978-0-444-63437-5.00018-2

    Article  CAS  PubMed  Google Scholar 

  40. Honrubia V, Baloh RW, Harris MR, Jacobson KM (1999) Paroxysmal positional vertigo syndrome. Am J Otol 20(4):465–470

    CAS  PubMed  Google Scholar 

  41. West N, Hansen S, Moller MN, Bloch SL, Klokker M (2016) Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome. Eur Arch Oto-rhino-laryngol 273(3):573–580. https://doi.org/10.1007/s00405-015-3583-z

    Article  Google Scholar 

  42. Chung KW, Park KN, Ko MH, Jeon HK, Choi JY, Cho YS, Hong SH, Chung WH (2009) Incidence of horizontal canal benign paroxysmal positional vertigo as a function of the duration of symptoms. Otol Neurotol 30(2):202–205

    Article  PubMed  Google Scholar 

  43. West N, Hansen S, Moller MN, Bloch SL, Klokker M (2015) Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome. Eur Arch Oto-rhino-laryngol. https://doi.org/10.1007/s00405-015-3583-z

    Article  Google Scholar 

  44. Steddin S, Ing D, Brandt T (1996) Horizontal canal benign paroxysmal positioning vertigo (h-BPPV): transition of canalolithiasis to cupulolithiasis. Ann Neurol 40(6):918–922. https://doi.org/10.1002/ana.410400615

    Article  CAS  PubMed  Google Scholar 

  45. Baloh RW, Jacobson K, Honrubia V (1993) Horizontal semicircular canal variant of benign positional vertigo. Neurology 43(12):2542–2549

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Thanks to the employees at the department of Otorhinolaryngology, Head and Neck Surgery, Haukeland, Bergen who have been helping me with the logistics. Special thanks to my cherished colleague Elisabeth Torkildsen, for her invaluable help with managing the collection and registration of data, and to Rolf Gjestad for his support of great value in data analysis.

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The authors have no funding and relationships.

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Authors and Affiliations

  1. Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, 5021, Bergen, Norway

    Camilla Martens, Frederik Kragerud Goplen, Torbjørn Aasen & Stein Helge Glad Nordahl

  2. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Camilla Martens, Frederik Kragerud Goplen & Stein Helge Glad Nordahl

  3. Department of Otorhinolaryngology and Head and Neck Surgery, Oslo University Hospital, Oslo, Norway

    Karl Fredrik Nordfalk

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  1. Camilla Martens
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  2. Frederik Kragerud Goplen
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Correspondence to Camilla Martens.

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Martens, C., Goplen, F.K., Aasen, T. et al. Dizziness handicap and clinical characteristics of posterior and lateral canal BPPV. Eur Arch Otorhinolaryngol 276, 2181–2189 (2019). https://doi.org/10.1007/s00405-019-05459-9

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  • DOI: https://doi.org/10.1007/s00405-019-05459-9

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