PRACTICAL GUIDELINE FOR BENIGN PAROXISMAL POSITIONAL VERTIGO
Abstract Introduction and objective: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vertigo, characterized by brief attacks of rotatory vertigo associated with nystagmus, which are elicited by specific changes in head position relative to gravity. The observation of positional nystagmus is essential for the diagnosis of BPPV. The treatment consists in maneuvers of canalith repositioning procedure to move otoconial debris from the affected semicircular canal to the utricle. These guidelines are intended for all who treat the BPPV in their work, with an intention to assist in the diagnosis and application of an appropriate therapeutic method. Method: The experience and analysis of different national and international consensus on BPPV, has allowed to a large group of ENT specialists of the Communities of Castilla y León, Cantabria and La Rioja (Spain), carry out this guide. Results: The different clinical entities are reviewed. BPPV of the posterior semicircular canal, horizontal canal and anterior canal, BPPV affecting several canals, atypical and central BPPV, subjective BPPV and the characteristics of this process in the elderly. Canalith repositioning procedures have been illustrated with explanatory drawings. Discussion and conclusions: Although the pathophysiology of BPPV is canalolithiasis comprising free-floating otoconial debris within the endolymph of a semicircular canal, or cupulolithiasis comprising otoconial debris adherent to the cupula, there are still many issues to be resolved. We think that the best way to find answers is part of using a common methodology in the diagnosis and treatment of these patients.
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Asprella-Libonati G: Vértigo posicional paroxístico benigno. En: Carmona S, Asprella G: Neuro-otología. Akadia. 3ª Ed. 2011. Cap 6; pp. 43-64.
PMid:22008871
Balatsouras DG, Koukoutsis G, Ganelis P, Korres GS, Kaberos A. Diagnosis of Single- or Multiple-Canal Benign Paroxysmal Positional Vertigo according to the Type of Nystagmus. Int J Otolaryngol. 2011;2011:483965. https://doi.org/10.1155/2011/483965 PMid:21792356 PMCid:PMC3139887
Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, Chalian AA, Desmond AL, Earll JM, Fife TD, Fuller DC, Judge JO, Mann NR, Rosenfeld RM, Schuring LT, Steiner RW, Whitney SL, Haidari J; American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008;139:S47-81. https://doi.org/10.1016/j.otohns.2008.08.022 PMid:18973840
Dix MR, Hallpike CS. The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med. 1952;45:341-54. https://doi.org/10.1177/000348945206100403
Kim JS, Zee DS. Clinical practice. Benign paroxysmal positional vertigo. N Engl J Med. 2014; 370:1138-47. https://doi.org/10.1056/NEJMcp1309481 PMid:24645946
López-Escámez JA. Abordaje práctico del vértigo posicional paroxístico benigno recurrente. Acta Otorrinolaringol Esp. 2008;59:413-9. https://doi.org/10.1016/S0001-6519(08)75990-9 - https://doi.org/10.1016/S2173-5735(08)70263-1
Nuti D, Masini M, Mandalà M. Benign paroxysmal positional vertigo and its variants. Handb Clin Neurol. 2016;137:241-56. https://doi.org/10.1016/B978-0-444-63437-5.00018-2 PMid:27638076
von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D. Benign paroxysmal positional vertigo: Diagnostic criteria. Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res. 2015;25(3-4):105-17. https://doi.org/10.3233/VES-150553 PMid:26756126
Bisdorff A, Von Brevern M, Lempert T, Newman-Toker DE. Classification of vestibular symptoms: Towards an international classification of vestibular disorders. Journal of Vestibular Research: 2009;19:1-13. PMid:19893191
Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2008;70:2067-74. https://doi.org/10.1212/01.wnl.0000313378.77444.ac PMid:18505980
Baloh RW, Jacobson K, Honrubia V. Horizontal semicircular canal variant of benign positional vertigo. Neurology. 1993; 43:2542-9. https://doi.org/10.1212/WNL.43.12.2542 PMid:8255454
Nuti D, Vannucchi P, Pagnini P. Benign paroxysmal positional vertigo of the horizontal canal: a form of canalolitiasis with variable clinical features. J Vestib R 1996:6:173-84. https://doi.org/10.1016/0957-4271(95)02010-1 https://doi.org/10.1016/0957-4271(95)02040-3
Casani A, Vannucchi G, Fattori B, Berrettini S. The treatment of horizontal canal positional vertigo: our experience in 66 cases. Laryngoscope. 2002; 112:172-8. https://doi.org/10.1097/00005537-200201000-00030 PMid:11802058
Amor Dorado JC, Rubio Rodríguez JP, Costa Ribas C, Rossi Vargas J. Diagnóstico y tratamiento de un caso de vértigo posicional paroxístico benigno del canal horizontal. Acta Otorrinolaringol Esp 2003;54:527-30. https://doi.org/10.1016/S0001-6519(03)78445-3
Lempert T, Tiel-Wilck K. A positional maneuver for treatment of horizontal-canal benign positional vertigo. Laryngoscope. 1996;106:476-8. https://doi.org/10.1097/00005537-199604000-00015 PMid:8614224
Ciniglio Appiani G, Catania G, Gagliardi M, Cuiuli G. Repositioning maneuver for the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo Otoneurotol 2005;26: 257-6.
Yacovino DA, Hain TC, Gualtieri F. New therapeutic maneuver for anterior canal benign paroxismal positional vértigo. J Neurol. 2009;256:1851. https://doi.org/10.1007/s00415-009-5208-1 PMid:19536580
Soto-Varela A, Rossi-Izquierdo M, Sanchez-Sellero I, Santos-Perez S. Revised criteria for suspicion of non-benign positional vértigo. Q J Med. 2013;106:317-21. https://doi.org/10.1093/qjmed/hct006 PMid:23404787
Esteban-Sanchez J, Rueda-Marcos A, Sanz-Fernández R, Martín-Sanz E. Nistagmo vertical inferior: ¿es obligada la resonancia magnética? Rev Neurol. 2016;62:107-12. PMid:26815847
Jung JY, Kim SH. Comparison between objective and subjective benign paroxysmal positional vertigo: clinical features and outcomes. Acta Otolaryngol. 2016;136:1267-72. https://doi.org/10.1080/00016489.2016.1203990 PMid:27388229
Plodpai Y, Atchariyasathian V, Khaimook W. The characteristic differences of benign paroxysmal positional vertigo among the elderly and the younger patients: A 10-year retrospective review. J Med Assoc Thai. 2014;97:850-5. PMid:25345261
Batuecas-Caletrio A, Trinidad-Ruiz G, Zschaeck C, Del Pozo de Dios J.C, De Toro Gil L., Martin-Sanchez V, Martin-Sanz E. Benign Paroxysmal Positional Vertigo in the Elderly. Gerontology. 2013;59:408-12. https://doi.org/10.1159/000351204 PMid:23689314
PMid:22008871
Balatsouras DG, Koukoutsis G, Ganelis P, Korres GS, Kaberos A. Diagnosis of Single- or Multiple-Canal Benign Paroxysmal Positional Vertigo according to the Type of Nystagmus. Int J Otolaryngol. 2011;2011:483965. https://doi.org/10.1155/2011/483965 PMid:21792356 PMCid:PMC3139887
Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, Chalian AA, Desmond AL, Earll JM, Fife TD, Fuller DC, Judge JO, Mann NR, Rosenfeld RM, Schuring LT, Steiner RW, Whitney SL, Haidari J; American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008;139:S47-81. https://doi.org/10.1016/j.otohns.2008.08.022 PMid:18973840
Dix MR, Hallpike CS. The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med. 1952;45:341-54. https://doi.org/10.1177/000348945206100403
Kim JS, Zee DS. Clinical practice. Benign paroxysmal positional vertigo. N Engl J Med. 2014; 370:1138-47. https://doi.org/10.1056/NEJMcp1309481 PMid:24645946
López-Escámez JA. Abordaje práctico del vértigo posicional paroxístico benigno recurrente. Acta Otorrinolaringol Esp. 2008;59:413-9. https://doi.org/10.1016/S0001-6519(08)75990-9 - https://doi.org/10.1016/S2173-5735(08)70263-1
Nuti D, Masini M, Mandalà M. Benign paroxysmal positional vertigo and its variants. Handb Clin Neurol. 2016;137:241-56. https://doi.org/10.1016/B978-0-444-63437-5.00018-2 PMid:27638076
von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D. Benign paroxysmal positional vertigo: Diagnostic criteria. Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res. 2015;25(3-4):105-17. https://doi.org/10.3233/VES-150553 PMid:26756126
Bisdorff A, Von Brevern M, Lempert T, Newman-Toker DE. Classification of vestibular symptoms: Towards an international classification of vestibular disorders. Journal of Vestibular Research: 2009;19:1-13. PMid:19893191
Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2008;70:2067-74. https://doi.org/10.1212/01.wnl.0000313378.77444.ac PMid:18505980
Baloh RW, Jacobson K, Honrubia V. Horizontal semicircular canal variant of benign positional vertigo. Neurology. 1993; 43:2542-9. https://doi.org/10.1212/WNL.43.12.2542 PMid:8255454
Nuti D, Vannucchi P, Pagnini P. Benign paroxysmal positional vertigo of the horizontal canal: a form of canalolitiasis with variable clinical features. J Vestib R 1996:6:173-84. https://doi.org/10.1016/0957-4271(95)02010-1 https://doi.org/10.1016/0957-4271(95)02040-3
Casani A, Vannucchi G, Fattori B, Berrettini S. The treatment of horizontal canal positional vertigo: our experience in 66 cases. Laryngoscope. 2002; 112:172-8. https://doi.org/10.1097/00005537-200201000-00030 PMid:11802058
Amor Dorado JC, Rubio Rodríguez JP, Costa Ribas C, Rossi Vargas J. Diagnóstico y tratamiento de un caso de vértigo posicional paroxístico benigno del canal horizontal. Acta Otorrinolaringol Esp 2003;54:527-30. https://doi.org/10.1016/S0001-6519(03)78445-3
Lempert T, Tiel-Wilck K. A positional maneuver for treatment of horizontal-canal benign positional vertigo. Laryngoscope. 1996;106:476-8. https://doi.org/10.1097/00005537-199604000-00015 PMid:8614224
Ciniglio Appiani G, Catania G, Gagliardi M, Cuiuli G. Repositioning maneuver for the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo Otoneurotol 2005;26: 257-6.
Yacovino DA, Hain TC, Gualtieri F. New therapeutic maneuver for anterior canal benign paroxismal positional vértigo. J Neurol. 2009;256:1851. https://doi.org/10.1007/s00415-009-5208-1 PMid:19536580
Soto-Varela A, Rossi-Izquierdo M, Sanchez-Sellero I, Santos-Perez S. Revised criteria for suspicion of non-benign positional vértigo. Q J Med. 2013;106:317-21. https://doi.org/10.1093/qjmed/hct006 PMid:23404787
Esteban-Sanchez J, Rueda-Marcos A, Sanz-Fernández R, Martín-Sanz E. Nistagmo vertical inferior: ¿es obligada la resonancia magnética? Rev Neurol. 2016;62:107-12. PMid:26815847
Jung JY, Kim SH. Comparison between objective and subjective benign paroxysmal positional vertigo: clinical features and outcomes. Acta Otolaryngol. 2016;136:1267-72. https://doi.org/10.1080/00016489.2016.1203990 PMid:27388229
Plodpai Y, Atchariyasathian V, Khaimook W. The characteristic differences of benign paroxysmal positional vertigo among the elderly and the younger patients: A 10-year retrospective review. J Med Assoc Thai. 2014;97:850-5. PMid:25345261
Batuecas-Caletrio A, Trinidad-Ruiz G, Zschaeck C, Del Pozo de Dios J.C, De Toro Gil L., Martin-Sanchez V, Martin-Sanz E. Benign Paroxysmal Positional Vertigo in the Elderly. Gerontology. 2013;59:408-12. https://doi.org/10.1159/000351204 PMid:23689314
Benito-Orejas, J. I. (2018). PRACTICAL GUIDELINE FOR BENIGN PAROXISMAL POSITIONAL VERTIGO. Revista ORL, 50p. https://doi.org/10.14201/orl.18072
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