Factors associated with poor short-term outcomes following positional maneuvers in patients with benign paroxysmal positional vertigo

Xiong Binbin; Zhao Xiaoming; Liu Jin; Lin Chunmei; Wu Huiqing; Liang Yong

doi:10.3969/j.issn.1672-2922.2016.03.008

Abstract：Objective To investigate factors that may be associated with poor short-term outcomes following position-al maneuvers in patients with BPPV. Methods From Jan, 2014 to Jun, 2015, 39 patients experiencing poor short-term out-comes following multiple positional maneuvers within two weeks were inquired and their clinical data were analyzed retro-spectively. Results The rate of poor outcomes among all treated patients in the period was 9.8% (39/396), including 15 (38.5%) men and 24 (61.5%) women, age ranging from 26 to 81 (mean 63.0±14.5) years. Among them, 28 (71.8%) were older than 60 years. The lesion involved unilateral posterior semicircular canal in 5 cases, unilateral posterior semicircular cupular in 7 cases, horizontal semicircular canal in 7 cases, horizontal semicircular cupular in 10 cases, superior semicircu-lar canal in 3 cases, and combined multiple semicircular canals in 7 cases. Twenty five patients (64.1%) presented with id-iopathic BPPV and secondary BPPV was diagnosed in 14 patients (head trauma in 7 cases, Meniere’s disease in 2 cases, vestibular neuritis in 1 case, sudden deafness in 1 case, 1 case of otitis media and 2 cases of migraine). All patients re-ceived more than 3 sessions of repositioning maneuver treatment within two weeks to three months after diagnosis. BPPV patients with lesions in the posterior semicircular canal and cupula were treated by Epley+Semont maneuver, horizontal semicircular canal and cupular lesions by Barbecue+Gufoni or Casani+force health side-lying position method, and supe-rior semicircular canal lesions by YACOVINO method. Twenty eight patients received both positional training and drug treatment. Complete remission of vertigo and nystagmus were recorded in 26 cases after 1 month, 31 cases after 2 months, 34 cases after 3 months, respectively. The repositioning maneuver was completely ineffective in 5 cases. Recurrence was seen in 21 (61.8%) out of 34 cases. Conclusions Short-term ineffective outcomes following more than 3 sessions of posi-tional maneuvers during the first two weeks were more prevalent in patients older than 60 years of age. Cupulolithiasis, multiple-canal involvement, head trauma and inner ear ischemia may be factors that can lead to poor curative effect. It is difficult for these patients to recover through single repositioning maneuver. Most of them need several repositioning ma-neuver approaches, combined with postural training and drugs. Repositioning maneuver may not be effective in a small number of these patients. Even for some of these patients to whom repositioning maneuvers are effective, it is easy for BP-PV to reoccur.