The researchers examined 359 patients that were diagnosed with BPPV, and determined the structural issue of the BPPV and what canal of the ear was most affected: the horizontal, posterior or anterior semi-circular canals.
Depending on the direction of nystagmus, the patient was diagnosed with geotrophic nystagmus (beating of the eyes towards the ground) or apogeotrophic nystagmus (beating of the eyes away from the ground). The Epley Maneuver was used for those diagnosed with a Posterior Semicircular Canal (PSC) and the Reverse Epley Maneuver was used with those patients diagnosed with an Anterior Semi-Circular Canal (ASC) BPPV. The supine roll test was used to differentiate between the types of Horizontal Semicircular Canal (HSC) involvement.
On testing, it was found that the PSC BPPV was most common (73.5%), followed by the HSC BPPV (22.5%). It was also found that a small amount (3.3%) had multi-canal involvement. Only 1% were positive for ASC BPPV.
Once a diagnosis was made, the repositioning test was repeated. Those who were negative after one bout of repositioning were followed up in 30 days. Those who were still positive for nystagmus after repositioning were given an exercise to complete at home and followed up again in 7 days, with further assessment every 7 days for one month or until tests were negative for nystagmus. The Epley Maneuver and Reverse Epley Maneuver were given to those with PSC BPPV and ASC BPPV, respectively. Patients diagnosed with HSC BPPV were assigned the barbecue roll maneuver.
The authors of this study found that the vast majority of participants (70%) were negative for symptoms following two bouts of re-testing, and 81% were negative by the end of the 30-day study. The authors state that repositioning maneuvers were clinically significant and effective in treating BPPV, but that the right test and assigned maneuver needs to be determined. On testing, it was found that the PSC BPPV was most common (73.5%), followed by the HSC BPPV (22.5%). It was also found that a small amount (3.3%) had multi-canal involvement. Only 1% were positive for ASC BPPV. This can be important to keep in mind as the assessor in a clinical practice. While the PSC was the most prevalent in this study, it is important to thoroughly screen for all three of the semi-circular canals so a correct diagnosis and treatment plan can be made.
> From: Wang et al., Ther Clin Risk Manag 15 (2019) 719-725 . All rights reserved to Therapeutics and Clinical Risk Management. Click here for the online summary.
