Utricular dysfunction in refractory benign paroxysmal positional vertigo

Simon I Angeli, Marianne Abouyared, Hillary A Snapp, Daniel Jethanamest

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective. To determine the prevalence of otolith dysfunction in patients with refractory benign paroxysmal positional vertigo (BPPV). Study Design. Unmatched case control. Setting. Tertiary care institution. Subjects and Methods. Patients included were diagnosed with BPPV, failed initial in-office canalith repositioning maneuvers (CRMs), and completed vestibular testing and vestibular rehabilitation (n = 40). Refractory BPPV (n = 19) was defined in patients whose symptoms did not resolve despite vestibular rehabilitation. These patients were compared with a control group of those with nonrefractory BPPV (n = 21) for results of a caloric test, cervical vestibular evoked myogenic potential (cVEMP), and subjective visual vertical (SVV). Results. Forty-six of 251 patients failed initial treatment with in-office CRM. Forty patients met inclusion criteria. There was no significant difference between the cases (refractory BPPV) (n = 19) and controls (nonrefractory BPPV) (n = 21) in terms of age, duration of symptoms, laterality of BPPV, and BPPV symptoms. There was no difference in the prevalence of caloric weakness and cVEMP abnormalities (P>05), with odds ratios (ORs [95% confidence interval (CI)]) of having abnormal results among cases vs controls of 1.1818 (0.3329- 4.1954) and 4.3846 (0.7627-25.2048), for caloric and cVEMP, respectively. Abnormal eccentric SVV was more prevalent in refractory BPPV cases (58%) than in controls (14%) (P<.0072). The OR (95% CI) of having abnormal SVV was 8.25 (1.7967-37.8822) higher among patients with refractory BPPV than those with nonrefractory BPPV. Conclusion. Patients with refractory BPPV are more likely to have abnormal eccentric SVV and thus underlying utricular dysfunction. This finding is important to take into account when designing rehabilitation strategies for patients with BPPV who fail CRM.

Original languageEnglish
Pages (from-to)321-327
Number of pages7
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume151
Issue number2
DOIs
StatePublished - Jan 1 2014

Fingerprint

Vestibular Evoked Myogenic Potentials
Rehabilitation
Benign Paroxysmal Positional Vertigo
Caloric Tests
Confidence Intervals
Otolithic Membrane
Tertiary Healthcare
Odds Ratio
Control Groups
Therapeutics

Keywords

  • BPPV
  • otolith dysfunction
  • refractory benign paroxysmal positional vertigo
  • saccule
  • subjective visual vertical
  • utricle
  • vertigo
  • vestibular testing

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery

Cite this

Utricular dysfunction in refractory benign paroxysmal positional vertigo. / Angeli, Simon I; Abouyared, Marianne; Snapp, Hillary A; Jethanamest, Daniel.

In: Otolaryngology - Head and Neck Surgery (United States), Vol. 151, No. 2, 01.01.2014, p. 321-327.

Research output: Contribution to journalArticle

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abstract = "Objective. To determine the prevalence of otolith dysfunction in patients with refractory benign paroxysmal positional vertigo (BPPV). Study Design. Unmatched case control. Setting. Tertiary care institution. Subjects and Methods. Patients included were diagnosed with BPPV, failed initial in-office canalith repositioning maneuvers (CRMs), and completed vestibular testing and vestibular rehabilitation (n = 40). Refractory BPPV (n = 19) was defined in patients whose symptoms did not resolve despite vestibular rehabilitation. These patients were compared with a control group of those with nonrefractory BPPV (n = 21) for results of a caloric test, cervical vestibular evoked myogenic potential (cVEMP), and subjective visual vertical (SVV). Results. Forty-six of 251 patients failed initial treatment with in-office CRM. Forty patients met inclusion criteria. There was no significant difference between the cases (refractory BPPV) (n = 19) and controls (nonrefractory BPPV) (n = 21) in terms of age, duration of symptoms, laterality of BPPV, and BPPV symptoms. There was no difference in the prevalence of caloric weakness and cVEMP abnormalities (P>05), with odds ratios (ORs [95{\%} confidence interval (CI)]) of having abnormal results among cases vs controls of 1.1818 (0.3329- 4.1954) and 4.3846 (0.7627-25.2048), for caloric and cVEMP, respectively. Abnormal eccentric SVV was more prevalent in refractory BPPV cases (58{\%}) than in controls (14{\%}) (P<.0072). The OR (95{\%} CI) of having abnormal SVV was 8.25 (1.7967-37.8822) higher among patients with refractory BPPV than those with nonrefractory BPPV. Conclusion. Patients with refractory BPPV are more likely to have abnormal eccentric SVV and thus underlying utricular dysfunction. This finding is important to take into account when designing rehabilitation strategies for patients with BPPV who fail CRM.",
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AU - Jethanamest, Daniel

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N2 - Objective. To determine the prevalence of otolith dysfunction in patients with refractory benign paroxysmal positional vertigo (BPPV). Study Design. Unmatched case control. Setting. Tertiary care institution. Subjects and Methods. Patients included were diagnosed with BPPV, failed initial in-office canalith repositioning maneuvers (CRMs), and completed vestibular testing and vestibular rehabilitation (n = 40). Refractory BPPV (n = 19) was defined in patients whose symptoms did not resolve despite vestibular rehabilitation. These patients were compared with a control group of those with nonrefractory BPPV (n = 21) for results of a caloric test, cervical vestibular evoked myogenic potential (cVEMP), and subjective visual vertical (SVV). Results. Forty-six of 251 patients failed initial treatment with in-office CRM. Forty patients met inclusion criteria. There was no significant difference between the cases (refractory BPPV) (n = 19) and controls (nonrefractory BPPV) (n = 21) in terms of age, duration of symptoms, laterality of BPPV, and BPPV symptoms. There was no difference in the prevalence of caloric weakness and cVEMP abnormalities (P>05), with odds ratios (ORs [95% confidence interval (CI)]) of having abnormal results among cases vs controls of 1.1818 (0.3329- 4.1954) and 4.3846 (0.7627-25.2048), for caloric and cVEMP, respectively. Abnormal eccentric SVV was more prevalent in refractory BPPV cases (58%) than in controls (14%) (P<.0072). The OR (95% CI) of having abnormal SVV was 8.25 (1.7967-37.8822) higher among patients with refractory BPPV than those with nonrefractory BPPV. Conclusion. Patients with refractory BPPV are more likely to have abnormal eccentric SVV and thus underlying utricular dysfunction. This finding is important to take into account when designing rehabilitation strategies for patients with BPPV who fail CRM.

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