후반고리관 양성돌발두위현훈의 치료에서 재평가 시기에 대한 피로 현상의 영향
Influence of Fatigability on the Timing of Reassessment in the Treatment of Posterior Canal Benign Paroxysmal Positional Vertigo
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Background and Objectives The early assessment of treatment is not done for benign paroxysmalpositional vertigo (BPPV) since the well-known phenomenon of fatigability after arepeated positional test can mimic successful treatment. The aim of this study is to evaluate theclinical implication of ‘fatigability’ after Epley maneuver and to identify the therapeutic efficacyof Epley maneuver in posterior canal BPPV (PC-BPPV). Subjects and Method This study was prospectively conducted by two dizziness clinics on51 consecutive patients diagnosed with PC-BPPV. All patients included in the study receivedEpley maneuver treatment. The therapeutic results were reassessed immediately after a singletrial of Epley maneuver. After 30 minutes, results were reassessed repeatedly to confirm thefatigability of diagnostic procedure immediately after treatment. If the treatment was not successfulafter 30 minutes, Epley maneuver was repeatedly performed until complete resolution. Results Immediately after the first maneuver, 45 of 51 (88.2%) patients had neither vertigonor nystagmus during the positional test. All patients demonstrated complete resolution afterreceiving one to three Epley maneuvers on the day of diagnosis. ‘Fatigability (false negativeresult)’ was confirmed for only one case (1 of 6 patients, 16.7%), in which nystagmus was observedafter 30 minutes but not identified immediately after the first Epley maneuver. Conclusion The therapeutic efficacy of Epley maneuver is very high in PC-BPPV. Consideringthe possibility of fatigability when reassessment is performed immediately after therapeuticmaneuver, clinicians should avoid assessing the outcome immediately after treatment in patientswith PC-BPPV.
Abstract
Background and Objectives The early assessment of treatment is not done for benign paroxysmalpositional vertigo (BPPV) since the well-known phenomenon of fatigability after arepeated positional test can mimic successful treatment. The aim of this study is to evaluate theclinical implication of ‘fatigability’ after Epley maneuver and to identify the therapeutic efficacyof Epley maneuver in posterior canal BPPV (PC-BPPV). Subjects and Method This study was prospectively conducted by two dizziness clinics on51 consecutive patients diagnosed with PC-BPPV. All patients included in the study receivedEpley maneuver treatment. The therapeutic results were reassessed immediately after a singletrial of Epley maneuver. After 30 minutes, results were reassessed repeatedly to confirm thefatigability of diagnostic procedure immediately after treatment. If the treatment was not successfulafter 30 minutes, Epley maneuver was repeatedly performed until complete resolution. Results Immediately after the first maneuver, 45 of 51 (88.2%) patients had neither vertigonor nystagmus during the positional test. All patients demonstrated complete resolution afterreceiving one to three Epley maneuvers on the day of diagnosis. ‘Fatigability (false negativeresult)’ was confirmed for only one case (1 of 6 patients, 16.7%), in which nystagmus was observedafter 30 minutes but not identified immediately after the first Epley maneuver. Conclusion The therapeutic efficacy of Epley maneuver is very high in PC-BPPV. Consideringthe possibility of fatigability when reassessment is performed immediately after therapeuticmaneuver, clinicians should avoid assessing the outcome immediately after treatment in patientswith PC-BPPV.
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