The Effect of Early Canalith Repositioning on Benign Paroxysmal Positional Vertigo on Recurrence

Abstract

113Copyright © 2011 by Korean Society of Otorhinolaryngology-Head and Neck Surgery. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0)which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The Effect of Early Canalith Repositioning on Benign Paroxysmal Positional Vertigo on Recurrence Youn-Kyoung Do, MD·Jin Kim, MD1·Chong Yoon Park, MD·Myung-Hyun Chung1·In Seok Moon, MD Hoon-Shik Yang, MD Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul;1Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea Clinical and Experimental Otorhinolaryngology Vol. 4, No. 3: 113-117, September 2011Original Article INTRODUCTION Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness, responsible for about 20% of cases (1,2). Diagnosis is simple compared to those of other dizziness-related diseases since specific nystagmus due to excitement of the semicircular canal can be revealed by a careful history combined with Frenzel glass or video imaging. When the otolith is displaced from the utricule to the rotational movement-detecting semicircular canal, severe dizziness is experienced due to the reaction of the semicircular canal. The displacement of the otolith to the semicircular canal is the most convincing theory to explain nystagmus and the associated symptoms, serving as the basic concept for canalith repositioning procedures (CRPs). There are many types of CRPs, categorized by the affected semicircular canal and the type of otolith. Regardless of affected canal, BPPV is shown to have a high treatment rate by CRPs (3, 4). Even though BPPV may be easily treated with CRPs, BPPV patients who visit a non-ENT clinic or emergency room often experience sustained symptoms and are treated with only medi-Objectives. Benign paroxysmal positional vertigo (BPPV) can be treated using a simple repositioning maneuver. This study demonstrates the effects of early repositioning therapy in patients with BPPV, especially with regard to recurrence. Methods. We enrolled 138 consecutive patients who had been diagnosed with BPPV in the emergency rooms and ENT out-patient clinics of Chung-Ang University Hospital and Samyook Medical Center from January to June 2009. All patients immediately underwent appropriate canalith repositioning procedures (CRPs) depending on canalith type and location. The CRPs were performed daily until the patient’s symptoms were resolved. The patients were classified into two groups according to the duration between symptom onset and initial treatment: less than 24 hours (early repositioning group, n=66) and greater 24 hours (delayed repositioning group, n=72). We prospectively compared the numbers of treatments received and the recurrence rates between the two groups. Results. Follow-up periods ranged from 8 to 14 months, 77 cases involved posterior canal BPPV, 48 cases were lateral canal BPPV (of which 20 cases were cupulolithiasis), and 13 cases were multiple canal BPPV. BPPV recurrence was found in a total of 46 patients (33.3%). The necessary numbers of CRPs were 2.3 for the early repositioning group and 2.5 for the late repositioning group, a difference that was not statistically significant (P=0.582). The early repositioning group showed a recurrence rate of 19.7%, and the delayed repositioning group showed a recurrence rate of 45.8% (P=0.002). Conclusion. Performing repositioning treatments as soon as possible after symptom onset may be an important factor in the prevention of BPVV recurrence.