scotsman9
08-07-2006, 01:14 PM
Hi All,
Here's a summary of two interesting and recent BPPV studies that appeared in the literature:
Life events and benign paroxysmal positional vertigo: A case-controlled study.
Dept Neurosci, Otolaryngology Unit, Modena, Italy.
Acta Otolaryngol. 2006 Sep;126(9):987-92.
1) BPPV is one of the most common peripheral vestibular disorders, and although it has been the subject of several studies and debates, its cause still remains unknown in most cases.
2) Fifty patients (40 females and 10 men; mean age 44 years) were recruited and compared with 50 healthy volunteers matched for sex, age and socio-demographc variables. Patients were selected among dizzy patients who were referred to the ENT Clinic of the University of Modena.
3) Patients with BPPV reported significantly more life events than control subjects in the year preceding the onset of vertigo (p<0.005). Negative life events, objective negative impact and a poor degree of control were also significantly more frequent in patients compared with controls (p<0.005). There were no significant differences between groups concerning positive life events (p>0.05).
4) The results of the trial provide clinical evidence of a potential role of emotional stress connected to adverse life events as a trigger of otoconial dysfunction. High levels of anxiety, depression and somatization (recurrent and multiple medical symptoms with no discernible organic cause) were recorded and considered psychogenic precursors of BPPV, thus emphasizing the role of psychological distress in precipitating peripheral vestibular disorders.
5) Appraisal of life stress and psychological attitudes may have potential implications in the clinical assessment of this labyrinthine vertigo and its frequent relapses.
Is it important to restrict head movement after Epley maneuver?
Rev Bras Otorrinolaringol. 2005 Nov-Dec;71(6):764-8.
1) The effectiveness of postmaneuver postural restrictions is controversial in patients with BPPV. The aim was to verify the role of postural restrictions in patients with BPPV of posterior canal, submitted to a single Epley maneuver.
2) 58 patients with BPPV of the posterior canal were randomly divided in two groups following the application of a unique Epley maneuver. The patients from group 1 were informed to restrict their head movements and to use a cervical collar and group 2 patients were not informed about these postmaneuver restrictions. The patients from both groups were re-evaluated one week after Epley maneuver, regarding the presence of symptoms and positional nystagmus.
3) One week after the Epley maneuver 82% of the patients from group 1 and 73% from group 2 did not present positional nystagmus (p=0.421). There was a clinical improvement in 96% of the patients from group 1 and in 94% from group 2 (p=0.781).
4) The use of head movement restrictions did not change the clinical progression of patients submitted to Epley maneuver, neither objectively, by observing positioning nystagmus. These results are in accordance with previous studies where restrictions of head movement were not necessary for good clinical progression of patients with BPPV.
So, in a nutshell, the first study shows that stress (negative life events, objective negative impact and a poor degree of control) is associated with a significant increase in triggering BPPV. And in the second study, that restricting head movements following the Epley procedure is not necessary.
Scott :cool:
Here's a summary of two interesting and recent BPPV studies that appeared in the literature:
Life events and benign paroxysmal positional vertigo: A case-controlled study.
Dept Neurosci, Otolaryngology Unit, Modena, Italy.
Acta Otolaryngol. 2006 Sep;126(9):987-92.
1) BPPV is one of the most common peripheral vestibular disorders, and although it has been the subject of several studies and debates, its cause still remains unknown in most cases.
2) Fifty patients (40 females and 10 men; mean age 44 years) were recruited and compared with 50 healthy volunteers matched for sex, age and socio-demographc variables. Patients were selected among dizzy patients who were referred to the ENT Clinic of the University of Modena.
3) Patients with BPPV reported significantly more life events than control subjects in the year preceding the onset of vertigo (p<0.005). Negative life events, objective negative impact and a poor degree of control were also significantly more frequent in patients compared with controls (p<0.005). There were no significant differences between groups concerning positive life events (p>0.05).
4) The results of the trial provide clinical evidence of a potential role of emotional stress connected to adverse life events as a trigger of otoconial dysfunction. High levels of anxiety, depression and somatization (recurrent and multiple medical symptoms with no discernible organic cause) were recorded and considered psychogenic precursors of BPPV, thus emphasizing the role of psychological distress in precipitating peripheral vestibular disorders.
5) Appraisal of life stress and psychological attitudes may have potential implications in the clinical assessment of this labyrinthine vertigo and its frequent relapses.
Is it important to restrict head movement after Epley maneuver?
Rev Bras Otorrinolaringol. 2005 Nov-Dec;71(6):764-8.
1) The effectiveness of postmaneuver postural restrictions is controversial in patients with BPPV. The aim was to verify the role of postural restrictions in patients with BPPV of posterior canal, submitted to a single Epley maneuver.
2) 58 patients with BPPV of the posterior canal were randomly divided in two groups following the application of a unique Epley maneuver. The patients from group 1 were informed to restrict their head movements and to use a cervical collar and group 2 patients were not informed about these postmaneuver restrictions. The patients from both groups were re-evaluated one week after Epley maneuver, regarding the presence of symptoms and positional nystagmus.
3) One week after the Epley maneuver 82% of the patients from group 1 and 73% from group 2 did not present positional nystagmus (p=0.421). There was a clinical improvement in 96% of the patients from group 1 and in 94% from group 2 (p=0.781).
4) The use of head movement restrictions did not change the clinical progression of patients submitted to Epley maneuver, neither objectively, by observing positioning nystagmus. These results are in accordance with previous studies where restrictions of head movement were not necessary for good clinical progression of patients with BPPV.
So, in a nutshell, the first study shows that stress (negative life events, objective negative impact and a poor degree of control) is associated with a significant increase in triggering BPPV. And in the second study, that restricting head movements following the Epley procedure is not necessary.
Scott :cool: