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Science articles
Science articlesPrevention of recurrent benign paroxysmal positional vertigo (BPPV)
E. A. Manaenkova (1)
(1) State-Financed Health Institution Scientific and Research Institute of Clinical Otorhinolaryngology named after L. I. Sverzhevskii of the Department of Healthcare of Moscow, Moscow, Russia
UDK: 616.282.6-08-039.71
DOI: https://doi.org/10.18692/1810-4800-2018-1-73-80
ABSTRACT
Insufficient study of BPPV etiological factors results in a high rate of the disease recurrence, which impairs the patients’ life quality. The objective of this study was to improve the efficacy of BPPV treatment based on identification of predictive factors of disease recurrence by means of assessment of the severity of utriculus dysfunction and the study of calcium-phosphorus exchange disorders. We conducted a study of 25(OH) D level and registration of ocular BPPVs 7 days after the treatment in 98 patients with idiopathic posterior semicircular canal (PSC) BPPV (the index group, IG) and assessment of the effect of the detected changes on the frequency of the disease recurrences. To assess the prevalence of calcium metabolism disorders in the population, we arranged a control group (CG) of 30 healthy volunteers, identical in terms of socio-demographic characteristics. The prevalence of vitamin D deficiency (25 (OH)D less than 20 ng/ml) in the index group was 67% (n = 66), in the control group it constituted 10% (n = 3). The dependence of idiopathic BPPV incidence on 25(OH)D deficiency (chi-square test) was statistically significant (p < 0.05), indicating that the 25(OH)D deficiency is a risk factor of idiopathic BPPV development. During registration of vestibular evoked myogenic potential (VEMP) 7 days after treatment, the P1N1 peaks of ocular VEMPs were not recorded on the affected side in 14(14%) patients, the clinically significant (>40%) asymmetry in the amplitude of the ocular VEMP was identified in 25(26%) patients, the restoration of symmetry occurred in 59 (60%) patients. Within 12 months, the relapse occurred in 28 (28.5%) patients with BPPV. The relapse occurred in all patients with no P1N1 peaks of ocular VEMP on the 7th day after treatment (n = 14), in 56% (n = 13) of the patients maintaining clinically significant asymmetry (>40%) of the ocular VEMP amplitude on the 7th day after treatment, in 2% (n = 1) patients with the restored symmetry of the ocular VEMP amplitude. The dependence of frequency of idiopathic BPPV recurrence development on existence of clinically significant asymmetry (>40%) of the ocular VEMP amplitude on the 7th day after treatment (chi-square test) was statistically significant (p <0.01). The combined determination of 25(OH)D level which is the etiological factor of idiopathic BPPV, and the functional state of the utriculus by means of ocular VEMP recording makes it possible to estimate the risk of a BPPV recurrence and to develop the preventive measures of the disease recurrence.
Publication date:
27.12.2017
Keywords:
benign paroxysmal positional vertigo, vitamin D, cervical VEMP, ocular VEMP, otolith function. For citation:
Manaenkova E. A. Prevention of recurrent benign paroxysmal positional vertigo (BPPV). Rossiiskaya otorinolaringologiya. 2018;1:73–80. https://doi.org/10.18692/1810-4800-2018-1-73-80