Treatment of horizontal canal BPPV-a randomized sham-controlled trial comparing two therapeutic maneuvers of different speeds

Camilla Martens, Frederik Kragerud Goplen, Torbjørn Aasen, Rolf Gjestad, Karl Fredrik Nordfalk, Stein Helge Glad Nordahl, Camilla Martens, Frederik Kragerud Goplen, Torbjørn Aasen, Rolf Gjestad, Karl Fredrik Nordfalk, Stein Helge Glad Nordahl

Abstract

Objectives: To compare the effect of a high-speed barbecue maneuver with the modified Lempert maneuver and sham in patients with benign paroxysmal positional vertigo (BPPV) of the horizontal canal.

Methods: Randomized sham-controlled, single blinded multicenter clinical trial in two university hospitals investigating consecutive patients with horizontal canal BPPV.Patients were randomly assigned to high-speed barbecue (HSB), modified Lempert maneuver (ML), or sham maneuver (SM). All treatments were performed in a biaxial rotational chair with weekly follow-up to a maximum of three treatment sessions. The final follow-up was 3 months after the last treatment.

Results: Primary outcome: 2-week recovery rate per protocol. Secondary outcome: Cumulative recovery rate and Dizziness Handicap Inventory (DHI) scores after 3 months per protocol (HSB and ML) and intention to treat (all groups).Fifty-four patients were analyzed after 2 weeks (HSB = 17; ML = 20; SM = 17). Two-week recovery rate was 14/17 after HSB, 11/20 after ML, and 4/17 after SM, with significantly better recovery in HSB [OR 15.17, 95% CI (1.85, 124.63), P = .001] using sham as base level. Recovery rate after 3 months was 15/17 after HSB and 15/19 after ML. Cumulative recovery rate showed no significant differences between the two treatment groups [95% CI (0.30, 13.14), P = .46] in cure rate DHI [95% CI (-16.56, 15.02), P = .92]. No unexpected adverse events were observed.

Conclusion: Velocity change in horizontal canal BPPV treatment gives a faster initial recovery. Rapid recovery could reduce the disease burden.

Trial registration: Clinicaltrials.gov. Identifier: NCT01905800.

Level of evidence: 1b.

Keywords: barbecue; benign positional vertigo; horizontal semicircular canal.

Conflict of interest statement

The Norwegian National Advisory Unit on Vestibular Disorders supported this work. The authors have no other funding, relationships, or conflicts of interest to disclose. Data were presented at the TRV seminar in Copenhagen February 28, 2020.

© 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.

Figures

FIGURE 1
FIGURE 1
CONSORT flow diagram showing participant flow through the stages of the randomized sham‐controlled trial

References

    1. Hwang M, Kim SH, Kang KW, et al. Canalith repositioning in apogeotropic horizontal canal benign paroxysmal positional vertigo: do we need faster maneuvering? J Neurol Sci. 2015;358(1–2):183‐187.
    1. Jinrang Li PG, Tian S, Li K, Zhang H. Quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo. J Otol. 2015;10(3):115‐117.
    1. Obrist D, Nienhaus A, Zamaro E, Kalla R, Mantokoudis G, Strupp M. Determinants for a successful semont maneuver: an in vitro study with a semicircular canal model. Front Neurol. 2016;7:150.
    1. Shan X, Peng X, Wang E. Efficacy of computer‐controlled and modified roll maneuver for treatment of geotropic lateral canal benign paroxysmal positional vertigo. Otol Neurotol. 201536(8):1412–1416.
    1. Imai T, Ito M, Takeda N, et al. Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology. 2005;64(5):920‐921.
    1. Moon SY, Kim JS, Kim BK, et al. Clinical characteristics of benign paroxysmal positional vertigo in Korea: a multicenter study. J Korean Med Sci. 2006;21(3):539‐543.
    1. Vannucchi P, Pecci R. Pathophysiology of lateral semicircular canal paroxysmal positional vertigo. J Vestib Res Equilib Orient. 2010;20(6):433‐438.
    1. Honrubia V, Baloh RW, Harris MR, Jacobson KM. Paroxysmal positional vertigo syndrome. Am J Otol. 1999;20(4):465‐470.
    1. De la Meilleure G, Dehaene I, Depondt M, Damman W, Crevits L, Vanhooren G. Benign paroxysmal positional vertigo of the horizontal canal. J Neurol Neurosurg Psychiatry. 1996;60(1):68‐71.
    1. Parnes LS, McClure JA. Free‐floating endolymph particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope. 1992;102(9):988‐992.
    1. Moriarty B, Rutka J, Hawke M. The incidence and distribution of cupular deposits in the labyrinth. Laryngoscope. 1992;102(1):56‐59.
    1. Shim DB, Ko KM, Lee JH, Park HJ, Song MH. Natural history of horizontal canal benign paroxysmal positional vertigo is truly short. J Neurol. 2015;262(1):74‐80.
    1. Imai T, Takeda N, Ito M, Inohara H. Natural course of positional vertigo in patients with apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. Auris Nasus Larynx. 2011;38(1):2‐5.
    1. Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update) executive summary. Otolaryngology. 2017;156(3):403‐416.
    1. Choi SJ, Lee JB, Lim HJ, et al. Clinical features of recurrent or persistent benign paroxysmal positional vertigo. Otolaryngology. 2012;147(5):919‐924.
    1. Babac S, Djeric D, Petrovic‐Lazic M, Arsovic N, Mikic A. Why do treatment failure and recurrences of benign paroxysmal positional vertigo occur? Otol Neurotol. 2014;35(6):1105‐1110.
    1. Rupa V. Persistent vertigo following particle repositioning maneuvers: an analysis of causes. Arch Otolaryngol. 2004;130(4):436‐439.
    1. Kim JS, Oh SY, Lee SH, et al. Randomized clinical trial for geotropic horizontal canal benign paroxysmal positional vertigo. Neurology. 2012;79(7):700‐707.
    1. Boleas‐Aguirre MS, Perez N, Batuecas‐Caletrio A. Bedside therapeutic experiences with horizontal canal benign paroxysmal positional vertigo (cupulolithiasis). Acta Otolaryngol. 2009;129(11):1217‐1221.
    1. Casani AP, Nacci A, Dallan I, Panicucci E, Gufoni M, Sellari‐Franceschini S. Horizontal semicircular canal benign paroxysmal positional vertigo: effectiveness of two different methods of treatment. Audiol Neurootol. 2011;16(3):175‐184.
    1. Casani AP, Vannucci G, Fattori B, Berrettini S. The treatment of horizontal canal positional vertigo: our experience in 66 cases. Laryngoscope. 2002;112(1):172‐178.
    1. Escher A, Ruffieux C, Maire R. Efficacy of the barbecue manoeuvre in benign paroxysmal vertigo of the horizontal canal. Eur Arch Oto‐Rhino‐Laryngol. 2007;264(10):1239‐1241.
    1. Riggio F, Dispenza F, Gallina S, Kulamarva G, Gargano R, Speciale R. Management of benign paroxysmal positional vertigo of lateral semicircular canal by Gufoni's manoeuvre. Am J Otolaryngol. 2009;30(2):106‐111.
    1. Kim JS, Oh SY, Lee SH, et al. Randomized clinical trial for apogeotropic horizontal canal benign paroxysmal positional vertigo. Neurology. 2012;78(3):159‐166.
    1. Nuti D, Agus G, Barbieri MT, Passali D. The management of horizontal‐canal paroxysmal positional vertigo. Acta Otolaryngol. 1998;118(4):455‐460.
    1. Kitahara T, Ota I, Horinaka A, et al. Idiopathic benign paroxysmal positional vertigo with persistent vertigo/dizziness sensation is associated with latent canal paresis, endolymphatic hydrops, and osteoporosis. Auris Nasus Larynx. 2018:46(1):27‐33.
    1. White JA, Coale KD, Catalano PJ, Oas JG. Diagnosis and management of lateral semicircular canal benign paroxysmal positional vertigo. Otolaryngology. 2005;133(2):278‐284.
    1. West N, Hansen S, Moller MN, Bloch SL, Klokker M. Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome. Eur Arch Oto‐Rhino‐Laryngol. 2016;273(3):573‐580.
    1. Semont A, Freyss G, Vitte E. Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol. 1988;42:290‐293.
    1. Hain TC, Squires TM, Stone HA. Clinical implications of a mathematical model of benign paroxysmal positional vertigo. Ann N Y Acad Sci. 2005;1039:384‐394.
    1. Begg C, Cho M, Eastwood S, et al. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA. 1996;276(8):637‐639.
    1. von Brevern M, Bertholon P, Brandt T, et al. Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res Equilib Orient. 2015;25(3–4):105‐117.
    1. Johansson MS, Arlinger SD. Hearing threshold levels for an otologically unscreened, non‐occupationally noise‐exposed population in Sweden. Int J Audiol. 2002;41(3):180‐194.
    1. Choung YH, Shin YR, Kahng H, Park K, Choi SJ. ‘Bow and lean test’ to determine the affected ear of horizontal canal benign paroxysmal positional vertigo. Laryngoscope. 2006;116(10):1776‐1781.
    1. Tamber AL, Wilhelmsen KT, Strand LI. Measurement properties of the dizziness handicap inventory by cross‐sectional and longitudinal designs. Health Qual Life Outcomes. 2009;7:101.
    1. Wilhelmsen K, Strand LI, Nordahl SH, Eide GE, Ljunggren AE. Psychometric properties of the vertigo symptom scale—short form. BMC Ear Nose Throat Disord. 2008;8:2.
    1. Martens C, Goplen FK, Nordfalk KF, Aasen T, Nordahl SH. Prevalence and characteristics of positional nystagmus in Normal subjects. Otolaryngology. 2016;154:861‐867.
    1. Barin K. Head Angle During Static Position Test; 2010. . Accessed 25th of April 2018.
    1. Gufoni M, Mastrosimone L, Di Nasso F. Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal. Acta Otorhinolaryngol Ital. 1998;18(6):363‐367.
    1. Tian L, Wang J, Sheng HB, et al. Comparative study on the roles of the number of accelerations and rotation angle in the treatment maneuvers for posterior semicircular canal benign paroxysmal positional vertigo. ORL J Otorhinolaryngol Relat Spec. 2015;78(1):36‐45.
    1. Steddin S, Ing D, Brandt T. Horizontal canal benign paroxysmal positioning vertigo (h‐BPPV): transition of canalolithiasis to cupulolithiasis. Ann Neurol. 1996;40(6):918‐922.
    1. Baloh RW, Jacobson K, Honrubia V. Horizontal semicircular canal variant of benign positional vertigo. Neurology. 1993;43(12):2542‐2549.
    1. Wang N, Zhou H, Huang HL. Comparison of automatic and manual reposition treatment for horizontal semicircular canal benign paroxysmal positional vertigo. J Biol Regul Homeost Agents. 2018;32(3):719‐723.
    1. Wang NZ, Huang H, Geng D, Yang X, Yu C, Shi D. Efficacy of SRM‐IV vestibular function diagnosis and treatment system in treating benign paroxysmal positional vertigo. Iran J Public Health. 2018;47(5):641‐647.
    1. Levo H, Aalto H, Petteri HT. Nystagmus measured with video‐oculography: methodological aspects and normative data. ORL J Otorhinolaryngol Relat Spec. 2004;66(3):101‐104.
    1. Bisdorff AR, Sancovic S, Debatisse D, Bentley C, Gresty MA, Bronstein AM. Positional nystagmus in the dark in normal subjects. Neuro‐Ophtalmology. 2000;24(1):283‐290.
    1. Jeffery H, Hopkins M, Anderson R, Patel V, Rogers J. The interpretation of static positional nystagmus in a balance clinic. Int J Audiol. 2017;56(12):958‐966.
    1. Lee NH, Kwon HJ, Ban JH. Analysis of residual symptoms after treatment in benign paroxysmal positional vertigo using questionnaire. Otolaryngology. 2009;141(2):232‐236.
    1. Nuti D, Mandala M, Salerni L. Lateral canal paroxysmal positional vertigo revisited. Ann N Y Acad Sci. 2009;1164:316‐323.
    1. Nakayama M, Epley JM. BPPV and variants: improved treatment results with automated, nystagmus‐based repositioning. Otolaryngology. 2005;133(1):107‐112.

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