The effect of vestibular rehabilitation on balance function and disability of adults with benign paroxysmal positional vertigo of posterior semicircular canals

Document Type : Original Article

Authors

Department of Audiology, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background and objective: Benign Paroxysmal Positional Vertigo (BPPV) is known as the most common cause of vertigo. Vestibular rehabilitation is an effective therapeutic option for patients with significant balance problems. The purpose of this study was to evaluate the degree of balance problems caused by BPPV as well as the effect of vestibular rehabilitation exercises on reducing the problems of this group of patients.
Methods: In this clinical trial study, 30 patients with posterior semicircular canal BPPV were studied. All patients underwent vestibular rehabilitation therapy using Epley repositioning maneuver method. The effect of balance problem on their quality of life and handicap before and two months after the intervention was assessed using the Dizziness Handicap Inventory (DHI) questionnaire.
Results: The handicap degree of the BPPV patients before therapy was at mild level. The highest and lowest scores were related to physical and emotional dimensions of DHI with values of 13.58 and 6.46, respectively. DHI scores significantly decreased following two months therapy (P <0.001). This highest and lowest improvement was observed in functional (mean change: 13.58) and emotional (mean change: 6.46) dimensions, respectively.
Conclusion: Vestibular rehabilitation is a beneficial approach for adults with unilateral BPPV of posterior semicircular canals. Through early diagnosis and intervention of vestibular disorders, the disability and handicap experienced by BPPV patients will be significantly reduced. Furthermore, the negative effects of this disease on the physical, functional and emotional aspects of patients will be noticeably diminished.

Keywords


1-Hornibrook J. Benign paroxysmal positional vertigo (BPPV): history, pathophysiology, office treatment and future directions. Int J Otolarngol. 2011:835671.
2-Chen J, Zhao W, Yue X, Zhang P. Risk factors for the occurrence of benign paroxysmal positional vertigo: a systematic review and meta-analysis. Front Neurol. 2020;11:506.

3-Yetiser S. Review of the pathology underlying benign paroxysmal positional vertigo. Int Med Res. 2019; 19: 300060519892370.

4-Imai T, Takeda N, Ito M. 3D analysis of benign positional nystagmus due to cupulolithiasis in posterior semicircular canal. Acta Otolaryngol. 2009; 129(10):1044-49.
5-Hughes CA, Proctor L. Benign paroxysmal positional vertigo. Laryngoscope 1997; 107: 607-13.
6-Riga M, Bibas A, Xenellis J, Korres S. Inner ear disease and benign paroxysmal positional vertigo: a critical review of incidence, clinical characteristics, and management. Int J Otolaryngol. 2011; 2011(11, Part 1): 709469.
7-Ichijo H. Cupulolithiasis of the posterior semicircular canal. Am J Otolaryngol. 2013; 34: 458-63.
8-Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992; 107: 399-404.
9-Hedman S. Vestibular rehabilitation. 3rd ed. Philadelphia: F. A. Davis Company; 2007.
10-Akkuzu G, Akkuzu B, Ozluoglu LN. Vestibular evoked myogenic potentials in benign paroxysmal positional vertigo and Meniere's disease. Europ Arch Otorhinolaryngol. 2006; 263: 510-17.
11-Blatt PJ, Georgakakis GA, Herdman SJ, Clendaniel RA, Tusa RJ. The effect of the canalith repositioning maneuver on resolving postural instability in patients withbenign paroxysmal positional vertigo. Am J Otol. 2000; 21: 356-63.
12-Giacomini PG, Alessandrini M, Magrini A. Long-term postural abnormalities in benign paroxysmal positional vertigo. ORL 2002; 64(4): 237-41.
13-Vaduva C, Esteban-Sanchez J, Sanz-Fernandez R, Martin-Sanz E. Prevalence and management of post-BPPV residual symptoms. Europ Arch Otorhinolaryngol. 2018; 275: 1429-37.
14-Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ. Practice parameter: therapies for benign paroxysmal positional vertigo . Neurology. 2008; 70: 2067-74.
15-Riga M, Bibas A, Xenellis J, Korres S. Inner ear disease and benign paroxysmal positional vertigo: a critical review of incidence, clinical characteristics, and management. Int J Otolaryngol. 2011; 2011: 709469.
16-von Brevern M, Seelig T, Neuhauser H, Lempert T. Benign paroxysmal positional vertigo predominantly affects theright labyrinth. J Neurol Neurosurg Psychiatry. 2004; 75:1487-88.
17-Sivrice ME. Efficacy of Epley Maneuver on quality of life of elderly patients with subjective BPPV. Int Adv Otol. 2020; 16(1): 145-146.
18-Lopez-Escamez JA, Molina MI, Gamiz M, Fernandez-Perez AJ, Gomez M, Palma MJ, et al. Multiple positional nystagmus suggests multiple canal involvement in benign paroxysmal vertigo. Acta oto-laryngologica. 2005; 125(9): 954-61.
19-Perez P, Franco V, Cuesta P, Aldama P, Alvarez MJ, Mendez JC. Recurrence of benign paroxysmal positional vertigo. Otol Neurotol. 2012; 33: 437-43
20-Piker EG, Jacobson GP. Self-report symptoms differ between younger and older dizzy patients. Otol Neurotol. 2014;35(5): 873–879.
21-Martens C, Goplen FK, Aasen T, Nordfalk KF, NordahlSHG. Dizziness handicap and clinical characteristics of posterior and lateral canal BPPV. Europ Arch Otorhinolaryngol. 2019; 276: 2181-89.
22-Lopez-Escamez GF, Fernandez AJ, Gamiz MJ, Sanchez CI. Impact of treatment on benign positional vertigo-related quality of life. Otol Neurotol. 2003; 24(4): 637-41.
23-Pollak L, Segal P, Stryjer R, Stern HG. Beliefs and emotional reactions in patients with benign paroxysmal positional vertigo: a longitudinal study. Am J Otolaryngol.33(2):221-5.
24-Nagarkar AN, Gupta AK, Mann SB. Psychological findingsin benign paroxysmal positional vertigo and psychogenic vertigo. J Otolaryngol. 2000; 29(3): 154-58.
25-Monzani D, Genovese E, Rovatti V, Malagoli ML, Rigatelli M, Guidetti G. Life events and benign paroxysmal positional vertigo: a case-controlled study. Acta Otolaryngol. 2006; 126: 987-92.
26-Castro ASO GJ, Natour J, Gananca FF. Versao brasileira do dizziness handicap inventory. Pro-Fono. 2007; 19(1): 97-104.
27-Pereira AB, Santos JN, Volpe FM. Effect of Epley's maneuver on the quality of life of paroxismal positional benign vertigo patients. Braz J Otorhinolaryngol 2010; 76:704-8.
28-Handa PR, Kuhn AM, Cunha F, Schaffleln R, Gananca FF. Quality of life in patients with benign paroxysmal positional vertigo and/orMeniere's disease. Braz J Otorhinolaryngol. 2005;  71:776-82.
29-Garanca Fg CA, Branco FC, Natour J. Interferencia da tontura ma qualidade de vida de pacientes com syndrome vestibular periferica. Rev Bras Otorrinolaryngol. 2004;70:94-101.
30-Kim MJ KK, Joo YH, Park SY, Han GC. The dizziness handicap inventory and its relationship with vestibular diseases. Int Adv Otol. 2012; 8: 69-77.
31-Jafarzadeh S, Bahrami E, Pourbakht A, Jalaie S, Daneshi A. Validity and reliability of the Persian version of the dizziness handicap inventory. J Res Med Sci 2014; 19(8): 769-75.
32-Hociota IM CR, Georjesco M. The impact of benign paroxysmal positional vertigo on quality of life. Romanian J Neurol. 2011; 10(2): 179.
33-Hoseinabadi R, Pourbakht A, Yazdani N, Kouhi A, Kamali M. The effects of abnormality of cVEMP and oVEMP on rehabilitation outcomes in patients with idiopathic benign paroxysmal positional vertigo. Europ Arch Otorhinolaryngol. 2016; 273: 643-48.
34-Paiva AD,Kuhn AMB. Psychological symptoms associated to dizziness complaint in neurootological patients of Universidade Federal de São Paulo – Escola Paulista de Medicina. Rev Bras Otorrinolaringol. 2004;70:512-15.