The Laryngoscope C 2014 The American Laryngological, V
Rhinological and Otological Society, Inc.
Vestibular Suppressants After Canalith Repositioning in Benign Paroxysmal Positional Vertigo Min-Beom Kim, MD; Hyun S. Lee, MD; Jae H. Ban, MD, PhD Objectives/Hypothesis: To investigate the characteristics of residual symptoms and to evaluate the effects of adjuvant vestibular suppressants on residual symptoms after successful canalith repositioning procedures (CRPs). Study Design: Individual randomized controlled trial. Methods: One hundred fifty patients with idiopathic benign paroxysmal positional vertigo who achieved successful CRPs on initial visit participated in this study. Dizziness Handicap Inventory (DHI) questionnaires were completed before CRPs. All study populations were divided into three groups after successful CRPs on the initial visit day: the medication (V) group (treated with a vestibular suppressant [dimenhydrinate 50 mg per day]), the placebo (P) group, and the no medication (N) group. One week after successful CRPs, residual symptoms were checked and repeated DHI questionnaires were completed to compare residual symptoms. Results: Among the 138 patients who did not show positional nystagmus at follow-up, 67 (48.5%) complained of residual symptoms. The presence of residual symptoms was more prevalent in the P and N group compared with the V group (P 5.035, P 5.017, respectively). The most frequent residual symptom was lightheadedness (n 5 42). Moreover, in the V group, lightheadedness was significantly reduced compared with the P group (P 5.029). However, in the analysis of DHI, total and subscale scores did not differ across the three groups before or after successful CRP. Conclusions: Vestibular suppressants significantly reduced residual symptoms compared to both placebo and no medication after CRP. However, there was no significant reduction in DHI score compared with the control group, suggesting that the residual symptoms could not be evaluated by DHI score alone. Key Words: Benign paroxysmal positional vertigo, vestibular suppressant, symptom, treatment. Level of Evidence: 1b Laryngoscope, 124:2400–2403, 2014
INTRODUCTION Canalith repositioning procedures (CRPs) are the most effective treatment for benign paroxysmal positional vertigo (BPPV).1–4 Appropriate CRPs depending on the affected canal can provide rapid and long-lasting symptom relief in BPPV patients.5–7 The results of a metaanalysis suggest that CRPs are safe and the only proven effective treatment for BPPV.5,6,8 According to clinical practice guidelines for BPPV, medication therapy, such as vestibular suppressants or antianxiety drugs, is not recommended for primary treatment.8 However, some reports, including a previous study by the authors, have found that residual nonspecific symptoms may remain even after disappearance of typical vertigo and nystagmus following a successful CRP.9–11 These residual symptoms can be explained by a small amount of residual canalith in the semicircular canal or increased emotional sensitivity in postural control.10 In addition, accompany-
From the Department of Otolaryngology–Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea. Editor’s Note: This Manuscript was accepted for publication April 26, 2014. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Jae Ho Ban, MD, 108 Pyoung-dong Jongno-gu, Seoul, Korea. E-mail: [email protected] DOI: 10.1002/lary.24741
Laryngoscope 124: October 2014
2400
ing utricular dysfunction in BPPV patients is a possible factor influencing residual symptoms.12 Psychological problems, such as anxiety and depression, are also correlated with residual symptoms.13 Recent studies have reported that anxiolytics and betahistine can reduce residual symptoms after successful CRP,9,10 but to the best our knowledge there have been very few previous studies analyzing the characteristics of residual symptoms in BPPV patients after CRP. The goal of this study was to identify the characteristics of residual symptoms after successful CRP in patients with BPPV and to analyze the effects of vestibular suppressants on residual symptoms. Additionally, we attempt to assess the feasibility of using Dizziness Handicap Inventory (DHI) scores to assess residual symptoms after CRP.
MATERIALS AND METHODS Patients diagnosed with idiopathic BPPV between January 2011 and August 2012 at our tertiary referral hospital who agreed to participate were enrolled in this study. The study protocol was approved by the institutional review board at our hospital. The diagnostic procedure consisted of a detailed clinical history, a neurologic bedside examination, and videonystagmography (VNG). Inclusion criteria included: 1) idiopathic BPPV, 2) confirmed successful CRPs (resolution of positional nystagmus and symptoms) on the initial visit day, and 3) no current use of any medication. Exclusion criteria included: 1) inability to obtain successful CRP, 2) a history of inner ear disease or
Kim et al.: Symptoms After Canalith Reposition in BPPV
18.0; SPSS Inc., Chicago, IL). Statistical significance was defined as P
Rhinological and Otological Society, Inc.
Vestibular Suppressants After Canalith Repositioning in Benign Paroxysmal Positional Vertigo Min-Beom Kim, MD; Hyun S. Lee, MD; Jae H. Ban, MD, PhD Objectives/Hypothesis: To investigate the characteristics of residual symptoms and to evaluate the effects of adjuvant vestibular suppressants on residual symptoms after successful canalith repositioning procedures (CRPs). Study Design: Individual randomized controlled trial. Methods: One hundred fifty patients with idiopathic benign paroxysmal positional vertigo who achieved successful CRPs on initial visit participated in this study. Dizziness Handicap Inventory (DHI) questionnaires were completed before CRPs. All study populations were divided into three groups after successful CRPs on the initial visit day: the medication (V) group (treated with a vestibular suppressant [dimenhydrinate 50 mg per day]), the placebo (P) group, and the no medication (N) group. One week after successful CRPs, residual symptoms were checked and repeated DHI questionnaires were completed to compare residual symptoms. Results: Among the 138 patients who did not show positional nystagmus at follow-up, 67 (48.5%) complained of residual symptoms. The presence of residual symptoms was more prevalent in the P and N group compared with the V group (P 5.035, P 5.017, respectively). The most frequent residual symptom was lightheadedness (n 5 42). Moreover, in the V group, lightheadedness was significantly reduced compared with the P group (P 5.029). However, in the analysis of DHI, total and subscale scores did not differ across the three groups before or after successful CRP. Conclusions: Vestibular suppressants significantly reduced residual symptoms compared to both placebo and no medication after CRP. However, there was no significant reduction in DHI score compared with the control group, suggesting that the residual symptoms could not be evaluated by DHI score alone. Key Words: Benign paroxysmal positional vertigo, vestibular suppressant, symptom, treatment. Level of Evidence: 1b Laryngoscope, 124:2400–2403, 2014
INTRODUCTION Canalith repositioning procedures (CRPs) are the most effective treatment for benign paroxysmal positional vertigo (BPPV).1–4 Appropriate CRPs depending on the affected canal can provide rapid and long-lasting symptom relief in BPPV patients.5–7 The results of a metaanalysis suggest that CRPs are safe and the only proven effective treatment for BPPV.5,6,8 According to clinical practice guidelines for BPPV, medication therapy, such as vestibular suppressants or antianxiety drugs, is not recommended for primary treatment.8 However, some reports, including a previous study by the authors, have found that residual nonspecific symptoms may remain even after disappearance of typical vertigo and nystagmus following a successful CRP.9–11 These residual symptoms can be explained by a small amount of residual canalith in the semicircular canal or increased emotional sensitivity in postural control.10 In addition, accompany-
From the Department of Otolaryngology–Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea. Editor’s Note: This Manuscript was accepted for publication April 26, 2014. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Jae Ho Ban, MD, 108 Pyoung-dong Jongno-gu, Seoul, Korea. E-mail: [email protected] DOI: 10.1002/lary.24741
Laryngoscope 124: October 2014
2400
ing utricular dysfunction in BPPV patients is a possible factor influencing residual symptoms.12 Psychological problems, such as anxiety and depression, are also correlated with residual symptoms.13 Recent studies have reported that anxiolytics and betahistine can reduce residual symptoms after successful CRP,9,10 but to the best our knowledge there have been very few previous studies analyzing the characteristics of residual symptoms in BPPV patients after CRP. The goal of this study was to identify the characteristics of residual symptoms after successful CRP in patients with BPPV and to analyze the effects of vestibular suppressants on residual symptoms. Additionally, we attempt to assess the feasibility of using Dizziness Handicap Inventory (DHI) scores to assess residual symptoms after CRP.
MATERIALS AND METHODS Patients diagnosed with idiopathic BPPV between January 2011 and August 2012 at our tertiary referral hospital who agreed to participate were enrolled in this study. The study protocol was approved by the institutional review board at our hospital. The diagnostic procedure consisted of a detailed clinical history, a neurologic bedside examination, and videonystagmography (VNG). Inclusion criteria included: 1) idiopathic BPPV, 2) confirmed successful CRPs (resolution of positional nystagmus and symptoms) on the initial visit day, and 3) no current use of any medication. Exclusion criteria included: 1) inability to obtain successful CRP, 2) a history of inner ear disease or
Kim et al.: Symptoms After Canalith Reposition in BPPV
18.0; SPSS Inc., Chicago, IL). Statistical significance was defined as P
