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Objective To identify variables affecting outcome in patients with benign paro‐ysmal positional vertigo (BPPV) treated with canalith repositioning maneuvers. Study Design Retrospective review of patients at a tertiary vestibular rehabilitation center. Methods Variables identified for statistical analysis included method of diagnosis, age, se‐, onset association with trauma, semicircular canal involvement, presence of bilateral disease, treatment visits, and cycles of canalith repositioning maneuvers per treatment visit. Multivariate statistical analysis using Pearson χ 2, likelihood ratio, linear‐by‐linear association, and cross‐tabulation tests were performed. Results Two hundred fifty‐nine patients with BPPV who received treatment were identified from 1996 to 1998. Average follow‐up time was 16.9 months. 74.8% required one treatment visit, 19.0% required a second treatment visit, and 98.4% were successfully treated after three treatment visits.
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The remainder required up to seven treatment visits for relief of symptoms. Variables affecting the number of treatment visits included bilateral disease or location of disease other than in the posterior semicircular canal. Patient age, se‐, method of diagnosis, and onset association with trauma had no statistically significant impact. Conclusion Patients with benign paro‐ysmal positional vertigo not located in a single posterior semicircular canal are more likely to require multiple visits for canalith repositioning. INTRODUCTION Benign paroxysmal positional vertigo (BPPV) is one of the most common diagnoses made in the otolaryngologist's office in patients presenting with complaints of vertigo. Dense free‐floating particles within the semicircular canals, cupula, or both are presumably the cause of positionally provoked abnormal vestibular stimulation resulting in nystagmus.
- The diagnosis of BPPV is based on a characteristic history of positionally provoked vertigo, and a physical examination or electronystagmogram showing a positive Dix‐Hallpike test. Posterior semicircular canal BPPV (PBPPV) is most common, but involvement of other canals is seen. - Canalith repositioning is thought to clear the offending particles out of the semicircular canals by a series of rotational maneuvers and has demonstrated good efficacy in providing rapid and long‐lasting relief of symptoms.
- Treatment requires only one treatment visit in most patients. However, there are a significant number of patients who require multiple treatment visits for relief or develop rapid recurrence of their symptoms.
The goal of this study is to identify variables that may be associated with these difficult to treat cases. MATERIALS AND METHODS A retrospective review was made of patients whose BPPV was diagnosed by the senior author (J.D.M.) and treated by the co‐authors (S.M., A.E., J.A.F.) at Good Samaritan Rehabilitation Institute in Phoenix, Arizona, between 1996 and 1998. Patient information was obtained from patient records and direct patient telephone calls were made to ensure accuracy on recurrence data. Only those patients demonstrating a positive Dix‐Hallpike test on physical examination at the time of treatment were included in this study. The Dix‐Hallpike test was considered positive if nystagmus was observed with appropriate positioning, and had characteristic latency, duration, and fatigue.