Healing criteria: How should an episode of benign paroxistic positional vertigo of posterior semicircular canal's resolution be defined? Prospective observational study

• Published in: Clinical otolaryngology 2019-05, Vol.44 (3), p.219-226
• Main Authors: Guerra-Jiménez, G, Domènech-Vadillo, E, Álvarez-Morujo de Sande, M G, González-Aguado, R, Galera-Ruiz, H, Morales Angulo, C, Martín-Mateos, A J, Figuerola-Massana, E, Ramos-Macías, Á, Domínguez-Durán, E
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Benign Paroxysmal Positional Vertigo - diagnosis; Benign Paroxysmal Positional Vertigo - physiopathology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Posture - physiology; Prognosis; Prospective Studies; Recovery of Function; Semicircular Canals - physiopathology; Vestibular Function Tests
• ISSN: 1749-4486
• DOI: 10.1111/coa.13173

To compare the outcome of the Epley maneuver (EM) in benign paroxysmal positional vertigo of the posterior canal (CSP-BPPV) depending on the definition used for recovery. Multicenter observational prospective study. Otoneurology Units of 5 tertiary reference hospitals. All patients presenting with unilateral CSP-BPPV assisted for 1-year period. Spontaneous nystagmus, positive McClure-Pagnini maneuver, positive bilateral Dix-Hallpike maneuver (DHM), positive DHM for vertigo but negative for nystagmus and atypical nystagmus. Response to EM was measured after 7 days in 3 different outcomes: disappearance of nystagmus during the DHM in the follow-up visit, disappearance of vertigo during the DHM and general status (GS) during daily life activities. 264 patients were recruited (68 male/166 female, mean age 62 years). After the EM, nystagmus disappeared in 67% of them, vertigo in 54% and 36% were asymptomatic in their daily life. These outcomes were strongly correlated, but they were not concordant in a clinically significant group of cases; only the 26% of patients met all of them. The healing process follows the next sequence: negativization of positional nystagmus, then disappearance of positional vertigo and, finally, the improvement of GS during daily life activities. Nowadays, healing criteria for the resolution of an PSC-BPPV episode have not been specifically defined yet. Provided that other otoneurological disorders have been ruled out, the next resolution criterion is proposed: absence of nystagmus and specifically during control DHM and disappearance of symptoms during daily life activities.