Nystagmus and vertigo usually happen after a latency of some seconds, has a limited duration and is fatigable by repeating the provocative maneurver 14, and, in the absence of such characteristics, one should consider a vertigo of central cause 4. The canal involved may be identified by the very characteristics of the positional nystagmus. In patients with BPPV affecting the posterior canal, the right side has been 1.41 times more frequently involved when compared to the left one, and the habit of sleeping on one’s right side may be a possible explanation 13. BPPV may involve the labyrinth bilaterally or affect different canals simultaneously 12. The theory of posterior canal canalolithiasis is considered the most convincing one, explaining BPPV’s pathogenesis and one that is supported by the efficiency of specific therapeutic maneuvers 11.īPPV most frequently affects the posterior semicircular canal 1 however, it may also involve the anterior 7 or the lateral 1 canals. After the vertigo spell, a vague feeling of floating-like dizziness may persist for hours, or even days the intensity of BPPV clinical manifestations and its recurrent character may impact a patient’s professional, social, domestic and even school activities 7.īPPV may be triggered by a head injury, infectious labyrinthitis, vertebro-basilar insufficiency, after ear surgery, endolymphatic hydrops, vestibular neuritis, or middle ear disease however, in most of the cases it is idiopatic 1,8.Īs to the physiopathology, there are two theories: cupulolithiasis, in which statocone debris are attached to the cupulla 9, and canalolithiasis, in which the debris float freely in the endolymph along the semicircular canal involved 10. Symptoms were present for an average of 30 months before therapeutic intervention in patients with BPPV 6.īPPV is characterized by brief spells of vertigo, nausea and/or positional nystagmus at head position change 7. Repeated Epley’s maneuvers in less sessions rendered more positional nystagmus-free patients when compared to those submitted to more sessions of single maneuvers.īenign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo 1, with an incidence that varies between 11 and 64 cases per 100 mil 2-3, predominantly in the age range between 50 and 55 years in idiopathic cases 4 and very rarely in childhood 5. Group II had 21.4% more nystagmus-free patients following only one session (CI95% ). We observed a significant association between number of sessions and group (p=0.039) studied. The number of sessions and standard deviation showed by group I was greater than in group II (p=0.008). Group II showed greater nystagmus latency and duration than group I (p<0.05). Group I consisted of 75 patients submitted to a single Epley’s maneuver on weekly sessions and group II consisted of 48 patients that were submitted to four Epley’s maneuvers during the first session. The number of sessions for positional nystagmus suppression was compared in two groups of patients. MethodĮpley’s maneuver was done in 123 patients with BPPV due to unilateral posterior semicircular canal canalolithiasis. To assess whether more than one Epley’s maneuver in the same session, compared to a single one, decreases the number of sessions necessary to suppress positional nystagmus.
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