Introduction: Benign paroxysmal positional vertigo (BPPV) stands as the most common cause of peripheral vertigo. Its treatment with repositioning maneuvers on an examination table is highly effective. However, patients with back or neck problems, paraplegia, or other conditions face challenges with these maneuvers, potentially experiencing longer healing times and creating additional difficulties for physicians diagnosing and treating BPPV in everyday practice. The emergence of mechanical rotational chairs (MRCs) offers a more convenient alternative for performing these maneuvers. Objectives: The primary objective was to compare the effectiveness of maneuvers on the examination table with those on MRCs in BPPV patients diagnosed in the emergency room and randomly classified into one of the treatment options. The secondary objectives included a comparison of patient quality of life during BPPV episodes and after their resolution and an analysis of recurrences and associated risk factors. Methods: This was a cohort study on sixty-three patients diagnosed with BPPV in the emergency department. Patients were classified into two cohorts depending on diagnostic and treatment maneuvers (MRC or conventional repositioning maneuvers (CRMs)) and received weekly follow-ups until positioning maneuvers became negative. Subsequent follow-ups were conducted at 1 month, 3 months, and 6 months after the resolution of vertigo. Patients were classified into two groups based on their assigned treatment method. Results: Thirty-one patients were treated with CRMs and 32 with TRV. Mean age was 62.29 ± 17.67 years and the most affected canal was the PSC (96.8%). The mean number of required maneuvers was two, while 55.56% only required one maneuver until resolution. Recurrence was present in 26.98% of the patients during the 6-month follow-up. Comparing both cohorts, there were no statistically significant differences between treatments (TRV vs. CRM) regarding the number of maneuvers, number of recurrences, and days until remission of BPPV. Dizziness Handicap Inventory and Visual Analogue Scale values decreased considerably after BPPV resolution, with no statistically significant differences between the groups. Age was identified as a covariable in the number of maneuvers and days until BPPV resolution, showing that an increase in age implies a greater need of maneuvers. Conclusions: There was no difference between the means of treatment for BPPV in our population ot There was no difference between the groups of treatments for BPPV in our population. The quality of life of patients improved six months after the resolution of BPPV, regardless of the treatment applied.

UNASSIGNED: Benign paroxysmal positional vertigo (BPPV) involving the posterior canal is more common than other canals; however, simultaneous involvement of multiple canals can be seen up to 20% of all BPPV cases. The diagnosis and management of multiple canal BPPV can be quite challenging due to the complexity of findings. Therefore, this systematic review and meta-analysis aimed at unveiling the most effective repositioning strategy for the treatment of multiple canal BPPV.
UNASSIGNED: A literature search through PubMed, Scopus, and Web of Science databases was conducted using search terms such as BPPV, multiple canals, bilateral BPPV, repositioning maneuvers etc. After duplicate removal, the retained articles underwent various stages of elimination by two independent reviewers, and a third reviewer resolved the discrepancy between them.
UNASSIGNED: A total of 22 articles were included in the systematic review. These publications documented 5,196 patients diagnosed with BPPV, of which 513 had multiple canal BPPV. Of 295 individuals with multiple canal BPPV, 58.9% were effectively treated in 1 session, whereas 18.3 and 4.4% achieved a symptom-free state after two and three sessions, respectively. Failure of treatment using repositioning maneuvers was found in 18.4%.
UNASSIGNED: This study offers insight into the real world of BPPV management in single and multiple canal BPPV. It is evident that repositioning maneuvers provide rapid and long-lasting relief of BPPV in most single canal BPPV patients; however, multiple canal BPPV often requires repeated treatment, and the risk of recurrence is higher in this variety than the single canal BPPV.

Based on the current state of the BPPV field, there are no guidelines that specify an angular head movement\'s velocity (AHMV) during diagnostic maneuvers of BPPV. The aim of this study was to evaluate the impact of AHMV during diagnostic maneuvers on proper BPPV diagnosis and therapy. The analysis covered the results obtained in 91 patients with a positive result of the Dix-Hallpike (D-H) maneuver or the roll test. The patients were divided into four groups based on values of AHMV (high 100-200°/s and low 40-70°/s) and the BPPV type (posterior: PC-BPPV or horizontal: HC-BPPV). The parameters of the obtained nystagmuses were analyzed and compared to AHMV. There was a significant negative correlation between AHMV and latency of nystagmus in all study groups. Furthermore, there was a significant positive correlation between AHMV and both maximum slow phase velocity and average frequency of nystagmus in the PC-BPPV groups, whereas it was not observed in the HC-BPPV patients. Complete relief of symptoms was reported after 2 weeks and was better in patients diagnosed with maneuvers performed with high AHMV. High AHMV during the D-H maneuver allows the nystagmus to be more visible, increasing the sensitivity of diagnostic tests and is crucial for a proper diagnosis and therapy.

OBJECTIVE: To assess clinical symptoms and rehabilitation of anterior canal benign paroxysmal positional vertigo (aBPPV) in comparison to horizontal canal BPPV (hBPPV) and posterior canal BPPV (pBPPV).
METHODS: The study included 22 patients with aBPPV, 450 patients with pBPPV and 88 patients with hBPPV from total 640 patients with definite BPPV. Rehabilitation of BPPV included different manual repositioning maneuvers. In case of unsuccessful reposition during the visit the patients practiced various home-based repositioning maneuvers and underwent reposition in multipositional mechanical chair. Clinical symptoms and repositioning process in patients with aBPPV were compared to patients with hBPPV and pBPPV, nystagmus was analyzed in aBPPV during the rehabilitation.
RESULTS: ABPPV is a rare type of otolithiasis (3.4% of all BPPVcases). aBPPV typically has no association with middle and inner ear pathology and head trauma. Clinical symptoms in aBPPV are equal to pBPPV and less severe than in hBPPV. In aBPPV cases dominates cupulolithiasis type of canal involvement, which leads to treatment resistance and complex rehabilitation process, which includes repeat visits, multiple repeat maneuvers by specialist, home-based treatment and use of multipositional mechanical chair. Residual dizziness with duration more than a week after successful reposition occurs more often in patients with aBPPV compared to hBPPV and pBPPV cases. In aBPPV cases atypical change of nystagmus could be observed which could be due to canal switch from anterior to posterior canals, primary location of otoliths in common crus of vertical canals or masking chronic otolithiasis of anterior short arm of posterior canal.
UNASSIGNED: Изучить течение и особенности реабилитации отолитиаза переднего полукружного канала (ППК) по сравнению с отолитиазом заднего (ЗПК) и горизонтального (ГПК) полукружных каналов.
UNASSIGNED: Из совокупной выборки в 640 пациентов с достоверным диагнозом доброкачественного пароксизмального позиционного головокружения сформированы выборки из пациентов с одноканальными поражениями различных полукружных каналов: ППК —22 человека, ЗПК — 450 человек, ГПК — 88 человек. Реабилитация отолитиаза проведена с использованием различных репозиционных маневров мануально. При сохранении отолитиаза после репозиции на приеме пациенты самостоятельно выполняли различные маневры, адаптированные для домашнего использования, проведена повторная репозиция на мультипозиционном механическом кресле. Выполнено сравнение клинической картины и реабилитации отолитиаза ППК по сравнению с отолитиазом ГПК и ЗПК, а также анализ нистагменных реакций при отолитиазе ППК в ходе реабилитации.
UNASSIGNED: Отолитиаз ППК относится к редко встречающимся типам доброкачественного пароксизмального позиционного головокружения (3,4% всех случаев). Для него нехарактерна ассоциация с заболеваниями среднего и внутреннего уха, а также с травмами головы. Выраженность клинической симптоматики при отолитиазе ППК сопоставима с поражением ЗПК и менее выражена по сравнению с отолитиазом ГПК. В структуре поражения ППК превалирует форма купулолитиаза, что обусловливает резистентное течение и сложности реабилитации, требующей повторных приемов специалиста и многократных повторений репозиционных маневров как специалистами, так и самими пациентами, а также использования мультипозиционного механического кресла. При поражении ППК чаще наблюдается резидуальное головокружение, длительностью более 1 нед после удачной репозиции по сравнению с поражением ГПК и ЗПК.
UNASSIGNED: При отолитиазе ППК возможно атипичное изменение характеристик нистагма в провокационных пробах при репозиции, что может быть связано с переключением ППК в ЗПК, изначальным наличием отолитов в общем гладком колене вертикальных каналов, а также маскировкой хронического отолитиаза переднего короткого колена ЗПК схожими нистагменными реакциями при поражении ППК.

UNASSIGNED: Throughout the last decade, several mechanical rotational chairs have been developed for diagnostics and treatment of patients with a typical case history of benign paroxysmal positional vertigo. Sparse evidence, however, exists in terms of diagnostic accuracy and treatment efficiency with these mechanical rotational chairs. Also, recommendations for optimal use of these chairs are yet to be determined.
UNASSIGNED: Primary objective was to evaluate overall treatment of benign paroxysmal positional vertigo with a mechanical rotational chair and secondary objectives included description of patient- and BPPV characteristics, determination of subjective and objective outcomes, as well as analyzation of recurrence- and recurrence-related risk factors following successful treatment.
UNASSIGNED: Retrospective cohort study with 635 patients diagnosed with benign paroxysmal positional vertigo and treated by means of a mechanical rotational chair during a 7-year period from 2014 to 2021 at a tertiary University hospital. Patient- and disease-specific characteristics, treatment and recurrence data were collected through reviewing of patient records.
UNASSIGNED: The mean number of required treatments was 2.7 when accounting for a six percent treatment failure rate (defined as a need of more than 10 treatments), and 3.7 when not. Bilateral mono-canal affection required 3.8 treatments, unilateral multi-canal 3.5 treatments, and the combination of bilateral and multi-canal affection 5.2 treatments. All these scenarios were associated with significantly higher numbers of required treatments when compared to unilateral mono-canal affection, which required 1.9 treatments. The overall recurrence rate was 25.4 percent.
UNASSIGNED: A mechanical rotational chair provides successful treatment of benign paroxysmal positional vertigo. Mechanical rotational chairs should primarily be reserved for the treatment of retractable and atypical benign paroxysmal positional vertigo patients. Many aspects of the optimal use of these chairs still require elaborative assessment.

Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders that causes dizziness. The incidence of horizontal semicircular canal (HSC) BPPV ranges from 5% to 40.5% of the total number of BPPV cases diagnosed. Several studies have focused on establishing methods to treat BPPV caused by the apogeotropic variant of the HSC, namely, the Appiani maneuver (App). In 2016, a new maneuver was proposed: the Zuma e Maia maneuver (ZeM), based on inertia and gravity. The aim of this study is to analyze the efficacy of App versus ZeM in the resolution of episodes of BPPV produced by an affectation of the horizontal semicircular canal with apogeotropic nystagmus (Apo-HSC). A retrospective, quasi-experimental study was conducted. Patients attended in office (November 2014-February 2019) at a third-level hospital and underwent a vestibular otoneurology assessment. Those who were diagnosed with Apo-HSC, treated with App or ZeM, were included. To consider the efficacy of the maneuvers, the presence of symptoms and/or nystagmus at the first follow up was studied. Patients classified as \"A\" were those with no symptoms, no nystagmus; \"A/N+\": no symptoms, nystagmus present during supine roll test; \"S\": symptoms present. Previous history of BPPV and/or otic pathology and calcium levels were also compiled. From the 54 patients included, 74% were women. The average age was 69. Mean follow-up: 52.51 days. In those patients without previous history of BPPV (n = 35), the probability of being group \"A\" was 63% and 56% (p = 0.687) when treated with App and ZeM, respectively, while being \"A/N+\" was 79% and 87% for App and ZeM (p = 0.508). Of the 19 patients who had previous history of BPPV, 13% and 64% were group \"A\" when treated with App and ZeM (p = 0.043), and 25% and 82% were \"A/N+\" after App and ZeM, respectively (p = 0.021). In conclusion, for HSC cupulolithiasis, ZeM is more effective than App in those cases in which there is a history of previous episodes of BPPV (\"A\": 64% (p = 0.043); \"A/N+\": 82% (p = 0.021)).

Benign paroxysmal positional vertigo (BPPV) of the lateral semicircular canal is a well-recognized condition, even though there are controversies about the repositioning maneuvers and their efficacy. In recent decades, several maneuvers have been proposed for treating both apogeotropic and geotropic variants of lateral canal BPPV. Our purpose is to discuss a practical approach to this pathology with the Zuma maneuver. In a single session, this maneuver may be useful to treat patients with canalithiasis of the ampullary and non-ampullary arms, and cupulolithiasis with the otoliths in the canal and utricular side of the lateral canal.

BACKGROUND: The geotropic variant of lateral canal BPPV occurs due to free floating otoconia in the non ampullary arm of this canal. Several repositioning maneuvers were effective to treat patients with this variant. We have previously proposed that the Zuma maneuver, first described for apogeotropic lateral canal BPPV, could also be effective for the geotropic variant as we believe that adopting a single maneuver may help the neurotological clinical practice.
METHODS: Fifteen patients with geotropic lateral canal BPPV were enrolled and treated with Zuma maneuver. Patients were reevaluated 1 h after a single maneuver.
RESULTS: All patients showed a nystagmus beating to the affected side in step I of Zuma maneuver that reversed its direction in step II. Besides, all patients achieved immediate resolution of vertigo and positional nystagmus after the application of the maneuver.
CONCLUSIONS: The reversal of the nystagmus in step II of Zuma maneuver could be considered as a good prognostic indicator of the successful of this maneuver in patients with geotropic lateral canal BPPV. Moreover, despite the small sample of patients, Zuma maneuver was effective on short-term follow up for geotropic LC-BPPV after a single application.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular vertigo. It is caused by free-floating otoconia moving freely in one of the semicircular canals (canalolithiasis) or by otoliths adhered to the cupula (cupulolithiasis). The posterior canal is the most common canal affected, followed by the lateral canal. Diagnosis of the side affected is critical for successful treatment; therefore, suppressing visual fixation is essential to examination of these patients\' eye movement. On the basis of our experience, we have adopted the Zuma maneuver and the modified Zuma maneuver for both apogeotropic and geotropic variants of lateral canal BPPV. Knowledge of the anatomy and pathophysiologic mechanisms of the semicircular canals is essential for correct management of these patients. Hence, using a single maneuver and its modification may facilitate daily neurotological practice.

UNASSIGNED: Nystagmus (i.e., involuntary eye movement) provoked by the Dix-Hallpike test (DHT) is considered the gold standard for diagnosing posterior semicircular canal benign paroxysmal positional vertigo (psc-BPPV). However, robust evidence regarding this diagnostic maneuver\'s treatment efficacy is still lacking. This study aimed to investigate the parameters of positional nystagmus in the DHT as prognostic factors for unilateral psc-BPPV.
UNASSIGNED: We reviewed 357 patients with unilateral psc-BPPV who underwent the computer-controlled canalith repositioning procedure (CCRP), which mimics the Epley maneuver. Additionally, positional nystagmus in the DHT was observed through a video-oculography. Patients were retrospectively divided into two groups according to resistance to the CCRP. Univariable and multivariable analyses were performed on age, gender, blood pressure, and nystagmus parameters of the affected side in the DHT in order to reveal associated factors causing resistance to the CCRP.
UNASSIGNED: With univariate and multivariate analysis, we observed a decrease in vertical time course during slow phase nystagmus on the affected side (odds ratio, OR 0.77, P=0.011 vs. OR 0.80, P=0.027). Moreover, an increased vertical velocity amplitude in the DHT during slow phase nystagmus (OR 3.16, P=0.029 vs. OR 2.96, P=0.035) remained an associated factor of maneuver resistance.
UNASSIGNED: Decreased canalith weight on the affected side was associated with resistance to the CCRP. This association corresponded to the observation that psc-BPPV patients with a decreased time course and increased velocity in the slow phase of recording nystagmus have a worse prognosis of their BPPV persisting after a single CCRP.