MATERIALS AND METHODS
This study was designed as a prospective study. The study included
patients who were admitted to the Faculty of Medicine, Department of
Otorhinolaryngology, in a local University between November 2019 and
February 2020. A total of 67 patients aged 18-65 years, who underwent
routine ENT examinations and diagnosed with benign paroxysmal positional
vertigo (BPPV) as a result of medical history and positional tests, were
included. Patients who were not previously treated with a maneuver for
dizziness, had no history of ototoxic drug use and had normal hearing
were included in the study. Patients with Meniere’s disease,
migraine-associated dizziness, vertebrobasilar insufficiency, postural
hypotension, neurological or systemic disease, and traumatic BPPV were
excluded from the study. Of the patients included in the study, 29 were
diagnosed with posterior canal canalithiasis and 8 were diagnosed with
posterior canal cupulolithiasis according to the affected side when they
met the following criteria in the Dix-Hallpike maneuver with VNG: the
presence of rotational nystagmus lasting less than 60 seconds in the
counterclockwise direction when the right ear is downward and in the
clockwise direction when the left ear is downward after a latency period
of 10-15 sec; the presence of rotational nystagmus usually lasting
longer than 60 sec in the counterclockwise direction when the right ear
is downward and in the clockwise direction when the left ear is downward
with no latency period; the development of reverse nystagmus when the
patient is placed in the sitting position 6.
Of the patients, 14 were diagnosed with lateral canal canalithiasis and
16 were diagnosed with lateral canal cupulolithiasis according to the
affected side when they met the following criteria in the Head Roll
maneuver with videonystagmography: the presence of nystagmus, which is
geotropic nystagmus decaying in a short time, when the right ear or left
ear is downward after a latent period of 10-15 seconds; the presence of
nystagmus, which is ageotropic nystagmus lasting longer than geotropic
nystagmus, when the right ear or left ear is downward with no latency
period; and the presence of simultaneous vertigo with nystagmus7.
After 10-15 minutes of resting following the maneuvers, the patients
filled in the Demographic Data Form, Vertigo Dizziness Imbalance Scale,
Dizziness Handicap Inventory, and visual analog scale forms. After 1
week, the diagnostic positional tests were performed again with
videonystagmography and the same forms were again filled by the patients
whose tests were negative.
The ”Dizziness Handicap Inventory” (DHI) used in our study is a method
used to evaluate the efficacy of otoneurological treatments8. The Dizziness Handicap Inventory is a scale
consisting of 25 questions that evaluates the quality of life
physically, functionally and emotionally in individuals with dizziness.
The DHI consists of three subscales: physical (7 questions), emotional
(9 questions) and functional (9 questions). The maximum score that can
be taken from the scale is 100 points. A high score indicates that
dizziness has a high impact on the patient’s quality of life. The other
scale used in our study is the “Vertigo Dizziness Imbalance Scale”.
This scale consists of two subscales. These are symptom scale and
quality of life scale. The symptom scale consists of 14 items, while the
quality of life scale consists of 22 items 9. Using
the visual analog scale, the global quality of life of the patients was
numerically evaluated between 0 (best) and 10 (worst).
Repositioning maneuvers were performed on the patients diagnosed with
BPPV. The repositioning maneuvers included the Epley maneuver for those
diagnosed with posterior canal canalolithiasis, the Semont maneuver for
those diagnosed with posterior canal cupulolithiasis, the Barbecue
maneuver for those diagnosed with lateral canal canalolithiasis, the
Gufoni maneuver for those diagnosed with lateral canal cupulolithiasis,
followed by the Barbecue maneuver for canalolithiasis10.
The approval for the study was obtained from the Non-Interventional
Clinical Research Ethics Committee of a local University Institute of
Health Sciences (decision number: 2019/397) and consent was obtained
from all individuals participating in the study.