DISCUSSION
Although the ages of the patients included in our study ranged between 18-65, it was found that a significant portion of the patients was in the 44-55 age range (35.8%, n=24) 12,13. In line with the literature, it was found that the incidence of BPPV in our study increased with increasing age 14. Given the gender distribution of patients, there was no statistically significant difference between the two genders. Although results similar to our study have been reported in the literature, some studies have reported that BPPV is more common among women than in men12,14. Considering the symptoms of the patients, the presence of nausea in 67.2% (n=45), vomiting in 23.9% (n=16), and history of fall in 7.5% (n=5) of the patients show similar rates with the studies in the literature 15,16. These symptoms arising when the vestibular system is affected are evaluated as the results of BPPV.
In accordance with the literature, the diagnosis was determined to be posterior canal canalolithiasis in 43.3% (n=29) of the patients diagnosed with BPPV in our study 3. The highest incidence of BPPV in the posterior canal is due to its anatomical position. In addition to the posterior canal canalolithiasis group, 11.9% (n=8) of the cases were diagnosed with posterior canal cupulolithiasis, 20.9% (n=14) with lateral canal canalolithiasis, and 23.9% (n=16) with lateral canal cupulolithiasis. The rate of diagnosis of lateral canal pathologies (canalolithiasis/cupulolithiasis) is found to be very low in some studies in the literature17,18, while in some studies, the rate of diagnosis of lateral canal pathologies (canalolithiasis/cupulolithiasis) is found to be much higher, as in our study. These high rates are believed to be associated with the use of the VNG for the diagnosis of BPPV in recent years. The use of VNG prevents missing lateral canal pathologies. Thus, higher rates of diagnosis are achieved compared to previous years3,4. The incidence of hearing loss in 19.4% (n=13) and tinnitus in 26.9% (n=18) of the patients in our study is consistent with the studies in the literature. However, these symptoms are considered not to be directly associated with BPPV 19.
In line with the literature, it was found in our study that there was a statistically significant decrease in the post-repositioning scores of DHI and all subscales of the scale (physical, functional and emotional)20. It is thought that the considerable reduction in the negative feelings of individuals is caused by the efficacy of the repositioning maneuvers on the BPPV pathology .
In our study, there was a statistically significant decrease in the post-repositioning dizziness intensity (VAS) scores. When the literature is reviewed, the statistically significant decrease in the VAS scores in various studies including BPPV patients diagnosed with posterior canal canalolithiasis 21, patients diagnosed with BPPV19 and patients with subjective BPPV is similar to our study.
The patients in our study got the highest scores from the functional, emotional and physical subscales of the DIH before and after repositioning maneuvers, respectively. Contrary to our study, Whitney et al. reported that there was no statistically significant difference among the subscale scores of the DIH in patients diagnosed with BPPV22. In some of the studies, the highest scores taken from the subscales were physical, functional and emotional groups, respectively 20. Some of the studies reported that patients with BPPV got the pre- and post-repositioning highest scores from the physical subscale 23. When we compared the scores obtained from the subscales of the DIH in the literature review, similar and different aspects were determined with our study. In the literature, it is thought that the differences in the scores obtained from the subscales of the DIH may be related to the differences of the regions where the studies were conducted and the sociocultural levels and educational levels of patients.
It was found in our study that the total mean scores obtained from the VDI-QOL and VDI-SS increased statistically significantly after repositioning maneuvers. The fact that the study by Kulcu et al. (2008) found statistically significant positive improvements in quality of life of individuals diagnosed with BPPV after repositioning maneuvers and vestibular rehabilitation exercises supports our study .
Given the literature, it was found that patients diagnosed with BPPV showed statistically significant positive improvements in their vertigo symptoms after repositioning maneuvers and vestibular rehabilitation exercises. These results demonstrate the strong effect of reposition maneuvers on quality of life and vertigo symptoms24,25.