title: Effectiveness of the particle repositioning maneuver in benign paroxysmal positional vertigo with and without additional vestibular pathology.
abstract: OBJECTIVE
  We compared the treatment outcome of patients with benign paroxysmal positional vertigo unassociated with additional objective evidence of vestibular pathology (BPPV) with that in patients who did demonstrate additional vestibular pathology on standard neurotologic testing (BPPV+).
  
  
  METHODS
  An open, retrospective, record-based study.
  
  
  METHODS
  Specialized outpatient dizziness clinic.
  
  
  METHODS
  We reviewed 58 unselected patients with a Dix-Hallpike test demonstrating positioning nystagmus characteristic of BPPV, who were treated during the past 4 years with the particle repositioning maneuver. Before treatment, all patients underwent detailed clinical and laboratory neurotological testing.
  
  
  METHODS
  The treatment outcome was assessed with regard to persistence of symptoms and the presence of positioning nystagmus on Dix-Hallpike testing.
  
  
  RESULTS
  Seventy-eight percent of patients with BPPV no longer demonstrated characteristic positional nystagmus after 1 particle repositioning maneuver compared with 71% of patients with BPPV+ (p = 0.56) who did, whereas 13% of the BPPV and 14% of the BPPV+ group required more than 1 treatment to be rendered nystagmus negative on Dix-Hallpike testing (p = 0.89). However, 14% of patients with BPPV remained dizzy, compared with 63% patients from the BPPV+ group, despite a negative Dix-Hallpike test after treatment (p = 0.0018). Patients with horizontal canal paresis (n = 15) had a better outcome than patients with central vestibular dysfunction (n = 7, p = 0.006). Etiologic factors seemed to affect outcome-patients with idiopathic BPPV and those with a preceding acute vestibular neuronitis had a tendency for a better outcome than BPPV patients with any other etiology (p = 0.058).
  
  
  CONCLUSIONS
  Our study demonstrates that patients with BPPV+ do not have a worse prognosis with respect to resolution of positional nystagmus, on performing the particle repositioning procedure, compared with patients with uncomplicated BPPV. However, they do suffer incomplete resolution of symptoms because of a coincidental anterior or horizontal canal dysfunction and otolithic or central vestibular dysfunction. It appears that the majority of patients with BPPV+ need further vestibular rehabilitation after the particle repositioning maneuver.
authors.affiliation: Department of Neuro-Otology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, England, UK.
authors.forename: Lea
authors.initials: L
authors.lastname: Pollak
authors.forename: Rosalyn A
authors.initials: RA
authors.lastname: Davies
authors.forename: Linda L
authors.initials: LL
authors.lastname: Luxon
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007762:Labyrinthitis / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009760:Nystagmus, Physiologic / Q000502:physiology; D011187:Posture; D012027:Reflex, Vestibulo-Ocular; D012189:Retrospective Studies; D012438:Saccades / Q000502:physiology; D012665:Semicircular Canals / Q000503:physiopathology; D012720:Severity of Illness Index; D014717:Vertigo / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D020338:Vestibular Neuronitis / Q000175:diagnosis / Q000503:physiopathology; D014722:Vestibule, Labyrinth / Q000503:physiopathology*