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.