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Inicio Acta Otorrinolaringológica Española Lateral semicircular canal-BPPV: Prospective randomized study on the efficacy of...
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Vol. 73. Issue 1.
Pages 27-34 (January - February 2022)
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Vol. 73. Issue 1.
Pages 27-34 (January - February 2022)
Original article
Lateral semicircular canal-BPPV: Prospective randomized study on the efficacy of four repositioning maneuvers
VPPB del canal semicircular lateral: estudio prospectivo aleatorizado de la eficacia de 4 maniobras de reposicionamiento
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Filipe Correiaa,b,
Corresponding author
filipe160490@gmail.com

Corresponding author.
, Luís Castelhanoa,b, Pedro Cavilhasa,b, Pedro Escadaa,b
a Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
b Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
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Figures (2)
Tables (3)
Table 1. Overall success rates of maneuvers and success rates considering only the first randomized maneuver.
Table 2. Success rates (no vertigo or nystagmus in the last SRT of the first session) according to different qualitative variables.
Table 3. Comparing means of quantitative variables according to symptoms and nystagmus in the last SRT of the first session. (Results are presented in mean±SD).
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Abstract
Introduction

Multiple repositioning maneuvers have been described to treat lateral semi-circular canal Benign Paroxysmal Positional Vertigo (LC-BPPV) patients. In this study, we compare efficacy of four therapeutic repositioning maneuvers for LC-BPPV patients and aim to identify clinical variables associated with persistent disease.

Material and methods

A prospective study was conducted at a tertiary center, between January 2017 and September 2019. Patients diagnosed with LC-BPPV were randomly treated with Gufoni or barbecue-roll maneuvers (for the geotropic variant) and Gufoni-Appiani, barbecue-roll or Zuma-e-Maia maneuvers (for the apogeotropic form). Efficacy was compared and statistical analysis was performed to find clinical factors associated with no response.

Results

Forty-eight patients and 82 maneuvers were included. Female patients and right side were more commonly affected. The mean age was 67 years. Seven cases (14.6%) resulted from a canal-switch. One single maneuver resolved 23 cases (47.9%) and the success rate rose to 75% at the end of the first visit (after up to 4 maneuvers) and to 93.8% after a-week of follow-up. Success rates were significantly better with Gufoni (68%) than with barbecue roll (34.8%; p=0.021) in geotropic LC-BPPV and better with Gufoni-Appiani (71.4%) than barbecue roll and Zuma-e-Maia maneuvers (33.3%; p=0.239) in apogeotropic LC-BPPV. Higher rates of persistent disease after first visit were found with older patients, left side and apogeotropic LC-BPPV and with longer latency and duration diagnostic nystagmus.

Conclusion

Our study suggests that Gufoni and Gufoni-Appiani maneuvers may be the most efficacious treatment for geotropic and apogeotropic LC-BPPV, respectively, compared to barbecue-roll and Zuma-e-Maia maneuvers.

Keywords:
BPPV
Gufoni
Gufoni-Appiani
barbecue-roll
Zuma-e-Maia
Abbreviations:
BMI
BPPV
FPP
IQR
LC-BPPV
MRI
PC-BPPV
SRT
Resumen
Introducción

Se han descrito múltiples maniobras de reposicionamiento para tratar a los pacientes con vértigo postural paroxístico benigno del canal semicircular lateral (VPPB-CSL). En este estudio comparamos la eficacia de 4 maniobras de reposicionamiento terapéutico para pacientes de BPPV-CSL, con el objetivo de identificar las variables clínicas asociadas a la persistencia de la enfermedad.

Material y métodos

Se realizó un estudio prospectivo en un centro terciario, entre enero de 2017 y septiembre de 2019. Se trató aleatoriamente a los pacientes diagnosticados de VPPB-CSL con las maniobras de Gufoni o Barbecue-Roll (para la variante geotrópica) y las maniobras de Gufoni-Appiani, Barbecue-Roll o Zuma-e-Maia (para la forma apogeotrópica), comparándose su eficacia y realizándose un análisis estadístico para encontrar los factores clínicos asociados a la falta de respuesta.

Resultados

El estudio incluyó 48 pacientes y 82 maniobras. Las mujeres y el lado derecho fueron los más comúnmente afectados. La edad media fue de 67 años. Siete casos (14,6%) fueron resultado de un fenómeno de reentrada. Una única maniobra resolvió 23 casos (47,9%), elevándose la tasa de éxito al 75% al finalizar la primera visita (tras un máximo de 4 maniobras) y al 93,8% tras una semana de seguimiento. Las tasas de éxito fueron significativamente más altas con la maniobra de Gufoni (68%) en comparación con la de Barbecue-Roll (34,8%; p=0,021) en VPPB-CSL geotrópico, y también fueron más altas con las maniobras de Gufoni-Appiani (71,4%) en comparación con las de Barbecue-Roll y Zuma-e-Maia (33,3%; p=0,239) en VPPB-CSL apogeotrópico. Las tasas más altas de persistencia de la enfermedad tras la primera visita se encontraron en pacientes mayores, lado izquierdo y VPPB-CSL apogeotrópica, con mayor latencia y duración del nistagmo diagnóstico.

Conclusión

Nuestro estudio sugiere que las maniobras de Gufoni y Gufoni-Appiani pueden ser el tratamiento más eficaz para VPPB-CSL geotrópico y apogeotrópico, respectivamente, en comparación con las maniobras de Barbecue-Roll y Zuma-e-Maia.

Palabras clave:
VPPB
Gufoni
Gufoni-Appiani
Barbecue-Roll
Zuma-e-Maia

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