Korean Journal of Otorhinolaryngology-Head and Neck Surgery

Korean Society of Otolaryngology-Head and Neck Surgery (대한이비인후과학회)
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Influence of Fatigability on the Timing of Reassessment in the Treatment of Posterior Canal Benign Paroxysmal Positional Vertigo

후반고리관 양성돌발두위현훈의 치료에서 재평가 시기에 대한 피로 현상의 영향

  • Kim, Chang-Hee (Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Shin, Jung Eun (Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Shin, Yong Gook (Department of Otorhinolaryngology-Head and Neck Surgery, Myongji Hospital) ;
  • Song, Mee Hyun (Department of Otorhinolaryngology-Head and Neck Surgery, Myongji Hospital) ;
  • Shim, Dae Bo (Department of Otorhinolaryngology-Head and Neck Surgery, Myongji Hospital)
  • 김창희 (건국대학교 의학전문대학원 이비인후-두경부외과학교실) ;
  • 신정은 (건국대학교 의학전문대학원 이비인후-두경부외과학교실) ;
  • 신용국 (명지병원 이비인후과) ;
  • 송미현 (명지병원 이비인후과) ;
  • 심대보 (명지병원 이비인후과)
  • Received : 2018.05.28
  • Accepted : 2018.09.03
  • Published : 2018.12.25
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Abstract

Background and Objectives The early assessment of treatment is not done for benign paroxysmal positional vertigo (BPPV) since the well-known phenomenon of fatigability after a repeated positional test can mimic successful treatment. The aim of this study is to evaluate the clinical implication of 'fatigability' after Epley maneuver and to identify the therapeutic efficacy of Epley maneuver in posterior canal BPPV (PC-BPPV). Subjects and Method This study was prospectively conducted by two dizziness clinics on 51 consecutive patients diagnosed with PC-BPPV. All patients included in the study received Epley maneuver treatment. The therapeutic results were reassessed immediately after a single trial of Epley maneuver. After 30 minutes, results were reassessed repeatedly to confirm the fatigability of diagnostic procedure immediately after treatment. If the treatment was not successful after 30 minutes, Epley maneuver was repeatedly performed until complete resolution. Results Immediately after the first maneuver, 45 of 51 (88.2%) patients had neither vertigo nor nystagmus during the positional test. All patients demonstrated complete resolution after receiving one to three Epley maneuvers on the day of diagnosis. 'Fatigability (false negative result)' was confirmed for only one case (1 of 6 patients, 16.7%), in which nystagmus was observed after 30 minutes but not identified immediately after the first Epley maneuver. Conclusion The therapeutic efficacy of Epley maneuver is very high in PC-BPPV. Considering the possibility of fatigability when reassessment is performed immediately after therapeutic maneuver, clinicians should avoid assessing the outcome immediately after treatment in patients with PC-BPPV.

Keywords

Acknowledgement

Supported by : Konkuk University

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