Benign Paroksismal Pozisyonel Vertigo: Patofizyoloji, Değerlendirme ve Tanılama

Yıl 2019, Cilt: 2 Sayı: 1, 18 - 28, 01.04.2019

Burak Öztürk Münevver Güleç Teslime Nur Deveci Meryem Tuğçe Güler

Öz

Benign Paroksismal Pozisyonel Vertigo BPPV , en sık karşılaşılan vestibüler hastalıklardan biridir. BPPV’ye bağlı pozisyonel vertigo yaşayan hastaların büyük çoğunluğunda posterior veya horizontal kanalın etkilendiği görülmüştür. Daha nadir olarak anterior kanal BPPV ile de karşılaşılmaktadır. BPPV’ye neden olan patofizyolojik mekanizmalar olarak kanalitiazis ve kupulolitiazis teorileri kabul görmektedir. BPPV’nin değerlendirilmesi sırasında genellikle kanala özgü manevralar kullanılmaktadır. Kanala özgü BPPV’nin tanılama kriterleri de birbirinden farklılık göstermektedir. BPPV’nin patofizyolojisi, prevalansı, klinik semptom ve bulguları iyi bilinmekle birlikte halen doğru tanılama ve tedavide zorluklar yaşanmaktadır. Bu derlemede BPPV’nin prevelansı, patofizyolojisi, değerlendirme yöntemleri ve tanılama kriterleri hakkında literatürde yer alan önemli kaynaklardan derlenen bilgiler, kendi klinik tecrübelerimizle harmanlanarak sunulmuştur

Anahtar Kelimeler

Benign paroksismal pozisyonel vertigo, kanalitiazis, kupulolitiazis, değerlendirm, diagnostik kriter

Bening Paroxysmal Positional Vertigo: Pathophysiology, Evaluation and Diagnosis

Öz

Benign Paroxysmal Positional Vertigo BPPV , is one of the most common vestibular disorders. The majority of patients with positioning vertigo with BPPV that affects either the posterior PC-BPPV or the horizontal HSC-BPPV .There is evidence that anterior canal BPPV AC-BPPV is the least common type of BPPV. The cupulolithiasis and canalithiasis pathophysiologic mechanisms continue to be the two primary theories explaining BPPV. There are several maneuvers that have been designed to evaluate each semicircular canals. Although the prevalence, pathophysiology, clinical presentation and diagnostic criteria are well known, yet the condition often goes undiagnosed or is treated inappropriately. In this review, we have provided the classification, prevalence, pathophysiologic mechanisms, evaluation techniques and diagnostic criteria of BPPV

Anahtar Kelimeler

Benign paroxysmal positional vertigo, canalolithiasis, cupulolithiasis, evaluation, diagnostic criteria

Kaynakça

• Barany R. Diagnose von Krankheitsercheinungen im Beriche des Otolithenapparates. Acta Otolaryngol 1921; 2: 434-7.)
• Bhattacharyya, N., Baugh, R. F., Ordivas, L., Barrs, D., Bronston, L. J., Cass, S., & Haidari, J. (2008). Clinical practice guideline: Benign Paroxymal positional vertigo. Otolaryngology-Head & Neck Surgery, 139 (5 Suppl, 4), S47-S81.
• Bertholon, P., Bronstein, A. M., Davies, R. A., Rudge, P. & Thilo, K. V. (2002). Positional down beating nystagmus in 50 patients: Cerebellar disorders and possible anterior semicircular canalithiasis. Journal of Neurology, Neurosurgery & Psychiatry, 72, 366-372.
• Cakir, B., Ercan, I., Cakir, Z., Civelek, S., Sayın, I., & Turgut, S. (2006). What is the true incidence of horizontal semicircular canal benign paroxysmal positional vertigo? Otolaryngology- Head & Neck Surgery, 119, 55-59.
• Choung, Y. H., Shin, Y. R., Kahng, H., Park, K., & Choi, S. J. (2006). ‘’Bow and lean test’’ to determine the affected ear of horizontal canal benign paroxysmal positional vertigo. Laryngoscope, 116(10), 1776-1781.
• Cohen, H. S. (2004). Side-lying as an alternative to the Dix-Hallpike test of the posterior canal. Otology & Neurotology, 25, 130-134.
• Crevits, L. (2004). Treatment of anterior canal benign paroxysmal positional vertigo by a prolonged forced position procedure. Journal of Neurology, Neurosurgery & Psychiatry, 75, 779-781.
• Dix, M. R. & Hallpike, C. S. (1952). The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Annals of Otology, Rhinology, and Laryngology, 61, 987-1016.
• Epley, J. M. (1992). The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngology- Head & Neck Surgery, 107, 399-404.
• Fife, T. (1998). Recognition and management of horizontal canal benign positional vertigo. American Journal of Otology, 19, 345-351.
• Gans, R., & Harrington-Gans, P. (2002). Treatment efficacy of benign paroxysmal positional vertigo (BPPV) with canalith repositioning maneuver and Semont liberatory maneuver in 376 patients. Seminars in Hearing, 23, 129-142.
• Hall, S., Ruby, P. & McClure, J. The mechanics of benign paroxysmal positional vertigo. J Otolaryngol 1979; 8: 151-8.
• Herdman, S. J., & Tusa, R. J. (1996). Complications of the canalith repositioning procedure. Archieves of Otolaryngoly Head Neck Surgery, 122, 281-286.
• Hilton, M. & Pinder, D. (2004). The Epley (canalith repositioning) maneuver for benign paroxysmal positional vertigo. Cochrane Database Systematic Review, 2, CD003162.
• Honrubia, V., Baloh, R., Harris, M., & Jacobson, K. (1999). Paroxysmal positional vertigo syndrome. American Journal of Otology, 20, 465-470.
• Humphriss, R. L., Baguley, D. M., Sparkes, V., Perman, S. E., & Moffat, D. A. (2003). Contraindications to the Dix-hallpike manoeuvre: A multidisciplinary review. International Journal of Audiology, 42, 166-173.
• Jackson, L., Morgan, B., Fletcher, J., & Krueger, W. (2007). Anterior canal benign paroxysmal positional vertigo: An underappreciated entity. Otology and Neurotology, 28, 218-222.
• Kim, Y.K., Shin, J. E., & Chung, J. W. (2005). The effecet of canalith repositioning for anterior semicircular canal canalithiasis. Journal of Otorhinolşaryngology and Related Specialities, 67, 56-60.
• Korres, S., Balatsouras, D., Kaberos, A., Economou, C., Kandiloros, D., & Ferekidis, E. (2002). Occurence of semicircular canal involvement in benign paroxysmal positional vertigo. Otolaryngology- Head & Neck Surgery, 23, 926-932.
• McClure J. A. (1985). Horizontal canal BPV. J Otolaryngol, 14: 30-5
• McCaslin, D.L. (2013). Positional and positioning testing. Electronystagmography and Videonystagmography. (pp. 105-147). San Diego, CA: Plural.
• Moon, S. Y., Kim, J. S., Kim, B. K., Kim, J. I., Lee, H., Son, S. L., …….. Lee, W. S. (2006). Clinical characteristics of benign paroxymal positional vertigo in Korea: A multicenter study. Journal of Korean Medical Science, 21, 539-543.
• Nuti, D., Mandala, M., & Salerni, L. (2009). Lateral canal paroxysmal positional vertigo: revisited. Basic and Clinical Aspects of Vertigo and dizziness: Ann. N. Y. Acad. Sci. 1164, 316-323.
• Oghalai, J. S., Manolidis, S., Barth, J. L., Stewart, M. G., & Jenkins, H. A. (2000). Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngology- Head & Neck Surgery, 122, 630-634.
• Pagnini, P. D. Nuti & Vannuchi, P. (1989). Benign paroxysmal vertigo of horizontal canal. ORL, 51, 161-170.
• Parnes, L. S., & McClure, J. A. (1992). Free-floating endolymph particles: a nex operative finding during posterior semicircular canal occlusion. Laryngoscope, 102, 988-992.
• Parnes, L. S., Agrawal, S. K. & Atlas, J. (2003). Diagnosis and management of benign paroxysmal positional vertigo (BPPV). Canadian Mediacal Association Journal, 169, 681-693.
• Roberts, R. & Gans, R. (2008). Background, technique, interpretation, and usefulness of positional/positioning testing. In G. P. Jacobson & N. T. Shepard (Eds.), Balance function assessment and management (pp. 171-196). San Diego, CA: Plural.
• Roberts, R., Gans, R., DeBoodt, J., & Lister, J. (2005). Treatment of benign paroxysmal positional vertigo: Necessity of postmaneuver patient restrictions. Journal of the American Academy of Audiology, 16, 357-366.
• Ruckenstein, M. (2001). Therapeutic efficacy the canalith repositioning maneuver. Laryngoscope, 111, 940-945.
• Schuknecht H. Cupulolithiasis. Arch Otolaryngol 1969; 90: 765-78. Yacovino, D. A., Hain, T. C., & Gualtieri, F. (2009). New therapeutic maneuver for anterior canal benign paroxysmal positional vertigo. Journal of Neurology, 256, 1851-1855.
• Watabane, Y., Ishikawa, K., Yamamoto, M., Nakamura, T., Shineno, K., …………..&Asai, M. (2009). Japanese practical guideline of BPPV. Equilib. Res., 68, 218-225.
• Wolf, J., boyev, K., Manokey, B., & Mattox, D. (1999). Success of the modified Epley maneuver in treating benign paroxysmal positional vertigo. Laryngoscope, 109, 900-903.
• Xia, L., Kang-Zhi, L., Bo, S., Li-Hong, S., Yuan, H., & Xu, Y. (2018). Diagnosis and treatment of anterior canal paraoxysmal positional vertigo. International Journal of Audiology, 57, 673-680.