jsmc-10083

EFFECTIVENESS OF CINNARIZINE AND/OR POSTURAL RESTRICTION AS AN ADJUVANT MEASURES ON THE THERAPEUTIC EFFECTS OF CANALITH REPOSITIONING PROCEDURE IN TREATING UNILATERAL PC-BPPV

Sherko Saeed Fathullah Zmnako *

* Department of Surgery, School of Medicine, Faculty of Medical Sciences, University of Sulaimani.

Submitted: 15/4/2015; Accepted: 30/8/2015; Published: 1/6/2016

DOI Link: https://doi.org/10.17656/jsmc.10083 

ABSTRACT

Background 

Posterior Canal Benign Paroxysmal Positional Vertigo (PC-BPPV) is by far the most common cause of vertigo, to establish the diagnosis the Dix-Hallpike maneuver (DX) is the definitive part of the physical examination.First-line therapy is organized around Canalith Repositioning Procedure (CRP). Further treatment options include: many otolaryngologists had routinely prescribed post-maneuver postural restriction and/or vestibular suppressants the latter as an adjuvant treatment for this disorder.

Patients and Methods

A prospective double blinded randomized interventional controlled study conducted on 109 patients diagnosed as having canalithiasis unilateral PC-BPPV. Enrolled patients were received CRP as an initial standard treatment then randomly assigned in to four groups of treatments. Two different scales of vertigo symptoms assessment were used before and after the procedure: 1- Dizziness Handicap Inventory (DHI). 2- Vertigo Symptom Scale - Short Form (SF).

Results

DHI 1, SF 1 (1 week post-CRP) and DHI 3, SF 3 (3 months post-CRP) didn’t show significant differences across the groups, P value: 0.487, 0.933, 0.979 and 0.145 respectively (P > 0.05). The mean ranks of DHI 2 and SF 2 (1month post-CRP) in G3 in compare with other groups are lower in both scales. The mean ranks of DHI

2 in Groups 1, 2, 3 and 4 are 59.78, 53.33, 29.39 and 42.1 respectively and in addition these ranks for SF 2 are 53.5, 57.07, 29.95 and 45.48 respectively.

Conclusion

Cinnarizine as adjuvant therapy didn’t enhance the therapeutic effect of CRP. Adjuvant postural restriction enhances the therapeutic effect of CRP by facilitating symptoms resolution within one month (medium term effect).

KEYWORDS

Posterior canal BPPV, Canalith Repositioning Procedure, Cinnarizine, Postural restriction, Vestibular suppressants.

References 

1. Neuhauser HK, Radtke A, von Brevern M, Lezius F, Feldmann M, Lempert T. Burden of dizziness and vertigo in the community. Archives of internal medicine. 2008;168(19):2118-24.

2. Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne. 2003;169(7):681-93.

3. Furman JM, Cass SP. Benign paroxysmal positional vertigo. The New England journal of medicine. 1999;341(21):1590-6.

4. Otsuka K, Suzuki M, Furuya M. Model experiment of benign paroxysmal positional vertigo mechanism using the whole membranous labyrinth. Acta oto-laryngologica. 2003;123(4):515-8.

5. Joel A. Goebel ELS. Evaluation of the Dizzy Patient. In:

 TYH, editor. Clinical Otology. 4th ed. ed. Thieme Medical Publishers, Inc. p. 2015. P. 153-4.

6. Balatsouras DG, Koukoutsis G, Ganelis P, Korres GS, Kaberos A. Diagnosis of Single- or Multiple-Canal Benign Paroxysmal Positional Vertigo according to the Type of Nystagmus. International Journal of Otolaryngology. 2011;2011.

7. Luxon D-EBLM. Vertigo: clinical management and rehabilitation. In: Michael Gleeson, editor. Scott Brown’s Otorhinolaryngology, Head & Neck Surgery 7th Ed (2008) 3 Volume: Edward Arnold (Publishers) Ltd. p. P. 3810.

8. Benjamin T. Crane DAS, Julian Nedzelski, Lloyd B. Minor. Peripheral Vestibular disorders. In: Paul W. Flint BHH, Valerie J. Lund,  John K. Niparko,  Mark A. Richardson,  K. Thomas Robbins,  J. Regan Thomas editor. Cummings Otolaryngology - Head and Neck Surgery. 5th ed: Mosby Elsevier 2010. p. 2331-2.

9. Cohen HS, Sangi-Haghpeykar H. Canalith Repositioning Variations for Benign Paroxysmal Positional Vertigo. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2010;143(3):405-12.

10. Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2008;139(5 Suppl 4):S47-81.

11. Gananca MM, Caovilla HH, Munhoz MS, Gananca CF, da Silva ML, Serafini F, et al. Optimizing the pharmacological component of integrated balance therapy. Brazilian journal of otorhinolaryngology. 2007;73(1):12-8.

12. Nuti D, Nati C, Passali D. Treatment of benign paroxysmal positional vertigo: no need for postmaneuver restrictions. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2000;122(3):440-4.

13. Papacharalampous GX, Vlastarakos PV, Kotsis GP, Davilis D, Manolopoulos L. The Role of Postural Restrictions after BPPV Treatment: Real Effect on Successful Treatment and BPPV’s Recurrence Rates. International journal of otolaryngology. 2012;2012:932847.

14. Kondo M, Kiyomizu K, Goto F, Kitahara T, Imai T, Hashimoto M, et al. Analysis of vestibular-balance symptoms according to symptom duration: dimensionality of the Vertigo Symptom Scale-short form. Health and quality of life outcomes. 2015;13(1):4.

15. Mutlu B, Serbetcioglu B. Discussion of the dizziness handicap inventory. Journal of vestibular research : equilibrium & orientation. 2013;23(6):271-7.

16. Jacobson GP, Newman CW. The development of the Dizziness Handicap Inventory. Archives of otolaryngology--head & neck surgery. 1990;116(4):424-7.

17. Froehling DA, Bowen JM, Mohr DN, Brey RH, Beatty CW, Wollan PC, et al. The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial. Mayo Clinic proceedings. 2000;75(7):695-700.

18. Vereeck L, Truijen S, Wuyts FL, Van de Heyning PH. The Dizziness Handicap Inventory and Its Relationship With Functional Balance Performance. Otology & Neurotology. 2007;28(1):87-93.

19. Rashad UM. Patients with benign paroxysmal positional vertigo and cervical spine problems: is Epley’s manoeuvre contraindicated, and is a proposed new manoeuvre effective and safer? The Journal of laryngology and otology. 2010;124(11):1167-71.

20. Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 1992;107(3):399-404.

21. Hilton M, Pinder D. The Epley manoeuvre for benign paroxysmal positional vertigo--a systematic review. Clinical otolaryngology and allied sciences. 2002;27(6):440-5.

22. Helminski JO, Zee DS, Janssen I, Hain TC. Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Physical therapy. 2010;90(5):663-78.

23. Korres S, Balatsouras DG, Ferekidis E. Prognosis of patients with benign paroxysmal positional vertigo treated with repositioning manoeuvres. The Journal of laryngology and otology. 2006;120(7):528-33.

24. Nunez RA, Cass SP, Furman JM. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2000;122(5):647-52.

25. Taghdiri F, Togha M, Razeghi Jahromi S, Refaeian F. Cinnarizine for the prophylaxis of migraine associated vertigo: a retrospective study. SpringerPlus. 2014;3:231.

26. Scholtz AW, Steindl R, Burchardi N, Bognar-Steinberg I, Baumann W. Comparison of the therapeutic efficacy of a fixed low-dose combination of cinnarizine and dimenhydrinate with betahistine in vestibular neuritis: a randomized, double-blind, non-inferiority study. Clinical drug investigation. 2012;32(6):387-99.

27. Hahn A, Novotny M, Shotekov PM, Cirek Z, Bognar-Steinberg I, Baumann W. Comparison of cinnarizine/dimenhydrinate fixed combination with the respective monotherapies for vertigo of various origins: a randomized, double-blind, active-controlled, multicentre study. Clinical drug investigation. 2011;31(6):371-83.

28. Pianese CP, Hidalgo LOV, González RH, Madrid CE, Ponce JEC, Ramírez AM, et al. New approaches to the management of peripheral vertigo: efficacy and safety of two calcium antagonists in a 12-week, multinational, double-blind study. Otology & neurotology. 2002;23(3):357-63.

29. Kim MB, Lee HS, Ban JH. Vestibular suppressants after canalith repositioning in benign paroxysmal positional vertigo. The Laryngoscope. 2014;124(10):2400-3.

30. Luxon

. D-EBLM. Vertigo: clinical management and rehabilitation. In: Michael Gleeson, editor. Scott Brown’s Otorhinolaryngology, Head & Neck Surgery 7th Ed (2008) 3 Volume: Edward Arnold (Publishers) Ltd. p. P. 3810.

31. Ganança FF, Simas R, Ganança MM, Korn GP, Dorigueto RS. Is it important to restrict head movement after Epley maneuver? Revista Brasileira de Otorrinolaringologia. 2005;71(6):764-8.

32. Mostafa BE, Youssef TA, Hamad AS. The necessity of post-maneuver postural restriction in treating benign paroxysmal positional vertigo: a meta-analytic study. European Archives of Oto-Rhino-Laryngology. 2013;270(3):849-52.

33. Devaiah AK, Andreoli S. Postmaneuver restrictions in benign paroxysmal positional vertigo: an individual patient data meta-analysis. Otolaryngology-Head and Neck Surgery. 2010;142(2):155-9.

34. Moon SJ, Bae SH, Kim HD, Kim JH, Cho YB. The effect of postural restrictions in the treatment of benign paroxysmal positional vertigo. European Archives of Oto-Rhino-Laryngology and Head & Neck. 2005;262(5):408-11.

35. Çakır B, Ercan İ, Çakır ZA, Turgut S. EFficacy of postural restriction in treating benign paroxysmal positional vertigo. Archives of Otolaryngology–Head & Neck Surgery. 2006;132(5):501-5.

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