Beruflich Dokumente
Kultur Dokumente
1
Department of Otolaryngology, County General Hospital Vukovar, 2Department of Otolaryngology, General Hospital Josip Benevi,
Slavonski Brod, 3Department of Neurology, Clinical Hospital Center, Osijek; Croatia
ABSTRACT
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Maslovara et al. Accurate diagnosis and BPPV therapy
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Medicinski Glasnik, Volume 11, Number 2, July 2014
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Maslovara et al. Accurate diagnosis and BPPV therapy
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Medicinski Glasnik, Volume 11, Number 2, July 2014
tional tests. Once the diagnosis is set, it is impor- up. The results of DHI testing on individual issu-
tant to assess and monitor the patients physical, es showed a statistically significant difference in
emotional, and mental status and determine their answers to certain questions among respondents.
risk of falling (20-22). The similar results were found for the results in
The average age of patients in this study of 60.1 ( relation to each group of questions as well. The
12.1) corresponds to other studies. Our results also highest sum was observed upon both the first exa-
show that a BPPV disease mainly affects elderly mination and the final check-up in the group of
persons, largely due to various degenerative chan- questions related to physical health. Upon the final
ges associated with the aging process (23, 24). check-up, it is evident that there was a statistically
significant improvement in answers to all three
When it comes to the patients gender, there was
sets of questions, with still the largest average
a significantly higher prevalence of females
scoring total for the group of questions related to
(72.8%) compared to males (27.2%), so that the
physical health. Nevertheless, this result is within
ratio was about 2/3 : 1/3. An equal representation
normal physiological limits, while the results of
of both sexes is described only in a BPPV that
the other two groups of questions related to mental
occurs after injury (25). There was no difference
and emotional health are fully within the normal
in age according to gender (26,27).
framework, set out for local population. The mean
In the majority of cases in this study (93.82%), values of total DHI score and all subscales, before
two repositions in one session were enough for and after repositioning treatment, corresponding
a significant recovery of the patient, which is al- to the results of other authors, as well as our previ-
most equal to healing, allowing the patients to ously published results (38-41). A relatively high
return to their daily life activities (28-30). initial scoring sum may be noted, which over time
According to the sides affected by the disease, an improves and becomes smaller, so that most an-
equal involvement of both ears was shown in this swers in the questionnaire were negative.
study. In the medical literature available, most The second questionnaire filled was the ABC sca-
authors found a significantly higher incidence le of balance confidence. This test is very reliable
of involvement of the right labyrinth in relation in assessing the difficulties that a respondent faces
to the left. Von Brevern et al. speculate that this due to dizziness, danger of falling, general health
finding is a result of sleeping habits on the right and quality of daily life. It showed a good corre-
for most people, and Damman et al. only confirm lation with the results of the DHI test (29). The
their claims (31,32). results obtained by completing the questionnaire
Considering the involvement of individual semi- at the beginning of treatment showed the score of
circular canal, the prevalence of otolith settled in 59.2% ( 22.4%), and thus pointed to a significant
the lateral canal (2.47%) corresponds to the data risk of falling and possible injury, before repositi-
from other studies (33,34). In contrast, with regard oning procedures were applied. In contrast, at the
to nystagmus direction, the prevalence of ageo- end of the treatment, which consisted of at least
topic direction (43.21%) in this study was higher two and a maximum of six repeated repositioning
than it was expected. This could be explained by procedures by Epley, the average score of respon-
a relatively small sample and a precise VNG dia- dents was significantly higher at 84.9% ( 15.2, far
gnosis. Over the last ten years, some authors also from the score which represents the risk of falling.
report a significantly higher prevalence of canalo In all patients involved in the study, subsequent to
and cupulolithiasis of lateral semicircular canal, the diagnosis of BPPV by the Dix-Hallpike and su-
explicable by their accurate diagnosis (35-37). pine roll test and proven by the VNG findings, an
The Croatian version of the simple DHI questio- appropriate procedure of otolith reposition was per-
nnaire accepted world-wide, translated and adap- formed (Epley, Lempert). In the majority of cases it
ted to local population was used as a tool to exa- was sufficient for a significant recovery of the pati-
mine the impact of BPPV on patients disability. ent. The DHI and ABC questionnaires were used in
The questionnaire is specific for testing the impact monitoring the status of patients disability and their
of various forms of dizziness on patients handicap quality of life related to health, especially in monito-
and their everyday life, seen from their perspec- ring their progress during the treatment. Subsequent
tive. The study subjects filled this questionnaire to a result analysis, one may conclude the following:
during the first examination and the final check- the average scoring sum of both administered qu-
374
Maslovara et al. Accurate diagnosis and BPPV therapy
estionnaires at the beginning and the end of the search in setting the precise diagnosis of otolith
treatment showed a statistically significant impro- localization and clinical forms of BPPV, which
vement, indicating the improvement of life quality allowed us to conduct the most appropriate re-
related to physical, emotional and mental health, as position process and thereby achieve satisfactory
well as a reduction of disability in performing usu- results in treatment.
al, everyday activities. The risk of falling in patients
is also significantly reduced: while the initial risk FUNDING
of falling and subsequent injury was very large, at No specific funding was received for this study.
the end of the treatment there was no real danger of
falling that would have been caused by vertigo. TRANSPARENCY DECLARATIONS
We must point out the significant role of VNG Competing interests: none to declare.
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SAETAK
Cilj Utvrditi vanost precizne topografske dijagnoze benigne paroksizmalne pozicijske vrtoglavice
(BPPV) kako bi se mogao primijeniti najprimjereniji oblik njegova lijeenja.
Metode Prospektivna studija provedena je u Opoj bolnici Vukovar, od sijenja 2011. do sijenja 2012.
godine. Ispitan je 81 pacijent obolio od BPPV-a, odnosno 59 ena (72,84%) i 22 mukarca (27,16%) (p
<0,001), prosjene ivotne dobi 60,1 ( 12,1) godina. Dijagnoza je potvrena i dokumentirana videoni-
stagmografijom (VNG). Onesposobljenost boleu i rizik od padanja praeni su popunjavanjem dvaju
upitnika, tablice klasifikacije vrtoglavica (DHI) i ljestvice sigurnosti ravnotee s obzirom na aktivnosti
(ABC), prije i nakon repozicijskog lijeenja.
Rezultati U 79 (97,3%) pacijenata bio je zahvaen stranji polukruni kanali, dok je boni bio zahva-
en u 2 (2,47%) sluaja. Nakon primjenjenog repozicijskog lijeenja, dolo je do znaajnog poboljanja,
pa ak i potpunog povlaenja simptoma kod 76 (93,82%) bolesnika. Prosjean skor DHI-a iznosio je
50,5 ( 22,2) na poetku i 20,4 ( 18,5) na koncu istraivanja (p<0.00). Slino ovome, rezultati upitnika
ABC-a na poetku istraivanja pokazivali su vrijednost od 59,2% ( 22,4%), dok je prosjean rezultat
po okonanju studije bio znaajno vii i iznosio 84,9% ( 15.2%).
Zakljuak Iako je za postavljanje dijagnoze BPPV-a dovoljna pozitivna Dix-Hallpikeova ili supine
roll proba, poeljno je uiniti i VNG pretragu, poglavito kod sumnje na zahvaenost bonog kanalia,
s ciljem precizne dijagnoze bolesti i najprimjerenijeg lijeenja, ali i rasvjetljavanja estih nedoumica da
li se BPPV pojavljuje kao samostalna bolest ili u sklopu nekog drugog vertiginoznog entiteta.
Kljune rijei: dijagnoza, videonistagmografija, kanalolitijaza, kupulolitijaza, postupak repozicije otolita
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