AOS013 - Immediate Improvement in Subjective Visual Vertical (SVV) and Disequilibrium Predicts Resolution of Benign Paroxysmal Positional Vertigo following Single Canalith Repositioning Maneuver
Friday, April 29, 2022
3:53 PM – 4:00 PM CT
Location: Landmark A
Christine C. Little, BA
Zachary G. Schwam, MD
Marc Campo PT, PhD
James Gurley, PT, DPT
Bryan Hujsak PT, DPT, MBA
Maura K. Cosetti, MD
Jennifer Kelly, PT, DPT
Medical Student Icahn School of Medicine at Mount Sinai
Objective: To evaluate whether immediate post-canalith repositioning maneuver (CRM) balance changes are predictive of Benign Paroxysmal Positional Vertigo (BPPV) resolution.
Study Design: Retrospective cohort study
Setting: Tertiary referral center.
Patients: Adults (n=33, average age 59, range 56-64 ) with confirmed unilateral BPPV.
Interventions: single CRM with frenzel goggles
Main Outcome Measures: Visual Analog Scale (VAS) for disequilibrium, the Subjective Visual Vertical (SVV), the Subjective Visual Horizontal (SVH), and the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) were administered pre- and immediately following single CRM. Dix-Hallpike was performed 2-3 weeks after CRM to assess for BPPV resolution. Pre- and post-treatment balance assessments were compared between groups to determine if post CRM balance changes could predict BPPV resolution.
Results: Change in VAS and SVV score following CRM treatment was statistically different between BPPV patients who responded to CRM therapy (n=18) and those who did not (n=15), (p =.02 and p =.02 respectively). Change in SVH and mCTSIB score did not predict improvement. Patients who responded to CRM treatment were statistically younger (p=.03) and more likely to present with idiopathic BPPV compared to secondary causes (p=.02).
Conclusions: Immediate improvement in VAS and SVV following CRM can be used to predict which patients are likely to experience resolution of BPPV and may assist in directing timing and need for future interventions. BPPV etiology and younger age may have a favorable predictive value for improvement following single CRM.
*Professional Practice Gap & Educational Need: Although canalith repositioning maneuvers (CRMs) are highlyeffective in treating BPPV, an estimated 8-50% of patients treated with a single session of CRM will experience persistent BPPV. BPPV can lead to significant medical costs when managed incorrectly, with >65% of the BPPV population undergoing unnecessary imaging, diagnostic testing, or therapeutic interventions. The burdensome financial cost to individuals, difficulty in complying with follow-up care and impact on quality of life warrant better predictive outcomes of BPPV resolution. Outcome measures that could predict the efficacy of CRM treatment can help reduce these costs, promote efficient care and improve allocation of healthcare resources.
*Learning Objective: demonstrate the utility of VAS and SVV balance changes as a predictive tool for evaluating which patients are likely to experience persist BPPV following CRM treatment.
*Desired Result: empower clinicians to make informed decision regarding which patients may benefit from closer follow up care for signs of persistent BPPV.
*Level of Evidence: III
*Indicate IRB or IACUC: IRB 15.07, Mercy College Cochlear