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Otorinolaringologia 2007 December;57(4):207-17

Copyright © 2007 EDIZIONI MINERVA MEDICA

language: Italian

Rehabilitation in lateral benign paroxysmal positional vertigo

Salami A., Dellepiane M., Mora R.

Clinica ORL, Università degli Studi di Genova, Genova, Italia

For some years now, numerous authors have been treating benign paroxysmal positional vertigo of the lateral semicircular canal with procedures designed to achieve rapid resolution of the pathology, guaranteeing maximum compliance, and limiting to the minimum the vertigo symptoms during performance of individual procedures. Diagnosis aims to determine the semicircular canal involved and identify the affected side in its geotropic and apogeotropic forms. Therapeutic procedures are based on three mechanisms: 1) removing otoconial detritus from the canal by barbecue rotation (exploiting the inertia of the detritus, which is heavier than the endolymph, compared to the movement of the canal); 2) abrupt exit of the detritus by violent deceleration on the level of the canal; 3) slow exit of detritus from the side canal by sedimentation. During the rehabilitative-therapeutic phase which makes use of numerous release procedures (Baloh, Brandt-Daroff, Epley, Fife, Gufoni, Lempert, Mosca, Nuti, Vannucchi-Asprella, and others) the tendency is to verify real ampullifugal progression of the otoconial material: videonystagmographic control of the nystagmus evoked by the various stages of therapy makes it possible to monitor its effectiveness. Reported data show that, having made the diagnosis, release procedures according to Gufoni or Vannucchi-Asprella are particularly effective. Barbecue type rotation procedures are more useful for transforming the apogeotropic into a geotropic picture, but less resolutive than the previous procedures in pathology remission. The forced release position should be considered useful in cases in which vagal symptomatology does not permit the execution of further procedures.