M. von Brevern

Epidemiology of benign paroxysmal positional vertigo: a population based study

Objectives: To examine the prevalence and incidence, clinical presentation, societal impact and comorbid conditions of benign paroxysmal positional vertigo (BPPV) in the general population. Methods: Cross-sectional, nationally representative neurotological survey of the general adult population in Germany with a two stage sampling design: screening of 4869 participants from the German National Telephone Health Interview Survey 2003 (response rate 52%) for moderate or severe dizziness or vertigo, followed by validated neurotological interviews (n = 1003; response rate 87%). Diagnostic criteria for BPPV were at least five attacks of vestibular vertigo lasting <1 min without concomitant neurological symptoms and invariably provoked by typical changes in head position. In a concurrent validation study (n = 61) conducted in two specialised dizziness clinics, BPPV was detected by our telephone interview with a specificity of 92% and a sensitivity of 88% (positive predictive value 88%, negative predictive value 92%). Results: BPPV accounted for 8% of individuals with moderate or severe dizziness/vertigo. The lifetime prevalence of BPPV was 2.4%, the 1 year prevalence was 1.6% and the 1 year incidence was 0.6%. The median duration of an episode was 2 weeks. In 86% of affected individuals, BPPV led to medical consultation, interruption of daily activities or sick leave. In total, only 8% of affected participants received effective treatment. On multivariate analysis, age, migraine, hypertension, hyperlipidaemia and stroke were independently associated with BPPV. Conclusion: BPPV is a common vestibular disorder leading to significant morbidity, psychosocial impact and medical costs.

Short-term efficacy of Epley’s manoeuvre: a double-blind randomised trial

Background: Benign paroxysmal positional vertigo of the posterior canal (PC-BPPV) is a common vestibular disorder and can be easily treated with Epley’s manoeuvre. Thus far, the short-term efficacy of Epley’s manoeuvre for treatment of PC-BPPV is unknown. Objectives: To evaluate the efficacy of Epley’s manoeuvre for treatment of PC-BPPV 24 h after applying the manoeuvre. Methods: The short-term efficacy of Epley’s manoeuvre was compared with a sham procedure in 66 patients with PC-BPPV by using a double-blind randomised study design. Results: 24 h after treatment, 28 of 35 (80%) patients in the Epley’s manoeuvre group had neither vertigo nor nystagmus on positional testing compared with 3 of 31 (10%) patients in the sham group (p<0.001). Conclusion: Epley’s manoeuvre is shown to resolve PC-BPPV both effectively and rapidly.

Screening for Menière's disease in the general population - the needle in the haystack.

Conclusion. Based on clinical history alone, 98.4% of the population with vestibular vertigo do not qualify for a diagnosis of Menières disease (MD). Although frequent in dizziness clinics, MD is rare in the general population. Objective. To narrow down the prevalence of MD in the general population. Subjects and methods. A representative sample adult population sample (n=4869) was screened for moderate or severe dizziness/vertigo. Subsequently, 1003 participants completed a validated neurotologic telephone interview on vestibular vertigo (VV). Prevalence of MD was determined by stepwise application of clinical criteria according to the AAO (1995): (1) at least two vertigo attacks of ≥20 min duration, (2) unilateral hearing loss, and (3) accompanying cochlear symptoms. Results. Lifetime prevalence of VV was 7.4%. Of 243 participants with VV, 51 (21%) had recurrent vertigo lasting ≥20 min. Of these, nine reported unilateral hearing loss, and four had accompanying cochlear symptoms (1.6% of VV patients, population prevalence 0.12%).

Benigner paroxysmaler Lagerungsschwindel Rasch erkennen, erfolgreich behandeln

Der benigne paroxysmale Lagerungsschwindel (BPLS) ist die häufigste vestibuläre Erkrankung und macht in Spezialambulanzen für Schwindelerkrankungen etwa 20% der Diagnosen aus. Die Ursache der Störung liegt nach neueren Befunden in einer sog. Kanalolithiasis des hinteren vertikalen Bogengangs. Frei bewegliche Partikel, die in den Endolymphschlauch des Bogengangs geraten sind, führen dort bei Lagewechsel zu einer unphysiologischen Endolymph-Strömung und Reizung des vestibulären Sinnesepithels. Das Verständnis der pathophysiologischen Grundlage führte zur Entwicklung spezifischer Lagerungsmanöver, die den Kopf in der Ebene des betroffenen Bogengangs rotieren, um ihn von den frei flottierenden Partikeln zu befreien. Die nach Epley und Semont benannten Manöver führen nach einmaliger Anwendung bei etwa 60% der Patienten zu sofortiger Beschwerdefreiheit, bei mehrfacher Anwendung erreicht die Erfolgsrate nahezu 100%.

Zur ärztlichen Versorgung von Patienten mit benignem paroxysmalen Lagerungsschwindel

ZusammenfassungDer benigne paroxysmale Lagerungsschwindel (BPLS) ist die häufigste vestibuläre Erkrankung und kann ohne apparative Diagnostik rasch diagnostiziert und behandelt werden. Um die Wege der Erkrankten durch das Gesundheitssystem und den verursachten diagnostischen Aufwand zu erfassen wurden 42 BPLS-Patienten einer Spezialambulanz für Schwindelerkrankungen und 29 BPLS-Patienten einer neurologischen Praxis hinsichtlich ihres klinischen Verlaufs sowie durchgeführter diagnostischer und therapeutischer Maßnahmen evaluiert.Die mittlere Erkrankungsdauer seit der Erstmanifestation lag bei 3,2 Jahren mit durchschnittlich 2,4 BPLS-Episoden, die typischerweise Wochen bis Monate dauerten. Mehr als die Hälfte der Patienten fühlte sich durch den BPLS stark beeinträchtigt, ein Viertel war vorübergehend arbeitsunfähig. Durchschnittlich wurden 3 ärztliche Fachrichtungen konsultiert. Eine zerebrale Bildgebung (42%), kalorische Untersuchung (46%) und Audiometrie (49%) wurden häufiger durchgeführt als eine diagnostische Lagerungsprobe (28%). Die Mehrzahl der Patienten wurden mit unwirksamen Maßnahmen behandelt oder gar nicht. Nur 4% erhielten ein spezifisches Lagerungsmanöver nach Epley oder Semont.SummaryBenign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder which can be simply diagnosed. The evolution of highly effective positioning maneuvers has made BPPV the most successfully treatable cause of vertigo. We evaluated patients with BPPV with regard to past medical history and disease-related diagnostic and therapeutic procedures. Forty-two patients were recruited from a specialised dizziness clinic, and a further 29 patients were recruited from a neurological practice. The mean duration of the disease was 3.2 years, with an average of 2.4 episodes lasting typically several weeks to months. More than half of the patients felt severely disabled by BPPV. On average, three different medical specialities were consulted. Cerebral imaging (42%), caloric testing (46%), and audiometry (49%) were performed more often than diagnostic positioning (28%). Most patients received ineffective or no therapy, and only 4% were treated with a specific therapeutic positioning maneuver. Benign paroxysmal positional vertigo is a long-lasting and frequently recurrent disease which leads to significant morbidity and medical costs. The recent progress in the diagnosis and therapy of BPPV has not yet been widely established in medical practice in Germany.

Benigner paroxysmaler Lagerungsschwindel

ZusammenfassungDer benigne paroxysmale Lagerungsschwindel (BPLS) ist die häufigste vestibuläre Erkrankung und macht in Spezialambulanzen für Schwindelerkrankungen etwa 20% der Diagnosen aus. Die Ursache der Störung liegt nach neueren Befunden zumeist in einer so genannten Kanalolithiasis des hinteren vertikalen Bogengangs: Frei bewegliche Partikel, die in den Endolymphschlauch des Bogengangs geraten sind, führen dort bei Lagewechsel zu einer unphysiologischen Endolymphströmung und Reizung des vestibulären Sinnesepithels. Das Verständnis der pathophysiologischen Grundlage führte zur Entwicklung spezifischer Lagerungsmanöver, die den Kopf in der Ebene des betroffenen Bogengangs rotieren, um ihn von frei flottierenden Partikeln zu befreien. Die nach Epley und Semont benannten Manöver führen nach einmaliger Anwendung bei etwa 60% der Patienten zu sofortiger Beschwerdefreiheit, bei mehrfacher Anwendung erreicht die Erfolgsrate nahezu 100%. Heutzutage ist der BPLS die am besten behandelbare Ursache für vestibulären Schwindel.SummaryBenign paroxysmal positional vertigo is the most common vestibular disorder, accounting for about 20% of referrals in specialized dizziness clinics. Nowadays, canalolithiasis of the posterior semicircular canal has been widely accepted as the biological basis for typical benign paroxysmal positional vertigo as it is compatible with all clinical features of the disorder. Better understanding of its pathophysiological concepts has led to specific therapeutic strategies, which aim to clear the affected semicircular canal from mobile particles. After a single maneuver both Epley’s and Semont’s procedures lead to complete recovery in about 60% of patients and in nearly 100% when performed repeatedly. These positioning maneuvers have made benign paroxysmal positional vertigo the most successfully treatable cause of vertigo.

Fahreignungsbeurteilung bei Schwindel aus neurologischer Sicht

The driving performance of patients with dizziness and vertigo has gained only minor attention so far. Patients with permanent vestibular loss or with episodic vestibular symptoms can experience difficulties in driving a motor vehicle. The presence of a chronic or episodic syndrome presenting with dizziness and/or vertigo does not automatically exclude the ability to drive. Assessment of driving performance should consider the degree of the deficits and compensation in chronic dysfunction and the severity and frequency of attacks, prodromes and triggers of symptoms in episodic disorders.ZusammenfassungDie Fahreignung bei Patienten mit Schwindel ist ein noch wenig beachtetes Thema. Es ist jedoch plausibel, dass insbesondere akut auftretende Schwindelattacken zu einer erheblichen Gefährdung für die Sicherheit des Straßenverkehrs führen können. Bei der Beurteilung der Fahreignung von Patienten mit Schwindel und Gleichgewichtsstörungen wurde dem Arzt bisher ein sehr weiter Ermessensspielraum belassen. Der Artikel stellt die neuen Begutachtungsleitlinien für Schwindelerkrankungen vor.SummaryThe driving performance of patients with dizziness and vertigo has gained only minor attention so far. Patients with permanent vestibular loss or with episodic vestibular symptoms can experience difficulties in driving a motor vehicle. The presence of a chronic or episodic syndrome presenting with dizziness and/or vertigo does not automatically exclude the ability to drive. Assessment of driving performance should consider the degree of the deficits and compensation in chronic dysfunction and the severity and frequency of attacks, prodromes and triggers of symptoms in episodic disorders.

Traffic medicine expert opinions in otorhinolaryngology : Current aspects

According to German law granting of driving licenses depends on the proof of an adequate driving capability. The corresponding guidelines are at present in the process of being revised. At the moment bilateral deafness and high-grade hearing loss (> or = 60% in pure tone audiometry) are not exclusion criteria for driving licenses grades A, B and C, while driving licenses grade D and licenses for public transport are generally excluded. In the forthcoming revised edition of the guidelines it has been suggested that the latter group will also not be excluded. The regulations concerning dizziness are wide-sweeping at the moment as no driving license will be granted if dizziness is present but will be more specific in the next issue. In particular a division will be made between single axle and two axle vehicles. An expert assessment about driving suitability can only be made by a certified specialist with qualifications in traffic medicine.

Assessment of driving in patients with vertigo and dizziness

The driving performance of patients with dizziness and vertigo has gained only minor attention so far. Patients with permanent vestibular loss or with episodic vestibular symptoms can experience difficulties in driving a motor vehicle. The presence of a chronic or episodic syndrome presenting with dizziness and/or vertigo does not automatically exclude the ability to drive. Assessment of driving performance should consider the degree of the deficits and compensation in chronic dysfunction and the severity and frequency of attacks, prodromes and triggers of symptoms in episodic disorders.ZusammenfassungDie Fahreignung bei Patienten mit Schwindel ist ein noch wenig beachtetes Thema. Es ist jedoch plausibel, dass insbesondere akut auftretende Schwindelattacken zu einer erheblichen Gefährdung für die Sicherheit des Straßenverkehrs führen können. Bei der Beurteilung der Fahreignung von Patienten mit Schwindel und Gleichgewichtsstörungen wurde dem Arzt bisher ein sehr weiter Ermessensspielraum belassen. Der Artikel stellt die neuen Begutachtungsleitlinien für Schwindelerkrankungen vor.SummaryThe driving performance of patients with dizziness and vertigo has gained only minor attention so far. Patients with permanent vestibular loss or with episodic vestibular symptoms can experience difficulties in driving a motor vehicle. The presence of a chronic or episodic syndrome presenting with dizziness and/or vertigo does not automatically exclude the ability to drive. Assessment of driving performance should consider the degree of the deficits and compensation in chronic dysfunction and the severity and frequency of attacks, prodromes and triggers of symptoms in episodic disorders.

Fahreignungsbeurteilung bei Schwindel aus neurologischer Sicht@@@Assessment of driving in patients with vertigo and dizziness

The driving performance of patients with dizziness and vertigo has gained only minor attention so far. Patients with permanent vestibular loss or with episodic vestibular symptoms can experience difficulties in driving a motor vehicle. The presence of a chronic or episodic syndrome presenting with dizziness and/or vertigo does not automatically exclude the ability to drive. Assessment of driving performance should consider the degree of the deficits and compensation in chronic dysfunction and the severity and frequency of attacks, prodromes and triggers of symptoms in episodic disorders.ZusammenfassungDie Fahreignung bei Patienten mit Schwindel ist ein noch wenig beachtetes Thema. Es ist jedoch plausibel, dass insbesondere akut auftretende Schwindelattacken zu einer erheblichen Gefährdung für die Sicherheit des Straßenverkehrs führen können. Bei der Beurteilung der Fahreignung von Patienten mit Schwindel und Gleichgewichtsstörungen wurde dem Arzt bisher ein sehr weiter Ermessensspielraum belassen. Der Artikel stellt die neuen Begutachtungsleitlinien für Schwindelerkrankungen vor.SummaryThe driving performance of patients with dizziness and vertigo has gained only minor attention so far. Patients with permanent vestibular loss or with episodic vestibular symptoms can experience difficulties in driving a motor vehicle. The presence of a chronic or episodic syndrome presenting with dizziness and/or vertigo does not automatically exclude the ability to drive. Assessment of driving performance should consider the degree of the deficits and compensation in chronic dysfunction and the severity and frequency of attacks, prodromes and triggers of symptoms in episodic disorders.