Supervisors info:
Θωμάς Νικολόπουλος, καθηγητής, Ιατρική σχολή, ΕΚΠΑ.
Παύλος Μαραγκουδάκης, αναπλ. καθηγητής, Ιατρική σχολή, ΕΚΠΑ.
Αλέξανδρος Δελίδης, Λέκτορας, Ιατρική σχολή, ΕΚΠΑ.
Summary:
BPPV is a peripheral vestibular disorder, probably the most common one that may be devastating for the patients as their symptoms’ intensity is dramatic, hence predisposing them to life-threatening thoughts. It may lead to income loss through less working hours, driving avoidance and associated fears that isolate and emotionally distress patients. Clinical doctors try to fully understand BPPV, so that a better treatment will be offered to their patients, targeting to limit their frequent exacerbations.
The aforementioned review is a systematic one with a wide search and use of papers and articles. There was a limited use of books concerning only the anatomy and physiology sections. The following databases were used: Pubmed-Medline, Cochrane Library, Google scholar, Scopus, DAI (Dissertation Abstacts International) and National Documentation Center. There was no meta-analysis on the present systematic review.
The clinical suspicion that BPPV shows a seasonal variation is supported by various studies. Seasonal variability has been shown a multifactorial dependence on various factors such as predominantly environmental temperature, serum levels of vitamin D, atmospheric pressure and environmental pollution (particles). Main predisposing factors are body decalcification (osteopenia, osteoporosis), stress and the grieving events that have happened in patients’ life the last 12 months, before BPPV first episode. Viral infections are a probable predisposing factor. On the contrary, smoking seems to play a protective role both in prevalence and in exacerbations. In the northern hemisphere, the peak in BPPV incidence has been noticed during spring (March, April and May).
Diagnostically, besides medical history, the Dix-Hallpike test is being performed to investigate the presence of the characteristic horizontal nystagmus with or without torsion for BPPV. Certain authors consider a positive Dix-Hallpike test as indicative of BPPV and not a prerequisite, suggesting that the subjective patients’ feeling of spinning is enough.
Therapeutically, primarily Epley and secondarily Semont maneuvers are being used to treat BPPV patients’ by repositioning their posterior semicircular canal’s otoliths. The use of vitamin D to restore the patients’ reserves has been shown to play a preventive role in BPPV episodes.
Keywords:
BPPV, Positional Vertigo, Posterior semicircular canal, Seasonal variation, Seasonality, Climatic variation
