Utricular Dysfunction by Subjective Visual Vertical after Canalolith Repositioning Maneuvers for Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo

Abstract

Introduction: Residual vestibular dysfunction is a common sequela of benign paroxysmal positional vertigo (BPPV), causing morbidity even after the resolution of vertigo with otolith repositioning maneuvers. The subjective visual vertical (SVV) measurement is used to detect the vertical spatial disorientation which may be associated with utricular dysfunction. We used the bucket test to measure possible residual utricular dysfunction in patients with BPPV after successful treatment of BPPV with canalolith repositioning maneuvers. Objective: (1) To document the presence of utricular dysfunction after canalolith repositioning maneuvers for posterior semicircular canal BPPV using bucket test for SVV. (2) To compare the difference in residual utricular dysfunction represented by SVV after Epley's and Semont's maneuvers. Study Design: Prospective, clinical, single center, cross sectional study. Methods: Sixteen consecutive patients attending ENT OPD at a tertiary care hospital for canalolith repositioning maneuvers for posterior semi circular canal BPPV underwent bucket test for SVV on the first follow up after a single physician directed maneuver for the correction of BPPV. Results: Sixteen bucket test results were analyzed after repositioning manoeuvres – twelve of which were Epley's maneuver and four were Semont's maneuver. Fourteen had a deviation of SVV more than 2° s. There was a significantly lower mean deviation of SVV following Semont's maneuver versus Epley's maneuver. Conclusion: There is a residual vertical spatial disorientation following repositioning maneuvers which contributes to dizziness after treatment. Our new finding was a lower mean deviation in SVV after Semont's compared to Epley's maneuver. Larger studies are required to confirm our findings with better statistical weight.