Post on 08-Aug-2018
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Journal Reading
Tutor :dr. Tris Sudyartono, Sp.THT-KL
dr. Agus Sudarwi, Sp.THT-KL
dr. Afif Zjauhari, Sp.THT-KL
Presented By :
Dimar Kumala Puspaningrum
Dyah Carano Fitri
Sultan Agung Islamic UniversityFaculty of Medicine
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Effect of the canalith repositioning
procedure on subjective visual
horizontalin patients with posterior canal benign paroxysmal
positional vertigo
SHINICHI IWASAKI, YASUHIRO CHIHARA, MUNETAKA USHIO, ATSUSHI OCHI,
TOSHIHISA MUROFUSHI & TATSUYA YAMASOBA
Department of Otolaryngology, Faculty of Medicine, University of Tokyo,
and Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital, Kawasaki, Japan
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ABSTRACT
To evaluate
the changes of subjective
visual horizontal (SVH) in
patients with p-BPPV
before and after treatment
with the canalith
repositioning procedure.
26 patients with p-BPPV
were treated with Epleys
maneuver. Baseline SVH
measurements were
taken before performingthe maneuver, just after
maneuver, and 2 weeks
after maneuver.
OBJECTIVE METHOD
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26 patients with p-BPPV,11 showed abnormal
deviation of SVH.
Just after and 2weeks
performing Epleysmaneuver, the patientswho showed an
abnormal deviationdecreased.
patients withposterior canal have
signs of
utricular dysfunction
at baseline improvesafter performing thecanalith repositioning
procedure.
RESULT CONCLUSION
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INTRODUCTION
BPPV isconsidered to be
caused by
small particlestrapped in the
semicircularcanals
The canalith
repositioningmaneuver relocates
the freefloating
particles from the
affected semicircularcanal
back into the utricle
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the results of SVH/V
in patients withBPPV have been
controversial.
that half of the
patients with BPPV
showed an abnormaldeviation of SVH/V
the timing of themeasurement of
SVH/V
Several
studies havereported that therewere no significant
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MeasurementBefore the
Dix-Hallpikemaneuver
and thecanalith
repositioningprocedure
Afterperformingthe canalith
repositioning
procedure
2 weeksafter
treatment
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Material andmethods
INCLUSION
unilateral
p-BPPV
ages ranged from 19
to 76 years
EXCLUSION
Bilateral BPPV,
previously
received Epleys
maneuver
Menieres disease,
other vestibular
diseases ,other ear
diseases.
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SUBJECTIVE VISUALHORIZONTAL
(SUBJECT)
2 weeks
post
Epley
Post-
Epley
Baseline
SUBJECTIVE VISUALHORIZONTAL
(CONTROL)
Post
Epley
Baseline
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P > 0,01
P < 0,01
R ti f bj ti i l
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Ratio of subjective visual
horizontal (SVH) in
patients with BPPV.
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DISCUSSION
Epleys
Manouver
40 % abnormal
deviation of SVH(baseline)
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Previous
Results studies
normal or slightly abnormal
SVH in
patients with BPPV
8 of 16 patients with BPPV
showed an abnormal deviation
of SVV before performing
the canalith repositioning
procedure
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dislodgement of
otoconia
posterior
semicircular
canal.
activities of the
utricular nerve
ABNORMAL DEVIATION OF SVH/V
Excitation -inhibition
head
movements
free-floating
otoconia
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Successive changes of the
mean value of SVH
(A) and 15 patients
who showed normal SVH at the baseline condition (B). Dotted lines show the upperand lower limits of normal SVH (+ 2.18 and2.18).
Positive values indicate affected side down and negative values indicate unaffected
side down.
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THE RESULT of CANALITH
REPOSITIONING PROCEDURE
NORMALABNORMAL
ABNORMAL NORMAL
20 %
73 %
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CONCLUSION
40% of patients with p-
BPPV show an
abnormal
deviation of SVH,which significantly
improved
after performing
Epleys maneuver.
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