Objectives The aim of this study was to determine the most effective treatment approach by comparing the impacts of various otolith reduction techniques in patients with apogeotropic lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV).Methods We performed a multicenter randomized prospective study from January to December 2015, involving 72 consecutive patients with apogeotropic LC-BPPV. The patients were divided into three treatment groups: therapeutic head-shaking (group A), the Gufoni-Appiani maneuver (group B), and the cupulolith repositioning maneuver (CuRM; group C). Each group underwent evaluation and treatment up to the fourth week. Treatment success was defined as the disappearance of positional vertigo and nystagmus.Results This study included 72 patients (49 male and 23 female), with a mean (±standard deviation) age of 55.4±13.5 years. The mean duration of vertigo experienced prior to treatment was 3.9±4.4 days. The mean latency and duration of nystagmus were 2.7±3.0 seconds and 47.9±15.8 seconds, respectively. The overall treatment frequency was 2.0±0.9. The number of treatments differed significantly among the three groups (P0.05). However, CuRM was the only method with a 100% treatment success rate.Conclusion While no clear difference was observed among the three treatments for LC-BPPV, CuRM was found to be superior to the other approaches in the long term.

Lee HJ, et al. Yonsei Med J. 2021 May;62(5):446-452. https://doi.org/10.3349/ymj.2021.62.5.446

Objectives. Canalolithiasis of the posterior semicircular canal (PC) is the most common reason for benign paroxysmal positional vertigo (BPPV). If a patient is diagnosed with PC-BPPV through the Dix-Hallpike test, the modified Epley maneuver (mEpley) is used as the gold standard treatment. To reduce the discomfort of the standard mEpley, we proposed placing a pillow under the shoulders during this therapeutic maneuver. The purpose of this study was to determine whether the therapeutic efficacy of the mEpley with a pillow under the shoulders (mEpley-PS) was comparable to that of the standard mEpley.Methods. A randomized controlled study at three academic referral hospitals was conducted in compliance with the CONSORT statement. Patients who were diagnosed with PC-BPPV through the Dix-Hallpike test were randomly assigned to groups A or B. Patients in groups A and B were treated with the standard mEpley and mEpley-PS, respectively. The resolution of vertigo and nystagmus on the Dix-Hallpike test at a 1-week follow-up after treatment was the main outcome measurement to assess the efficacy of treatment.Results. Forty-one patients diagnosed with PC-BPPV were enrolled in this study. Twenty-one patients were assigned to group A and 20 were assigned to group B. The success rate at 1 week after treatment was 85.7% in group A and 80.0% in group B. There was no statistically significant difference between the two groups (P=0.697).Conclusion. The therapeutic efficacy of the mEpley-PS was comparable to that of the standard mEpley. The use of the pillow modification may be an excellent alternative if a patient cannot tolerate the head-hanging position, and it is helpful for patients who have anxiety about the head-hanging position. The mEpley-PS can be performed on a bed with or without a headboard. It is both a patient-friendly and a clinician-friendly maneuver.

Objectives: We aimed to investigate the effect of obstructive sleep apnea (OSA) on hearing ability.Methods: We retrospectively reviewed the population-based survey data collected by the Korean National Health and Nutrition Examination Survey between January 1, 2019 and December 31, 2020. The data included 3,575 participants who completed the STOP-BANG questionnaire (SBQ) and pure-tone audiometry. OSA risk was assessed using the SBQ, and the hearing level was compared between the risk groups.Results: Among the 3,575 participants, 2,152 (60.2%), 891 (24.9%), and 532 (14.9%) were classified as being low, intermediate, and high risk, respectively. The intermediate- and high-risk groups showed significantly worse hearing levels than the low-risk group. When age and sex were adjusted, the hearing level did not differ between the risk groups.Conclusion: The study found that the presence of OSA minimally affected hearing level. Because hearing loss due to hypoxic damage develops over a long period of time, further research on the association between the duration of OSA, rather than the presence or severity of OSA, and hearing loss is needed.

Objectives. The aim of study is to find conditions that aggravate auditory deprivation in patients with symmetric hearing loss after unilateral digital, non-linear hearing aid (HA).Methods. In the retrospective case-comparison study, we assessed 47 patients with symmetric sensorineural hearing loss (SNHL), wearing unilateral conventional HAs. Audiological outcomes were assessed >1 year after HA fitting (mean duration, 31.0 months). Pure-tone audiometry in HA-aided and HA-unaided conditions was performed over time. Word recognition score (WRS) was evaluated at the most comfortable listening level.Results. The initial pure tone average of four frequency thresholds at 500, 1,000, 2,000, and 4,000 Hz (PTA4) did not show a difference of >5 dB HL between HA-aided and HA-unaided ears. WRS progressively decreased for both HA-aided and HA-unaided ears although the extent of decrease was significantly greater for HA-unaided (7.6%) than for HA-aided ears (5.1%, P<0.05). Notably, auditory deprivation in HA-unaided ears was significantly greater in patients with an initial PTA4 ≥53 dB HL (P<0.001).Conclusion. Bilateral HAs are strongly recommended, particularly for patients with moderate to severe SNHL to prevent auditory deprivation in the contralateral ear.