CASE OF THE WEEK- "Innovation of a new treatment strategy in treating persistent refractory positional vertigo using mastoid vibration device." by Dr. Shwan Mohamed- Consultant, ENT Surgeon at NMC Royal Hospital, Sharjah

CASE OF THE WEEK- "Innovation of a new treatment strategy in treating persistent refractory positional vertigo using mastoid vibration device." by Dr. Shwan Mohamed- Consultant, ENT Surgeon at NMC Royal Hospital, Sharjah

Innovation of a new treatment strategy in treating persistent refractory positional vertigo using mastoid vibration device." by Dr. Shwan Mohamed- Consultant, ENT Surgeon.

Introduction

Benign paroxysmal positional vertigo (BPPV) is defined as recurrent episodes of vertigo triggered by change in head position. This condition is one of the most common causes of vertigo. The underlying mechanism typically involves a small calcified otolith ( ear debris) moving around loose in the inner ear of two main types, canalolithiasis and cupololithiasis ( Figure 1)

Case report

A 48 years old patient presented to ENT Out-patient clinic with recurrent severe episodes of vertigo triggered by turning head and lying flat. These episodes have been going on for the past 3 years. He has presented to various Hospitals elsewhere for these episodes and received treatment with no improvement. He reached a stage that he could not lie flat which triggers these episodes and he has been sleeping in a head up position to avoid these episodes which interfered with his sleep and affecting his quality of life.

The clinical examination including Dix-Hallpike test confirmed left sided posterior canal BPPV. Initially this condition was treated with traditional canalolith repositioning method (Eply maneuver). However, despite multiple treatment sessions, the problem persisted and deemed refractory to the traditional treatment ( Cupololithiasis type).

New Treatment Strategy

This challenging case failed to respond to traditional treatment method. This lead to development of a new treatment strategy using mastoid vibration device by ENT department ( Dr. Shwan Mohamed, Consultant ENT Surgeon) with input from Audiology department ( Mr Mirshad, senior Audiologist ). This device is applied on the mastoid bone behind the ear during canal repositioning procedure ( Figure 2 ).

This was based on the theory that mechanical vibration transmitted through mastoid bone to inner earto potentially aid dislodging and replacement of the debris in the semicircular canals as the main underlying factor, hence treating this condition. This was tried on this patient and this debilitating condition was successfully treated. The patient’s symptoms completely resolved and remained symptoms free on further follow up after 2 months. This novel technique were successfully applied subsequently on two more patient with similar condition not responding to the traditional treatment.

Conclusion

Persistent refractory positional vertigo can be difficult to treat with traditional method and can be debilitating , significantly affecting quality of life. This initial finding show that this new treatment strategy is giving promising results in treating these patients. Further use of this technique in a large patient group is underway to support further its effectiveness with a potential to apply it for patients with this medical problem worldwide.

References

Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, Chalian AA, Desmond AL, Earll JM, Fife TD, Fuller DC, Judge JO, Mann NR, Rosenfeld RM, Schuring LT, Steiner RW, Whitney SL, Haidari J (November 2008). "Clinical practice guideline: benign paroxysmal positional vertigo".

Otolaryngology–HeadandNeckSurgery. 139 (5Suppl4):S47-81. Doi:10.1016 j.otohns.2008.08.022. PMID 18973840. S2CID 16175316. Lay summary – AAO-HNS (2008-11-01).

Dickson, Gretchen (2014). Primary Care ENT, An Issue of Primary Care: Clinics in Office Practice,Volume41,Issue1ofTheClinics:InternalMedicine.ElsevierHealthSciences. p. 115. ISBN 9780323287173.

Archived from the original on 15 August 2016. Retrieved 25 July 2016.

Innovation of a new treatment strategy in treating persistent refractory positional vertigo using mastoid vibration device.