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Background: It has been reported that head-up sleep (HUS) prevents free-floating otoliths from entering canals and that vertical recognition training (VRT) promotes vestibular compensation. Aims/objectives: We would like to assess HUS and VRT for intractable motion-evoked dizziness, including possible benign paroxysmal positional vertigo (BPPV). Materials and methods: 162 patients diagnosed with intractable motion-evoked dizziness of unknown origin were enrolled and randomly divided into the following four groups: HUS−/VRT−, HUS+/VRT−, HUS−/VRT+, and HUS+/VRT+. The at-home interventions comprised HUS with an upper head position of 45° when lying down and VRT with a right down-left down 30° head inclination while watching the vertical index. Results: At the post-treatment 6th month, visual analogue scale (VAS) scores for vertiginous sensation were significantly lower in the HUS+/VRT + group than in the HUS+/VRT − and HUS−/VRT + groups, which were in turn significantly lower than those in the HUS−/VRT − group. VAS scores in the HUS−/VRT + group of patients with abnormal subjective visual vertical (SVV) were significantly lower than those in the HUS+/VRT − group, while those in the HUS+/VRT − group of patients with normal SVV were significantly lower than those in the HUS−/VRT + group. Conclusions: HUS and/or VRT is a good initial treatment for patients with intractable undiagnosed motion-evoked dizziness, including possible BPPV. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to examine the association of neuro-otological examination, blood test, and scoring questionnaire data with treatment-resistant intractability in idiopathic benign paroxysmal positional vertigo (BPPV) patients.Methods: We experienced 1520 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University during May 2014 to April 2018. Six hundred and eleven patients were diagnosed as BPPV (611/1520; 40.2%) according to the diagnostic guideline of the International Classification of Vestibular Disorder in 2015. Among BPPV patients, there were 201 intractable patients (201/611; 32.9%), 66 of whom were idiopathic and enrolled to be hospitalized and receive neuro-otological examinations, including the caloric test (C-test), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV), glycerol test (G-test), electrocochleogram (ECoG), inner ear magnetic resonance imaging (ieMRI), blood tests including anti-diuretic hormone (ADH) and bone alkaline phosphatase (BAP), and self-rating questionnaires of depression score (SDS). Sixty-six patients were diagnosed as horizontal type cupula (hBPPVcu; n=30), horizontal type canal (hBPPVca; n=10), posterior type (n=20), and probable and/or atypical BPPV (n=6). Data are presented as ratios (+) of the number of idiopathic BPPV patients with examination and questionnaire data outside of the normal range.Results: The ratio (+) data were as follows: C-test=21.2% (14/66), cVEMP=24.2% (16/66), SVV=48.5% (32/66), G-test=18.2% (12/66), ECoG=18.2% (12/66), ieMRI=12.1% (8/66), ADH=9.1% (6/66), BAP=13.6% (9/66), and SDS=37.9% (25/66). Multivariate regression analysis revealed that the periods of persistent vertigo/dizziness were significantly longer in BPPV patients with hBPPVcu, C-test (+), endolymphatic hydrops (+), and BAP (+) compared with those with negative findings.Conclusion: Although patients with idiopathic BPPV are usually treatable and curable within 1 month, the presence of hBPPVcu, canal paresis, endolymphatic hydrops, and elevated BAP may make the disease intractable, and thus require additional treatments. [ABSTRACT FROM AUTHOR]