Approach to Residual Dizziness After Successfully Treated Benign Paroxysmal Positional Vertigo: Effect of a Polyphenol Compound Supplementation
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Clinical Pharmacology: Advances and Applications Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Approach to residual dizziness after successfully treated benign paroxysmal positional vertigo: effect of a polyphenol compound supplementation This article was published in the following Dove Press journal: Clinical Pharmacology: Advances and Applications Augusto Pietro Casani,1 Purpose: To assess if a polyphenol compound supplementation (Vertigoval®) could improve Elena Navari,1 Roberto Albera,2 residual dizziness earlier after benign paroxysmal positional vertigo (BPPV) and relieve Giuseppe Agus,3 patients from this disabling symptomatology. Giacinto Asprella Libonati,4 Methods: In this prospective, multicentric study, 127 patients were randomized in the Giuseppe Chiarella,5 treatment group (TG), who received a 60-day supplementation, while 131 patients were Nicola Lombardo,6 randomized in the control group (CG), who did not receive any medication. The dizziness Vincenzo Marcelli,7 handicap inventory (DHI) score, static posturography, and the visual analog scale (VAS) for Giovanni Ralli,8 both dizziness (D-VAS) and nausea/vomit (N/V-VAS) were used as measures of outcome at baseline and after 30 and 60 days. Patients were asked about efficacy and tolerance to the Leonardo Scotto di Santillo,9 treatment. Side effects were examined. Roberto Teggi,10 Pasquale Viola,5 Results: A statistically significant greater decrease was established in the TG for DHI, D- Luigi Califano11 VAS, and N/V-VAS compared to the CG. On the other hand, static posturography did not 1 Department of Medical and Surgical show statistical differences between the two groups, though a better clinical improvement Pathology, Otorhinolaryngology Section, Pisa University, Pisa, Italy; 2Division of after 60-day supplementation was shown in the TG in comparison to the CG. We counted Otorhinolaryngology, Department of mild side effects in only 2 patients. Most patients reported an excellent or good efficacy and Surgical Sciences, University of Turin School tolerance to the treatment. of Medicine, Turin, Italy; 3Otorhinolaryngology, Private Practice, Conclusion: Residual dizziness is a frequent condition of unknown origin that manifests as Cagliari, Italy; 4Ear, Nose and Throat persistent disabling imbalance after successful repositioning maneuvers for BPPV. The Department, Unit of Audiology, Vestibology decreasing postural control can affect the quality of life, contributing to falling and psycho- and Phoniatry, Madonna delle Grazie Hospital, Matera, Italy; 5Department of logical problems. The supplementation with the polyphenol compound used in our study is Experimental and Clinical Medicine, Unit of safe, manageable, and appeared to be able to reduce subjective symptoms and improve Audiology and Phoniatrics, Magna Græcia University,Catanzaro,Italy; instability earlier, decreasing the risk of potential complications. 6Otorhinolaryngology Section, Mater Keywords: residual dizziness, benign, paroxysmal positional vertigo, BPPV, Vertigoval® Domini University, Catanzaro, Italy; 7Department of Neuroscience, Vestibular and Audiology Unit, University of Naples “Federico II”,Naples,Italy;8Department of Sense Organs, Sapienza University of Rome, Introduction Rome, Italy; 9Vestibology and Vestibular Rehabilitation Unit, Antero Micone Hospital, Benign paroxysmal positional vertigo (BPPV) represents the most frequent vestib- Genoa, Italy; 10Ear, Nose and Throat ular disorder in neuro-otological clinical practice with a prevalence in the general Department, San Raffaele ScientificHospital, 1,2 Milan, Italy; 11Audiovestibology Unit, G. population of about 2.4%. Rummo Hospital, Benevento, Italy Even if this disorder may arise at any time of life, it rarely manifests in Correspondence: Augusto Pietro Casani adolescents, resulting more frequently in adults and elderly people. The peak of Department of Surgical Pathology, incidence is around the fifth to seventh decade of life.2–4 Medical, Molecular and Critical Area, ENT Section, Pisa University Hospital, Via Recurrent, brief and violent crises of true vertigo triggered by horizontal and Paradisa, 2, 56124, Pisa, Italy vertical movements of the head characterize the disorder. While the etiology of Tel +39 0 5099 7496 Email [email protected] BPPV has still not been fully understood and is classified as idiopathic in more than submit your manuscript | www.dovepress.com Clinical Pharmacology: Advances and Applications 2019:11 117–125 117 DovePress © 2019 Casani et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the http://doi.org/10.2147/CPAA.S210763 work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Casani et al Dovepress 70% of cases,3 the pathogenesis of BPPV is on the other Materials and methods hand almost certain: it may be identified in the detachment In this prospective, multicentric, randomized study, 290 of otoliths and in their displacement in one of the three patients were recruited from different centers in Italy 5 semicircular canals. between January 2017 and November 2017. Participating A careful anamnesis normally addresses the diagnosis centers were Benevento, Cagliari, Catanzaro, Genova, of BPPV. The diagnosis will be confirmed by the clinical Matera, Milan, Naples, Pisa, Rome, and Turin. The enroll- examination of the patient that employs specific diagnostic ment of patients was made according to a randomization maneuvers according to which of the canals is involved. list taking into account the ratio 1:1 between the two While the Dix-Hallpike maneuver is used in order to groups of patients having the foresight to balance the identify otoliths inside the posterior semicircular canal two groups in each center. For this purpose, we have (PSC), the supine head roll test is used for the horizontal utilized the Lehmer algorithm using the number generator semicircular canal and the head-hanging maneuver for the as reports in the Emilia Romagna sites (http://wwwservizi. anterior semicircular canal. A proper diagnostic approach regione.emilia-romagna.it/generatore/). means avoiding a series of useless and costly instrumental This study was approved by the Ethics Committee of tests and enables clinicians to go ahead swiftly with the the AOUP (Azienda Ospedaliero-Universitaria Pisana). treatment. All the patients belonging to the study group under- The importance of timely recognition of BPPV derives went only routinely performed tests, without invasive or also from the high incidence of this pathology in the experimental procedures. Written informed consent was elderly. This disorder prevents the capacity to carry out obtained from all participants and the study was conducted normal routine daily activities determining a significant in accordance with the Declaration of Helsinki. increase in the risk of falling and consequent injury.6 Inclusion criteria were the presence of dizziness even- Also, the treatment is through maneuver able to bring tually associated with neurovegetative symptoms after the detached otoliths back to the utricle. Most patients canalolithiasis of PSC BPPV2 successfully treated using have a good recovery after the treatment.7 However, up canalith repositioning procedures (paroxysmal positional to two-thirds of patients may perceive a prolonged and nystagmus is no more detectable by using an infrared/ handicapping instability, lightheadedness and malaise also video googles). The age had to be between 20 and 80 known as “residual dizziness.”8 This residual symptoma- years old. Exclusion criteria were a post-traumatic or a tology after the resolution of BPPV is variably described post-neuritis BPPV, central nervous system disease, alco- among patients. Some patients also complain of nausea hol or drug addiction, uncontrolled hypertension, hypoten- and vomiting. Previous studies reported an association sion, or thyroid disease, severe coronary artery disease, with a condition of stress of the subject that may be severe renal and/or hepatic impairment, antiplatelet and/or correlated with the duration of the BPPV and number of anticoagulant therapy, pregnant or breastfeeding, chronic recurrences.8,9 Some authors reported the duration of the instability pre-existing at the onset of BPPV, known intol- residual symptoms of about 6–20 days.8–10 However, some erance to the components of the supplementation, and poor patients recover later than others and some of these still compliance. present symptoms after 1 and 2 months.2,11 To our knowl- The recruited patients were randomized in the treat- edge, there is no accordance in the literature about any ment group (TG), who took the polyphenol compound drug or any other measure to approach this residual dis- containing the recommended daily intake (150 mg), one abling symptomatology. tablet two times in a day away from meals for 60 days. In this study, we report the effect of 30- and 60-day The supplementation is a polyphenol compound contain- supplementation with a polyphenol compound ing ViNitrox,