Detecting Otoconia With CT-Scan
Study Details
Study Description
Brief Summary
Benign Paroxysmal Positional Vertigo (BPPV) is a benign inner ear disease that causes the patient to experience short episodes of vertigo when there are changes in head position. The current theory on the causes of BPPV is the displacement of the otoconia from the otolith organ to the semicircular canal organs. BPPV's current treatments consist of repositioning maneuvers to readjust the location of the otoconia back to its original place. Even though the treatments are highly successful in many cases, this study, if proven successful, will confirm this theory and will help diagnose complicated cases where BPPV is recurrent and treatment has been unsuccessful.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
Benign Paroxysmal Positional Vertigo (BPPV) is a benign inner ear disease that causes the patient to experience vertigo when there are changes in head position. The prevalence is estimated to account for 20-30% of all vertigo diagnoses in a specialized clinic (von Brevern et al., 2007). The current theory on the cause of BPPV is the displacement of otoconia from the otolith organ to the semicircular canal organs due to gravitational forces, referred to as canalithiasis. These microstructures stimulate the vestibular organ without any head movement, resulting in vertigo (von Brevern et al., 2015).
The diagnosis of BPPV relies on history taking and positional tests. Treatment with particle repositioning maneuvers can be performed immediately following the positional test.
Current treatments for BPPV consist of repositioning maneuvers to readjust the location of the otoconia back to its original place (von Brevern et al., 2015). Even though the treatment is highly successful in many cases, a significant number of patients still have recurrent (27%) or persistent symptoms (Dorigueto et al., 2009), and objective confirmation of the disease is warranted. Until now, visualization and confirmation of the presence of otoliths have not been successful in clinical practice. This is largely due to the very small size of the otoliths in a small inner ear structure, requiring sensitive and ultra-high-resolution imaging.
In 2021, a study was performed in Japan using 3 Dimensional Computed Tomography (3D CT) scans to detect the otoconia inside the horizontal canal. It compared scans of people with BPPV in the horizontal canal and healthy individuals (Yamane et al., 2021). The authors were able to visualize otoconias inside the canal in all affected patients and three of the healthy participants (Yamane et al., 2021). In this study, the investigators will image the patients with a CT with an ultra-high-resolution scanning with concomitant spectral imaging. They will focus on imaging the posterior canal BPPV as it represents the most affected canal in BPPV and compare the imaging of the canal pre and post-treatment using the Epley maneuver as the most effective repositioning maneuver (Bruintjes et al., 2014; von Brevern et al., 2015).
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Experimental group Patient diagnosed with Posterior canal BPPV |
Diagnostic Test: ultra-high-resolution CT-scan
Use of ultra-high-resolution CT-scan to detect otoconia in the posterior canal BPPV
|
| Placebo Comparator: Control group Patient who are scheduled for CT-imaging as part of standard clinical routine and do not have BPPV |
Diagnostic Test: ultra-high-resolution CT-scan
Use of ultra-high-resolution CT-scan to detect otoconia in the posterior canal BPPV
|
Outcome Measures
Primary Outcome Measures
- Visualisation of presence or absence of otoconia in the posterior semicircular canal by comparing patient with confirmed BPPV symptoms compared to control subjects without BPPV [25min]
The presence or absence of otoconia in the posterior semicircular canal will be assessed qualitatively and semi-quantitatively using the CT parameters for BPPV patients, and the radiological images will be compared to those of control subjects.
Secondary Outcome Measures
- Visualization of the presence or absence of otoconia in patients with confirmed Benign Paroxysmal Positional Vertigo (BPPV) symptoms before and after a repositioning procedure. [35min]
Change in position of the otoconia will be assessed qualitatively and semi-quantitively using the CT parameters in BPPV patients by comparing the radiological images before and after repositioning maneuver (Epley)
Eligibility Criteria
Criteria
Inclusion Criteria:
Group 1: Experimental group:
Age 18 or older, Patients diagnosed with Posterior canal BPPV, clear nystagmus consistent with the direction of the tested canal and stimulation of the same canal, Patients should have at least mild complaints (no complaints, mild, moderate, severe) Crescendo-decrescendo nystagmus pattern should be observed, with at least a slow-phase eye velocity of 15 deg/sec.
Group 2: Control Group:
Age 18 or older, Patients scheduled for a CT scan for cochlear implantation (CI), no history of vestibular pathology such as DFNA9, meningitis, etc.
Exclusion Criteria:
Experimental group:
Patients with Anterior BPPV or lateral canal BPPV, Patients who are unable to properly undergo the Canalith Repositioning Maneuver (CRM) and Dix Hallpike maneuver, Patients with central vestibular disorders, Patients with Multi-canal BPPV or Subjective BPPV, Pregnant women.
Control group:
Patients with BPPV, central vestibular disorders, or Multi-canal BPPV, Patients with Subjective BPPV or ossifying labyrinthitis, Patients with Deafness, autosomal dominant 9 (DFNA9), Patients with known obstructive vestibular schwannoma on MRI, Patients with normal The video Head Impulse Test (vHIT), Patients with a history of meningitis, Pregnant women. Patients with other vestibular pathologies or past history of BPPV.
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Academisch Ziekenhuis Maastricht
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
- Benson JC, Rajendran K, Lane JI, Diehn FE, Weber NM, Thorne JE, Larson NB, Fletcher JG, McCollough CH, Leng S. A New Frontier in Temporal Bone Imaging: Photon-Counting Detector CT Demonstrates Superior Visualization of Critical Anatomic Structures at Reduced Radiation Dose. AJNR Am J Neuroradiol. 2022 Apr;43(4):579-584. doi: 10.3174/ajnr.A7452. Epub 2022 Mar 24.
- Bruintjes TD, Companjen J, van der Zaag-Loonen HJ, van Benthem PP. A randomised sham-controlled trial to assess the long-term effect of the Epley manoeuvre for treatment of posterior canal benign paroxysmal positional vertigo. Clin Otolaryngol. 2014 Feb;39(1):39-44. doi: 10.1111/coa.12217.
- Dorigueto RS, Mazzetti KR, Gabilan YP, Gananca FF. Benign paroxysmal positional vertigo recurrence and persistence. Braz J Otorhinolaryngol. 2009 Jul-Aug;75(4):565-72. doi: 10.1016/s1808-8694(15)30497-3.
- Rajendran K, Voss BA, Zhou W, Tao S, DeLone DR, Lane JI, Weaver JM, Carlson ML, Fletcher JG, McCollough CH, Leng S. Dose Reduction for Sinus and Temporal Bone Imaging Using Photon-Counting Detector CT With an Additional Tin Filter. Invest Radiol. 2020 Feb;55(2):91-100. doi: 10.1097/RLI.0000000000000614.
- von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D. Benign paroxysmal positional vertigo: Diagnostic criteria. J Vestib Res. 2015;25(3-4):105-17. doi: 10.3233/VES-150553.
- von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007 Jul;78(7):710-5. doi: 10.1136/jnnp.2006.100420. Epub 2006 Nov 29.
- Yamane H, Konishi K, Anniko M. Visualization of horizontal canal benign paroxysmal positional vertigo using 3DCT imaging and its assessment. Acta Otolaryngol. 2021 May;141(5):482-489. doi: 10.1080/00016489.2021.1892822. Epub 2021 Mar 29.
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