Personalized medicine to treat refractory benign paroxysmal positional vertigo, through computational fluid dynamics analysis from magnetic resonance image reconstructions

Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, often effectively treated with standard canalith repositioning maneuvers (CRMs). However, approximately 12.5% of cases remain refractory, leading to persistent symptoms and increased healthcare burden. Varia...

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Autores: Rossi Izquierdo, Marcos, Santos Pérez, Sofía María de la Soledad, Arán Tapia, Ismael, Blanco Ulla, Miguel, Arán González, Ismael, Vaamonde Sánchez-Andrade, Isabel, Franco-Gutiérrez, Virginia, Pérez Muñuzuri, Vicente, Pérez Muñuzuri, Alberto, Soto Varela, Andrés
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Universidad de Santiago de Compostela (USC)
Repositorio:Minerva. Repositorio Institucional de la Universidad de Santiago de Compostela
Idioma:inglés
OAI Identifier:oai:dnet:minerva_____::7308b7f35ad47134488be356393114ed
Acceso en línea:https://hdl.handle.net/10347/46589
Access Level:acceso abierto
Palabra clave:Benign paroxysmal positional vertigo
Canalith repositioning maneuvers
Computational fluid dynamics
Mechanical rotation chair
MRI
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spelling Personalized medicine to treat refractory benign paroxysmal positional vertigo, through computational fluid dynamics analysis from magnetic resonance image reconstructionsRossi Izquierdo, MarcosSantos Pérez, Sofía María de la SoledadArán Tapia, IsmaelBlanco Ulla, MiguelArán González, IsmaelVaamonde Sánchez-Andrade, IsabelFranco-Gutiérrez, VirginiaPérez Muñuzuri, VicentePérez Muñuzuri, AlbertoSoto Varela, AndrésBenign paroxysmal positional vertigoCanalith repositioning maneuversComputational fluid dynamicsMechanical rotation chairMRIBackground: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, often effectively treated with standard canalith repositioning maneuvers (CRMs). However, approximately 12.5% of cases remain refractory, leading to persistent symptoms and increased healthcare burden. Variations in the anatomical orientation of the semicircular canals (SCCs) may explain the resistance to conventional maneuvers. This study explores a personalized medicine approach, utilizing computational fluid dynamics (CFD) based on MRI reconstructions to tailor CRMs with the help of mechanical rotation chair according to individual inner ear anatomy. Methods: We conducted a randomized, multicenter, open-label study targeting patients with refractory posterior canal BPPV. Participants were allocated to either a control group (receiving repeated standard CRMs and Brandt-Daroff exercises) or an intervention group (receiving personalized CRMs based on CFD simulations derived from MRI scans). The intervention group’s maneuvers were executed using a mechanical rotational chair designed for precise angulation. Primary outcomes included resolution of nystagmus and vertigo symptoms, while secondary outcomes measured the reduction in healthcare visits and improved quality of life (Dizziness Handicap Inventory score). Discussion: Personalized CRMs based on CFD models may enhance treatment efficacy for refractory BPPV by optimizing maneuver angles according to the specific SCC orientation. This approach could significantly reduce symptom persistence, decrease the need for repeated healthcare visits, and improve patient outcomes. The use of non-invasive MRI and CFD techniques represents a novel step toward individualized treatment in vestibular disorders, with potential for broader application in personalized otoneurology. Further analysis will determine the extent of clinical benefit and cost-effectiveness of this approach. Clinical trial registration: ClinicalTrials.gov, Identifier: NCT06725966.Frontiers MediaUniversidade de Santiago de Compostela. Departamento de Cirurxía e Especialidades Médico-CirúrxicasUniversidade de Santiago de Compostela. Departamento de Física de PartículasUniversidade de Santiago de Compostela. Centro Interdisciplinar de Investigación en Tecnoloxías Ambientais (CRETUS)20252025-01-0120252025-01-01journal articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10347/46589reponame:Minerva. Repositorio Institucional de la Universidad de Santiago de Compostelainstname:Universidad de Santiago de Compostela (USC)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2© 2025 Rossi-Izquierdo, Santos-Pérez, Arán-Tapia, Blanco-Ulla, Arán-González, Vaamonde-Sánchez-Andrade, Franco-Gutiérrez, Pérez-Muñuzuri, Muñuzuri and Soto-Varela. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:dnet:minerva_____::7308b7f35ad47134488be356393114ed2026-06-15T12:47:27Z
dc.title.none.fl_str_mv Personalized medicine to treat refractory benign paroxysmal positional vertigo, through computational fluid dynamics analysis from magnetic resonance image reconstructions
title Personalized medicine to treat refractory benign paroxysmal positional vertigo, through computational fluid dynamics analysis from magnetic resonance image reconstructions
spellingShingle Personalized medicine to treat refractory benign paroxysmal positional vertigo, through computational fluid dynamics analysis from magnetic resonance image reconstructions
Rossi Izquierdo, Marcos
Benign paroxysmal positional vertigo
Canalith repositioning maneuvers
Computational fluid dynamics
Mechanical rotation chair
MRI
title_short Personalized medicine to treat refractory benign paroxysmal positional vertigo, through computational fluid dynamics analysis from magnetic resonance image reconstructions
title_full Personalized medicine to treat refractory benign paroxysmal positional vertigo, through computational fluid dynamics analysis from magnetic resonance image reconstructions
title_fullStr Personalized medicine to treat refractory benign paroxysmal positional vertigo, through computational fluid dynamics analysis from magnetic resonance image reconstructions
title_full_unstemmed Personalized medicine to treat refractory benign paroxysmal positional vertigo, through computational fluid dynamics analysis from magnetic resonance image reconstructions
title_sort Personalized medicine to treat refractory benign paroxysmal positional vertigo, through computational fluid dynamics analysis from magnetic resonance image reconstructions
dc.creator.none.fl_str_mv Rossi Izquierdo, Marcos
Santos Pérez, Sofía María de la Soledad
Arán Tapia, Ismael
Blanco Ulla, Miguel
Arán González, Ismael
Vaamonde Sánchez-Andrade, Isabel
Franco-Gutiérrez, Virginia
Pérez Muñuzuri, Vicente
Pérez Muñuzuri, Alberto
Soto Varela, Andrés
author Rossi Izquierdo, Marcos
author_facet Rossi Izquierdo, Marcos
Santos Pérez, Sofía María de la Soledad
Arán Tapia, Ismael
Blanco Ulla, Miguel
Arán González, Ismael
Vaamonde Sánchez-Andrade, Isabel
Franco-Gutiérrez, Virginia
Pérez Muñuzuri, Vicente
Pérez Muñuzuri, Alberto
Soto Varela, Andrés
author_role author
author2 Santos Pérez, Sofía María de la Soledad
Arán Tapia, Ismael
Blanco Ulla, Miguel
Arán González, Ismael
Vaamonde Sánchez-Andrade, Isabel
Franco-Gutiérrez, Virginia
Pérez Muñuzuri, Vicente
Pérez Muñuzuri, Alberto
Soto Varela, Andrés
author2_role author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universidade de Santiago de Compostela. Departamento de Cirurxía e Especialidades Médico-Cirúrxicas
Universidade de Santiago de Compostela. Departamento de Física de Partículas
Universidade de Santiago de Compostela. Centro Interdisciplinar de Investigación en Tecnoloxías Ambientais (CRETUS)
dc.subject.none.fl_str_mv Benign paroxysmal positional vertigo
Canalith repositioning maneuvers
Computational fluid dynamics
Mechanical rotation chair
MRI
topic Benign paroxysmal positional vertigo
Canalith repositioning maneuvers
Computational fluid dynamics
Mechanical rotation chair
MRI
description Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, often effectively treated with standard canalith repositioning maneuvers (CRMs). However, approximately 12.5% of cases remain refractory, leading to persistent symptoms and increased healthcare burden. Variations in the anatomical orientation of the semicircular canals (SCCs) may explain the resistance to conventional maneuvers. This study explores a personalized medicine approach, utilizing computational fluid dynamics (CFD) based on MRI reconstructions to tailor CRMs with the help of mechanical rotation chair according to individual inner ear anatomy. Methods: We conducted a randomized, multicenter, open-label study targeting patients with refractory posterior canal BPPV. Participants were allocated to either a control group (receiving repeated standard CRMs and Brandt-Daroff exercises) or an intervention group (receiving personalized CRMs based on CFD simulations derived from MRI scans). The intervention group’s maneuvers were executed using a mechanical rotational chair designed for precise angulation. Primary outcomes included resolution of nystagmus and vertigo symptoms, while secondary outcomes measured the reduction in healthcare visits and improved quality of life (Dizziness Handicap Inventory score). Discussion: Personalized CRMs based on CFD models may enhance treatment efficacy for refractory BPPV by optimizing maneuver angles according to the specific SCC orientation. This approach could significantly reduce symptom persistence, decrease the need for repeated healthcare visits, and improve patient outcomes. The use of non-invasive MRI and CFD techniques represents a novel step toward individualized treatment in vestibular disorders, with potential for broader application in personalized otoneurology. Further analysis will determine the extent of clinical benefit and cost-effectiveness of this approach. Clinical trial registration: ClinicalTrials.gov, Identifier: NCT06725966.
publishDate 2025
dc.date.none.fl_str_mv 2025
2025-01-01
2025
2025-01-01
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/10347/46589
url https://hdl.handle.net/10347/46589
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Frontiers Media
publisher.none.fl_str_mv Frontiers Media
dc.source.none.fl_str_mv reponame:Minerva. Repositorio Institucional de la Universidad de Santiago de Compostela
instname:Universidad de Santiago de Compostela (USC)
instname_str Universidad de Santiago de Compostela (USC)
reponame_str Minerva. Repositorio Institucional de la Universidad de Santiago de Compostela
collection Minerva. Repositorio Institucional de la Universidad de Santiago de Compostela
repository.name.fl_str_mv
repository.mail.fl_str_mv
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