VPPB, le vertige positionnel paroxystique bénin

En deux mots :

Le vertige positionnel paroxystique bénin (VPPB) se soigne très bien en ostéopathie vestibulaire

 

Explications :

Le VPPB est un vertige violent de courte durée qui apparaît après un changement de position, par exemple en passant de la position assise à la position allongée. C'est le vertige le plus rencontré. Il est attribué à la présence anormale de débris de cristaux dans un conduit (semi-circulaire) de l'oreille interne, organe dont la fonction intervient dans l'équilibration de l'ensemble du corps et dans l'orientation du regard.

En vidéo :  Vertige Positionnel Paroxystique Bénin, AlloDocteur, France 5

Qu'est-ce qu'un vertige paroxystique positionnel bénin ? Dr Bouccara dans AlloDocteur sur France 5

 

 

 

 

Effets indésirables transitoires du traitement classique du VPPB, YEO Fev 2018
 Tête lourde (50,8%)
 Nausées (46,4%) / Vomissements (4,9%)
Instabilité (31,9%)
Hypotension ou palpitations (8,6%)
Conversion canalaire (3,1%)

Il y a 11% d'échec complet, même avec les appareils les plus sophistiqués du monde. Les techniques médicales sont parfois invasives ou brusques.

Des spécialistes estiment que 40% de leurs manœuvres thérapeutiques "réussies" seraient insuffisantes, oubliant des débris mal placés.

Par conséquent, si vous refusez ces approches habituelles, si vous les avez déjà essayé, si votre VPPB a été traité mais que persiste une gène résiduelle, une instabilité debout ou un mal des transports (cinétose), une sensation ébrieuse, une instabilité, un défaut de coordination ou une douleur associée à une asymétrie posturale, un bilan d'ostéopathie vestibulaire mérite d'être effectué.

 

L'ostéopathie-vestibulaire Traitement d'ostéopathie vestibulaire pour un VPPB

 

C'est une approche du VPPB différente de celle de la plupart des cabinets ORLs, ou des autres ostéopathes ou kinésithérapeutes spécialisés en rééducation vestibulaire :

  • Sur le plan diagnostic, ce sont les tensions musculaires du corps venant de l'oreille interne qui sont évaluées (test des réponses vestibulo-spinales). C'est, à mon avis, une méthode plus fiable que l'observation des mouvements oculaires sous masque à caméra infra-rouge.
  • La prise en charge d'un VPPB, se fait par des manœuvres douces de positionnement de la tête permettant d'évacuer les débris ayant envahi un conduit.

Tout comme pour un syndrome postural ou une instabilité, une seule séance d'ostéopathie vestibulaire, souvent longue, est suffisante. Dans 1 cas sur 10, ce traitement hors-norme doit être renouvelé pour un autre conduit. Des exercices complémentaires, voir une rééducation classique, peuvent être préconisés par la suite.

 

Les 5 signes cardinaux du VPPB postérieur déclenché par le test de Dix et Hallpike

  1. Un nystagmus rotatoire à composante verticale supérieure doit apparaître en regard primaire lorsque l’oreille affectée est la plus basse
  2. Il doit y avoir un temps de latence bref avant le vertige : de 1 à 20s, en moyenne 5s
  3. Apparition d'un vertige de durée brève : de 4 à 30s, en moyenne 12,5s
  4. Il doit y avoir inversion du nystagmus lors du retour assis (rotatoire à composante verticale inférieure)
  5. Il doit être fatigable, c.à.d. moins intense lors d'une 2e manœuvre de même vitesse

Image schématique du concept des cristaux bloqués dans un conduit semi-circulaire

Vous pouvez me contacter directement si vous avez tous les signes d'un VPPB postérieur, latéral ou antérieur (les signes ressentis peuvent être proches) ou bien en cas de simples étourdissements ou d'instabilité debout.

Un vertige au changement de position qui n'est pas un VPPB nécessite de consulter un généraliste ou bien un ORL avant de me consulter : Des examens complémentaires et un traitement complètement différent de celui-ci sont nécessaires pour certains vertiges.

 

Références scientifiques :

https://www.has-sante.fr/portail/upload/docs/application/pdf/2018-01/vertiges_positionnels_paroxystiques_benins_-_manoeuvres_diagnostiques_et_therapeutiques_-_recommandations.pdf

https://screenshots.firefox.com/Qm8xKsslKE717XnA/www.medecine.ups-tlse.fr

https://www.orlfrance.org/wp-content/uploads/2017/06/Vertige-Positionnel-Paroxystique-Benin-2012-Janvier.pdf

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