RT Journal Article
T1 Numerical simulations of the Epley maneuver with clinical implications
A1 Arán Tapia, Ismael
A1 Soto Varela, Andrés
A1 Pérez Muñuzuri, Vicente
A1 Santos Pérez, Sofía María de la Soledad
A1 Arán González, Ismael
A1 Pérez Muñuzuri, Alberto
K1 Benign paroxysmal positional vertigo
K1 Canalith repositioning procedure
K1 Epley maneuver
K1 Mathematical modeling
K1 Numerical simulations
K1 Personalized medicine
AB Objectives: Canalith repositioning procedures to treat benign paroxysmal positional vertigo are often applied following standardized criteria, without considering the possible anatomical singularities of the membranous labyrinth for each individual. As a result, certain patients may become refractory to the treatment due to significant deviations from the ideal membranous labyrinth, that was considered when the maneuvers were designed. This study aims to understand the dynamics of the endolymphatic fluid and otoconia, within the membranous labyrinth geometry, which may contribute to the ineffectiveness of the Epley maneuver. Simultaneously, the study seeks to explore methods to avoid or reduce treatment failure.Design: We conducted a study on the Epley maneuver using numerical simulations based on a three-dimensional medical image reconstruction of the human left membranous labyrinth. A high-quality micro-computed tomography of a human temporal bone specimen was utilized for the image reconstruction, and a mathematical model for the endolymphatic fluid was developed and coupled with a spherical particle model representing otoconia inside the fluid. This allowed us to measure the position and time of each particle throughout all the steps of the maneuver, using equations that describe the physics behind benign paroxysmal positional vertigo.Results: Numerical simulations of the standard Epley maneuver applied to this membranous labyrinth model yielded unsatisfactory results, as otoconia do not reach the frontside of the utricle, which in this study is used as the measure of success. The resting times between subsequent steps indicated that longer intervals are required for smaller otoconia. Using different angles of rotation can prevent otoconia from entering the superior semicircular canal or the posterior ampulla. Steps 3, 4, and 5 exhibited a heightened susceptibility to failure, as otoconia could be accidentally displaced into these regions.Conclusions: We demonstrate that modifying the Epley maneuver based on the numerical results obtained in the membranous labyrinth of the human specimen under study can have a significant effect on the success or failure of the treatment. The use of numerical simulations appears to be a useful tool for future canalith repositioning procedures that aim to personalize the treatment by modifying the rotation planes currently defined as the standard criteria.
PB American Auditory Society
YR 2024
FD 2024-07
LK https://hdl.handle.net/10347/37593
UL https://hdl.handle.net/10347/37593
LA eng
NO Arán-Tapia, Ismael; Soto-Varela, Andrés; Pérez-Muñuzuri, Vicente; Santos-Pérez, Sofía; Arán, Ismael; Muñuzuri, Alberto P. Numerical Simulations of the Epley Maneuver With Clinical Implications. Ear & Hearing 45(4):p 1033-1044, July/August 2024. | DOI: 10.1097/AUD.0000000000001493
DS Minerva
RD 27 abr 2026