What Inner Ear Diseases Cause Benign Paroxysmal Positional Vertigo?

Benign paroxysmal positional vertigo (BPPV) originating from the posterior semicircular canal (pSCC) is a common vestibular disorder that is easy to diagnose and usually easy to treat. The majority of patients with BPPV have no known inner ear disease; they have ?primary? or ?idiopathic? BPPV. However, a minority does have objective evidence of an inner ear disease on the same side as the BPPV and this group has ?secondary? or ?symptomatic? BPPV. Previous publications differ on the prevalence of secondary BPPV and about the types of inner ear diseases capable of causing it. In order to determine what proportion of patients have secondary as opposed to primary BPPV and which inner ear diseases are capable of causing secondary BPPV, we searched our database for the 10-year period from 1988 to 1997 and found a total of 2847 patients with BPPV. Of these, 81 (3%) had definite pSCC-BPPV secondary to an ipsilateral inner ear disease. Sixteen had Menière's disease, 24 had an acute unilateral peripheral vestibulopathy, 12 had a chronic unilateral peripheral vestibulopathy, 21 had chronic bilateral peripheral vestibulopathy and 8 had unilateral sensorineural hearing loss. It seems that any inner ear disease that detaches otoconia and yet does not totally destroy pSCC function can cause BPPV and that a case can be made for audiometry and caloric testing in all patients with BPPV.     

What inner ear diseases cause benign paroxysmal positional vertigo?

Benign paroxysmal positional vertigo (BPPV) originating from the posterior semicircular canal (pSCC) is a common vestibular disorder that is easy to diagnose and usually easy to treat. The majority of patients with BPPV have no known inner ear disease; they have "primary" or "idiopathic" BPPV. However, a minority does have objective evidence of an inner ear disease on the same side as the BPPV and this group has "secondary" or "symptomatic" BPPV. Previous publications differ on the prevalence of secondary BPPV and about the types of inner ear diseases capable of causing it. In order to determine what proportion of patients have secondary as opposed to primary BPPV and which inner ear diseases are capable of causing secondary BPPV, we searched our database for the 10-year period from 1988 to 1997 and found a total of 2847 patients with BPPV. Of these, 81 (3%) had definite pSCC-BPPV secondary to an ipsilateral inner ear disease. Sixteen had Menière's disease, 24 had an acute unilateral peripheral vestibulopathy, 12 had a chronic unilateral peripheral vestibulopathy, 21 had chronic bilateral peripheral vestibulopathy and 8 had unilateral sensorineural hearing loss. It seems that any inner ear disease that detaches otoconia and yet does not totally destroy pSCC function can cause BPPV and that a case can be made for audiometry and caloric testing in all patients with BPPV.     

继发性后半规管良性阵发性位置性眩晕的诊治

目的 探讨继发性良性阵发性位置性眩晕(BPPV)的诊断和治疗。方法研究继发性后半规管BPPV的内耳疾病6例病历资料,诊断依据为病史及Dix-Hallpike试验诱导出现的眼震结果。结果 6例内耳疾病(分别为突发性聋3例, 梅尼埃病2例, 前庭神经元炎1例)伴有后半规管良性阵发性位置性眩晕被确诊,通过Dix-Hallpike试验诱发出垂直扭转型眼震。结论 继发性BPPV临床较少见,常为后半规管受累,通过Dix-Hallpike试验和Epley手法复位可以确诊和治愈。     

突发性聋继发良性阵发性位置性眩晕的临床观察

目的了解继发于突发性聋的良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的发病情况并探讨其治疗策略。方法观察眩晕门诊及耳内科病房中心2004年1月-2010年1月收治的210例突发性聋患者（包括伴有眩晕的突发性聋）合并BPPV的发病情况,并与同期183例原发性BPPV相比较。结果本组突发性聋病例并发BPPV为19．0％（40／210）;40例患者均为高频感音神经性聋或平坦型感音神经性聋。本文40例继发于突发性聋的BPPV,出现时间均在突发性聋发病后t周内。继发性BPPV的手法复位效果与原发性BPPV相似,大多数都于1～2次就诊后治愈。结论突发性聋继发的BPPV是临床常见的现象;继发于突聋的BPPV与原发性BPPV都是以后半规管BPPV多见,并与原发性BPPV手法复位的疗效相似。     

内耳病变并发良性阵发性位置性眩晕

目的了解继发于几种内耳疾病的良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）的发病情况，进一步了解BPPV的可能发病机制。方法观察眩晕诊疗中心2004年1月至2006年11月53例前庭神经炎、90例突发性聋（包括伴眩晕的突发性聋）、381例梅尼埃病BPPV等的发病情况，并与同期183例原发性BPPV比较。结果4种内耳疾病后可以出现BPPV，分别是前庭神经炎、突发性聋、梅尼埃病和Bell麻痹。前庭神经炎后出现BPPV为9．4％（5／53）；突发性聋后出现BPPV为38．9％（35／90）；梅尼埃病后出现BPPV为0．3％（1／381）；1例Bell麻痹后出现BPPV。其中外半规管BPPV5例；后半规管37例，其中1例后半规管BPPV在复位过程中出现同侧前半规管BPPV。管结石症39例，外半规管嵴顶结石症3例。内耳病变后出现BPPV在发病后半年内出现者占75．0％（27／36）。继发性BPPV的手法复位效果与原发性BPPV相似，大多都可1、2次就诊后治愈。结论内耳病突发性聋、前庭神经炎和梅尼埃病后可以出现BPPV。这种类型的BPPV主要表现为后半规管管结石，偶见外半规管嵴帽结石。原发性BPPV与内耳病变后出现的BPPV手法复位疗效相似。     

继发于突发性聋的良性阵发性位置性眩晕的临床治疗分析

目的　回顾性分析继发于突发性聋的良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）患者的临床表现,并探讨其可能的发病机制,探索合适的诊断与治疗方案。方法　观察218例突发性聋患者中BPPV的发病情况和临床治疗效果,另有37例同期原发性BPPV作为对照组。所有患者均经Dix-Hallpike实验和Barbecue滚转检查确定诊断,继发性BPPV患者的原发病（突发性聋）符合中华医学会耳鼻咽喉头颈外科学分会制定的诊断标准。按照BPPV类型,进行Epley手法复位或Barbecue翻滚手法治疗,并评价治疗效果。结果　218例突发性聋患者中有9l例出现BPPV,发生率41.7%,均为同侧患耳。BPPV经耳石复位,其中1次治愈62例（68.1%）,2次治愈16例（17.6%）,3次治愈13例（14.3%）。随访6～22个月,高频听力改善均不及低频,外半规管型BPPV复发2例,后半规管型复发5例,经过再次复位后治愈。继发性BPPV与原发性BPPV均经手法复位治愈,疗效相似。结论　BPPV可继发于突发性聋,且突发性聋继发BPPV可达41.7%,其中以后半规管BPPV常见,耳石复位治疗是最为有效的治疗方法,治愈率与原发性BPPV相似。     

突发性聋伴发良性阵发性位置性眩晕的临床特点及疗效观察

目的　探讨突发性聋伴发良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的临床特点,观察其疗效。方法　观察2012年10月～2014年6月耳 鼻咽喉科收治的36例突发性聋伴发BPPV发病情况,并与同期原发性BPPV患者40例及突发性聋不伴眩晕患者40例进行疗效比较。结果　伴发BPPV的36例突发性聋患者,受累半规管均与突发性聋发病侧一致,其中水平半规管BPPV 6例,占16.7%（6/36）;后半规管BPPV 27例,占75.0%（27/36）;混合管BPPV 3例,占8.3%（3/36）。36例患者出现BPPV的时间均在突发性聋发病后数小时至数天（＜10天）发生。突发性聋伴发BPPV组1次治愈率明显低于原发性BPPV组,但两种治疗方法的总治愈率均为100%。不伴眩晕突发性聋组的痊愈率、显效率及有效率均高于伴发BPPV组。结论　伴发于突发性聋的BPPV以后半规管多见,与原发性BPPV经耳石复位治疗后均可取得较好疗效。而不伴眩晕的突发性聋其疗效优于伴发BPPV的突发性聋。     

Sudden unilateral hearing loss with simultaneous ipsilateral posterior semicircular canal benign paroxysmal positional vertigo: a variant of vestibulo-cochlear neurolabyrinthitis?

We describe 4 patients who all simultaneously developed a sudden total or partial unilateral sensorineural hearing loss and an unusual acute peripheral vestibulopathy in the same ear characterized by posterior semicircular canal benign paroxysmal positional vertigo with intact lateral semicircular canal function. Two patients also had ipsilateral loss of otolith function. The vertigo resolved in all 4 patients after particle-repositioning maneuvers. The findings of audiometry and vestibular tests indicated that the lesion responsible for this syndrome was probably located within the labyrinth itself rather than within the vestibulocochlear nerve and that it was more likely a viral vestibulocochlear neurolabyrinthitis than a labyrinthine infarction.     

Anterior Canal benign paroxysmal positional Vertigo following surgical Management of superior canal dehiscence

Objective

Benign paroxysmal positional vertigo (BPPV) is a common post-surgical finding in patients managed for superior semicircular canal dehiscence (SSCD). The posterior semicircular canal has been reported as the involved canal in the majority of cases of post-surgical BPPV, with only two cases reported of lateral canal involvement. The objective of this report is to present a case in which an anterior semicircular canal BPPV response was identified in a patient following surgical management for SSCD.

Posterior semicircular canal type benign paroxysmal positioning vertigo with ageotropic paroxysmal positioning nystagmus

We report on 3 patients with typical benign paroxysmal positioning vertigo (BPPV) and atypical, paroxysmal positioning nystagmus. When the Dix-Hallpike test was performed, the patients exhibited an ageotropic nystagmus, different from that classically described in posterior semicircular canal BPPV. It was torsional-vertical with the vertical component beating downwards, and the torsional component was beating away from the lowermost ear. In both left and right Dix-Hallpike positions, the upper poles of the eyes were turning away from the lowermost ear. The atypical ageotropic paroxysmal positional nystagmus of the posterior semicircular canal was observed in the evolution of the BPPV in 2 patients and on the first examination in the third. Two patients had changing patterns of paroxysmal positioning nystagmus.     

Mumps virus may damage the vestibular nerve as well as the inner ear

We report a case of mumps deafness with acute vestibular symptoms secondary to both retrolabyrinthine and inner ear dysfunction. To our knowledge, no such case has been reported elsewhere. The patient was a 6-year-old girl in whom mumps deafness was initially diagnosed. Two days after onset of the hearing impairment, severe vertigo developed. Neurotologic examinations revealed spontaneous right-beating nystagmus, left canal paresis, absence of vestibular-evoked myogenic potentials in the left ear, and absence of responses to a left galvanic body sway test (GBST). The vertigo resolved 7 days after onset. However, the left hearing impairment progressed to complete deafness. Six months later, left canal paresis was still present, but bilateral GBST responses were normal, suggesting that retrolabyrinthine vestibular function had been restored. Mumps virus may affect retrolabyrinthine function as well as the inner ear.     

Benign paroxysmal positioning vertigo: diagnosis and therapy using video-oculographic control

In this prospective study, 82 patients (40 males, 42 females, aged between 15 and 80 years) with benign paroxysmal positioning vertigo (BPPV) were treated with different positioning manoeuvres using video-oculographic control. The maximum age for females and males was 31 and 40 years respectively. After an interview about the special history related to vertigo imbalance symptoms and using video-oculographic control, we diagnosed 79 patients with BPPV of the posterior semicircular canal and 3 of the horizontal semicircular canal. The Dix-Hallpike and Cawthorne manoeuvres were used for the diagnosis of BPPV of the posterior semicircular canal and the McClure manoeuvre for the diagnosis of BPPV of the horizontal semicircular canal. 72% of the patients had an idiopathic BPPV and 12.2% were post-traumatic. 3.7% had BPPV after ear surgery and 2.4% were pregnant. 39 patients with posterior BPPV were treated with Semont's manoeuvre and 40 with Epley's. The 3 patients with horizontal BPPV were treated with Baloh's manoeuvre. More than half of the patients (52.5%) were free of symptoms after one session of Epley's manoeuvre and all of them after four sessions. 51.3% had no further symptoms after one session of Semont's manoeuvre and all of them after four sessions. These results, in agreement with the literature, show that the success rate of Semont's and Epley's manoeuvres is approximately the same. Video-oculographic control is helpful for the diagnosis and for the registration of the eye movements during the therapeutic manoeuvres.     

难治性良性阵发性位置性眩晕的临床分析

目的 探讨难治性良性阵发性位置性眩晕(BPPV)的临床特点及治疗。 方法 回顾分析2014年8月至2016年1月诊断为难治性BPPV的13例患者的临床资料,分析其病因相关因素、类型、临床特点及治疗效果。 结果 13例难治性BPPV中,头部外伤为最常见因素,离地性水平半规管BPPV为最常见类型。根据病因积极治疗伴随疾病,正确手法复位治疗,联合Brandt-Daroff康复训练,11例治愈,随访1年无复发;2例无效;1例后半规管、1例水平半规管BPPV,至他院行半规管堵塞术手术治疗,术后效果好。 结论 难治性BPPV可能与头部外伤及突发性聋等疾病相关,首先需根据病因积极治疗伴随疾病,同时采用正确的手法复位治疗,并联合康复训练。治疗后大部分患者疗效好,无效者行半规管堵塞术效果好。     

Surgical management for benign paroxysmal positional vertigo of the superior semicircular canal

Benign paroxysmal positional vertigo of the superior semicircular canal is a rare form of BPPV. It accounts for 1% to 3% of cases. The characteristic nystagmus is positional, down‐beating, with a torsional component elicited by the Dix‐Hallpike maneuver. Symptoms of superior semicircular canal BPPV often resolve spontaneously; however, it can be refractory to repositioning maneuvers. Surgical management is described for posterior semicircular canal BPPV. To date, however, there is only one reported case of surgical management for superior semicircular canal BPPV. Here we show video documentation of positional, down‐beating nystagmus and describe a case of superior semicircular canal BPPV requiring canal occlusion with successful resolution of symptoms. Laryngoscope, 125:1965–1967, 2015     

Benign paroxysmal positional vertigo of the anterior semicircular canal: clinical aspects and treatment

OBJECTIVE: To describe the videonystagmographic characteristics and the treatment of the patients reached with a canalolithiasis or a cupulolithiasis of the anterior semicircular canal. MATERIAL AND METHOD: Retrospective study concerning patients treated for a Benign Paroxysmal Positional Vertigo (BPPV) of the anterior semicircular canal. Each patient after analysis under videonystagmoscopy (VNS) and under videonystagmography (VNG) was treated by maneuvers. RESULTS: On 462 observations of typical BPPV 6 cases of VPPB of the anterior semicircular canal were treated concerning 5 patients (1.3%). CONCLUSION: The BPPV of the anterior semicircular canal are rare. We modified our method of diagnosis, and our therapeutic techniques could be validated with the help of the two-dimensional videonystagmography.     

Persistent positional nystagmus

Involvement of the superior semicircular canal (SSC) in benign paroxysmal positional vertigo (BPPV) is rare. SSC BPPV is distinguished from the more common posterior semicircular canal (PSC) variant by the pattern of nystagmus triggered by the Dix-Hallpike position: down-beating torsional nystagmus in SSC BPPV versus up-beating torsional nystagmus in PSC BPPV. SSC BPPV may be readily treated at the bedside, which is a key component in excluding central causes of down-beating nystagmus. We present an unusual video case report believed to represent refractory SSC BPPV based on the pattern of nystagmus and the absence of any other central signs.     

Treatment of anterior benign paroxysmal positional vertigo by canal plugging: a case report

A 75-year-old man with incapacitating anterior canal benign paroxysmal positional vertigo (BPPV) was relieved of symptoms following anterior semicircular canal occlusion using a transmastoid approach. The preoperative symptoms were similar to those of posterior canal BPPV. The preoperative findings on Dix-Hallpike's maneuver were a paroxysmal torsional nystagmus with a down-beating component that increased when the patient's gaze was directed towards the affected ear. The most provoking head movement for the vertigo/nystagmus was Dix-Hallpike's maneuver with the affected ear lowermost.     

Particulate Matter in the Posterior Semicircular Canal

The pathoetiology of benign paroxysmal positional vertigo (BPPV) is controversial. Particulate matter within the posterior semicircular canal has been identified intraoperatively in patients with BPPV but has also been reported in non-BPPV patients at the time of translabyrinthine surgery (Parnes LS, McClure JA. Free-floating endolymphatic particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 1992;102:988-92; Schuknecht HF, Ruby RRF. Cupulolithiasis. Adv Otorhinolaryngol 1973;20:434-43; Kveton JF, Kashgarian M. Particulate matter within the membranous labyrinth: pathologic or normal? Am J Otol 1994;15:173-6). The nature of the particulate matter remains unknown. The purpose of this study was to prospectively examine the posterior semicircular canal of patients with and without a clinical history of BPPV for the presence of particulate matter. Seventy-three patients without BPPV symptoms undergoing labyrinthine surgery (vestibular schwannoma excision or labyrinthectomy) and 26 patients with BPPV undergoing the posterior semicircular canal occlusion procedure were compared. Additionally, 70 archived temporal bones without a history of BPPV were examined microscopically for the presence of particulate matter within the lumen of the membranous labyrinth. No particles were observed intraoperatively in any of the 73 patients without a history of BPPV. Particulate matter was observed in 8 of 26 patients at the time of the posterior semicircular canal occlusion procedure for intractable BPPV. Of the 70 temporal bones examined, 31 did not show significant postmortem changes and also did not demonstrate cupulolithiasis or canalithiasis. Particulate matter from within the membranous posterior semicircular canal was removed from one patient at the time of posterior semicircular canal occlusion for intractable BPPV symptoms and was examined by scanning electron microscopy. The particulate matter appeared morphologically consistent with degenerating otoconia. These data show a statistically significant association between the presence of particles within the posterior semicircular canal in this study and the symptom complex of BPPV.     

Complex nystagmus in traumatic benign paroxysmal positional vertigo: A case study on the critical value of knowing semicircular canal excitation and inhibition patterns

A 73-year-old female presented to the emergency department with chief complaint of dizziness after sustaining a fall one month prior to dizziness onset. Although careful examination of eye movement patterns during positional testing was attempted at varying stages of her inpatient admission, her complex nystagmus patterns as a result of traumatic benign paroxysmal vertigo were difficult to manage. In particular, the nystagmus pattern from this case suggests the BPPV was variable and affecting either 1) left posterior semicircular canal (pSCC) exclusively 2) left pSCC and right anterior semicircular canal, 3) left and right pSCC canal. This case illustrates the importance of two critical details; positional testing should include observing nystagmus with fixation removed and an experienced clinician should be involved as early as possible.     

The role of high-resolution magnetic resonance in atypical and intractable benign paroxysmal positional vertigo: our preliminary experience

BACKGROUND: The diagnosis of benign paroxysmal positional vertigo (BPPV) is easy when typical nystagmus is present. However, diagnostic doubts arise when faced with cases presenting atypical features of the positional paroxysmal nystagmus as well as the clinical course and disease evolution. METHODS: A morphological evaluation of inner ear structures via high-resolution magnetic resonance (HR-MR) studies has been performed in 2 patients that did not respond to traditional therapeutic manoeuvres. RESULTS: In 1 patient, a filling defect at the level of the middle portion of the right lateral semicircular canal (LSC) has been demonstrated, while in the second one, a geometric-architectural abnormality - a 'fold' in the LSC - has been observed. CONCLUSION: HR-MR study of the inner ear offers a meaningful contribution to interpreting the physiopathogenesis of atypical cases of BPPV. HR-MR of the inner ear is a safe and useful tool to investigate patients with atypical and intractable BPPV.