A new variant of posterior canal-benign paroxysmal positional vertigo-canalolithiasis

ObjectiveThe characteristics of typical posterior canal-benign paroxysmal positional vertigo-canalolithiasis (P-BPPV-Can) are well known. We found 10 patients with a new variant of P-BPPV-Can: Reverse (Rev)-P-BPPV-Can. The characteristics and pathophysiology of Rev-P-BPPV-Can are discussed.MethodsFor 4 years and 9 months, 10 patients with Rev-P-BPPV-Can (9 women and 1 man; mean age: 73 years) visited our clinic. Within the same period, 268 patients with unilateral typical P-BPPV-Can were treated. During the Dix–Hallpike and Epley maneuvers, nystagmus was recorded using an infrared charge-coupled device camera mounted on a pair of spectacles.ResultsThe patients exhibited entirely opposite direction of nystagmus from typical P-BPPV-Can in both the Dix–Hallpike head position and upright sitting position. The patients had typical characteristics of nystagmus due to canalolithiasis, such as latency, duration of <1 min, linear-torsional nystagmus, and fatigability. Rev-P-BPPV-Can appeared after the Epley maneuver for typical P-BPPV-Can; in other patients, Rev-P-BPPV-Can changed to typical P-BPPV-Can. The affected sides of Rev-P-BPPV-Can were decided by those of typical P-BPPV-Can.ConclusionCanalolithiasis in the non-ampullary distal portion of the posterior semicircular canal may be a potential pathophysiology of Rev-P-BPPV-Can. The Epley maneuver has little effect for treating Rev-P-BPPV-Can, but spontaneous transition to typical P-BPPV-Can or spontaneous recovery is expected.     

Orthotropic nystagmus in predicting the efficacy of treatment in posterior canal benign paroxysmal positional vertigo

ObjectiveTo observe the type of nystagmus in each position of posterior semicircular canal benign paroxysmal positional vertigo (BPPV) after treatment with the Epley maneuver and analyze the relationship between the type of nystagmus in the second and third positions of the Epley maneuver and the effect of treatment. Then, the role of orthotropic nystagmus in predicting the success of posterior semicircular canal BPPV treatment was explored.MethodsTwo hundred seventy-six patients diagnosed with posterior semicircular canal BPPV who were admitted from September 2018 to October 2019 to Zhejiang Hospital were included. All patients were treated with BPPV diagnosis and treatment system (Epley maneuver). During the treatment, we observed and recorded the type of nystagmus in the second and third positions, including the direction and duration of nystagmus. One hour after the first treatment, all patients were evaluated by both the Dix-Hallpike and Roll tests to determine whether the treatment was successful. The difference in the success rate of treatment between different types of nystagmus was compared, and the differences in sensitivity and specificity of orthotropic nystagmus in the second and third positions in predicting the effect of treatment were compared.ResultsAmong the 234 patients who had successful repositioning for the first time, the proportion of orthotropic nystagmus during the third position of the Epley maneuver was 88.9%, which was significantly higher than 23% in the unsuccessful group (42 cases) (P < 0.05) The proportion of patients with reversed nystagmus (4.7% vs 33.3%, P < 0.05) and no nystagmus (6.4% vs 42.9%, P < 0.05) was lower in the successful group than in the unsuccessful group. The proportion of orthotropic nystagmus during the second position of the Epley maneuver was 50.9%, which was also higher than the 19% in the unsuccessful group (P < 0.05). The proportion of reversed nystagmus (13.7% vs 31%, P < 0.05) was lower in the successful group than in the unsuccessful group. Additionally, the proportion of no nystagmus (35.5% vs 50%, P = 0.074) was lower in the successful group than in the unsuccessful group, but the difference was not statistically significant. The sensitivity of orthotropic nystagmus in the third position (88.9%) of the Epley maneuver in predicting the efficacy of treatment was higher than that of orthotropic nystagmus in the second position (50.9%), but there was no significant difference in specificity between the two.ConclusionOrthotropic nystagmus during the Epley maneuver, especially in the third position, has certain value in predicting the efficacy of posterior semicircular canal BPPV repositioning, which is better than its predictive effect in the second position, whereas reversed nystagmus or no nystagmus in the third position is suggestive of unsuccessful repositioning. Therefore, clinicians can carry out individualized treatments based on nystagmus types during repositioning to improve the effect of treatment.     

Adverse effects of semicircular circle angles variation on Epley repositioning procedure: a study on reconstruction of Micro-CT images 3D

Abstract

Background: For patients with posterior semicircular canal (PSC) BPPV, Epley re-position maneuver and some improvement methods are the most efficient treatment methods. But there were still 9.43% patients who were not benefit from Epley re-position maneuver.

Objective: To measure the angles of semicircular canals and evaluate its effect on Epley maneuver.

Methods: Fifteen skull specimens, containing 30 temporal bone specimens were included. After Micro-CT scanning, 3D reconstruction was loaded with the CT image. The angles between each semicircular canal and each standard skull plane were measured. Furthermore, the angles’ effect on Epley maneuver was evaluated according to the three-dimension (3D) model.

Results: Angles of PSC plane: Frankfurt plane was 71.54?±?6.51, sagittal plane was 53.77?±?5.36°, and the coronal plane was 43.33?±?3.56°. Angles between PSC and the sagittal plane of skulls had an adverse effect on Epley maneuver, when it was less than 45°.

Conclusion: 1. Variation could be found in angles between the semicircular canals and the standard planes of skulls, which meant variation of semicircular canals’ location existing in skulls. 2. The variation of angles between PSC and sagittal plane could have an adverse effect on the Epley maneuver when the angle was less than 45°, which may cause the Epley maneuver to be invalid.     

Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is characterized by positional vertigo (brief attacks of rotatory vertigo triggered by head position changes in the direction of gravity) and is the most common peripheral cause of vertigo. There are two types of BPPV pathophysiology: canalolithiasis and cupulolithiasis. In canalolithiasis, otoconial debris is detached from the otolithic membrane and floats freely within the endolymph of the canal. In cupulolithiasis, the otoconial debris released from the otolithic membrane settles on the cupula of the semicircular canal and the specific gravity of the cupula is increased. Consensus has been reached regarding three subtypes of BPPV: posterior-canal-type BPPV (canalolithiasis), lateral-canal-type BPPV (canalolithiasis) and lateral-canal-type BPPV (cupulolithiasis). In the interview-based medical examination of BPPV, questions regarding the characteristics of vertigo, triggered movement of vertigo, duration of vertigo and cochlear symptoms during vertigo attacks are important for the diagnosis of BPPV. The Dix–Hallpike test is a positioning nystagmus test used for diagnosis of posterior-canal-type BPPV. The head roll test is a positional nystagmus test used for diagnosis of lateral-canal-type BPPV. When the Dix–Hallpike test is repeated, positional nystagmus and the feeling of vertigo typically become weaker. This phenomenon is called BPPV fatigue. The effect of BPPV fatigue typically disappears within 30 min, at which point the Dix–Hallpike test again induces clear positional nystagmus even though BPPV fatigue had previously caused the positional nystagmus to disappear. For the treatment of BPPV, sequential head movements of patients can cause the otoconial debris in the semicircular canal to move to the utricle. This series of head movements is called the canalith repositioning procedure (CRP). The appropriate type of CRP depends on the semicircular canal in which the otoconial debris is located. The CRP for posterior-canal-type BPPV is called the Epley maneuver, and the CRP for lateral-canal-type BPPV is called the Gufoni maneuver. Including a time interval between each head position in the Epley maneuver reduces the immediate effect of the maneuver. This finding can inform the development of methods for reducing the effort exerted by doctors and the discomfort experienced by patients with posterior-canal-type BPPV during the Epley maneuver.     

A new treatment (the affected-ear-up 90° maneuver) for benign paroxysmal positional vertigo of the lateral semicircular canal

Background: Although several researchers have tried various kinds of canalith repositioning procedures for lateral canalolithiasis, a standard treatment has not been established. We have adopted 90° rotation, which is anatomically appropriate.

Objective: To clarify the efficacy of the affected-ear-up 90° maneuver.

Materials and methods: The subjects were 23 consecutive patients (15 females, 8 males) who revealed transient direction-changing geotropic positional nystagmus. After determining the affected side, we immediately performed the canalith repositioning procedure. To perform this maneuver: (1) Place the patient in the supine position. (2) Rotate the head toward the healthy side until 90° from the supine. (3) Sit up. (4) Ask the patient to remain upright with the chin down until going to bed.

Results: Nineteen patients (83%) became symptom-free by only one maneuver. However, three patients converted to ipsilateral cupulolithiasis of the lateral canal, and one patient required a second maneuver.

Conclusion: The affected-ear-up 90° maneuver is effective against lateral canalolithiasis.     

Cupulolithiasis of the horizontal semicircular canal

To clarify whether positional nystagmus of horizontal cupulolithiasis contains vertical and torsional components, and to quantify the asymmetry, we analyzed nystagmus in four positions (healthy-ear-down, affected-ear-down, supine, nose-down), using 3-dimensional video-oculography. Subjects were 20 patients with direction-changing apogeotropic positional nystagmus, 11 females and 9 males, with a mean age of 58.1 years. Nystagmus was recorded using an infrared camera and the findings were converted to digital data. Using ImageJ, we performed 3-dimensional video-oculography and measured maximum slow-phase velocity (MSV) of three components. Positional nystagmus was not purely horizontal. Eleven (55%) patients revealed a vertical component, and 14 (70%) patients had a torsional component in the healthy-ear-down position. The mean value of MSV of the horizontal component in the healthy-ear-down position was 18°/s and that in the affected-ear-down position was 7.8°/s. For the horizontal component, MSV in the healthy-ear-down position was significantly greater than that in the affected-ear-down position (p < 0.01). These results suggest that vertical and torsional components occur from the horizontal semicircular canal, and the response to ampullopetal bending is more than two times as strong as that to ampullofugal bending.     

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.     

Effect of applying head-shaking maneuver before Epley maneuver in BPPV

IntroductionThe Epley maneuver is applied in the treatment of benign paroxysmal positional vertigo, the BPPV. However, dizziness and balance problems do not improve immediately after the treatment.ObjectiveIn this study, the effectiveness of the head-shaking maneuver before the Epley maneuver was investigated in the treatment of BPPV.MethodsBetween March 2020 and August 2020, ninety-six patients with posterior semicircular canal BPPV were analyzed prospectively. The patients were divided into two groups: patients who underwent the Epley maneuver only in the treatment (Group 1) and patients who underwent the Epley maneuver after the head-shaking maneuver (Group 2). The results of the Berg balance scale and dizziness handicap index were evaluated before the treatment and at the first week after the treatment.ResultsThe improvement in functional, emotional, and physical dizziness handicap index and Berg balance scale values after the treatment was found to be statistically significant in both groups. It was determined that the change in functional and physical dizziness handicap index and Berg balance scale values of the patients in Group 2 was statistically higher than those in Group 1. Although, the change in emotional dizziness handicap index values in Group 2 was higher than those in Group 1, no statistical significance was found between the groups.ConclusionAs a result of our hypothesis, we think that in the treatment of posterior semicircular canal BPPV, the otoliths adhered to the canal can be mobilized by the head-shaking maneuver, and this will contribute to the increase of the effectiveness of the Epley maneuver.     

Diagnosis and treatment of the short-arm type posterior semicircular canal BPPV

IntroductionThe Epley maneuver is useful for the otoconia to return from the long arm of the posterior semicircular canal into the utricle. To move otoconia out of the posterior semicircular canal short arm and into the utricle, we need different maneuvers.ObjectiveTo diagnose the short-arm type BPPV of the posterior semicircular canal and treat them with bow-and-yaw maneuver.Methods171 cases were diagnosed as BPPV of the posterior semicircular canal based on a positive Dix–Hallpike maneuver. We first attempted to treat patients with the bow-and-yaw maneuver and then performed the Dix–Hallpike maneuver again. If the repeated Dix–Hallpike maneuver gave negative results, we diagnosed the patient with the short-arm type of BPPV of the posterior semicircular canal and considered the patient to have been cured by the bow-and-yaw maneuver; otherwise, probably the long-arm type BPPV of the posterior semicircular canal existed and we treated the patient with the Epley maneuver.ResultsApproximately 40% of the cases were cured by the bow-and-yaw maneuver, giving negative results on repeated Dix–Hallpike maneuvers, and were diagnosed with short-arm lithiasis.ConclusionThe short-arm type posterior semicircular canal BPPV can be diagnosed and treated in a convenient and comfortable manner.     

Persistent direction-changing geotropic positional nystagmus

The aims of the study were to clarify whether persistent direction-changing geotropic positional nystagmus contains vertical and torsional components, and to quantify the asymmetry. We analyzed nystagmus in four positions (healthy-ear-down, affected-ear-down, supine, nose-down) using three-dimensional video-oculography. Subjects were 18 patients with persistent direction-changing geotropic positional nystagmus, 16 females and 2 males, with a mean age of 55 years. Nystagmus was recorded using an infrared camera and the findings were converted to digital data. Using ImageJ, we performed three-dimensional video-oculography and measured maximum slow-phase velocity (MSV) of three components. Positional nystagmus was not purely horizontal. Eight (44%) patients revealed a vertical component (upward) and 15 (83%) patients had a torsional component in the healthy-ear-down position. Seven (39%) patients revealed a vertical component (downward) and 10 (56%) patients showed a torsional component in the nose-down position. The mean value of MSV of the horizontal component in the supine position was 9.3°/s and that in the nose-down position was 15.7°/s. The latter was significantly greater than the former (p < 0.05). Eye movements in the supine position and the nose-down position were not mirror images. These results suggest that vertical and torsional components occur from the horizontal semicircular canal, and that horizontal canal ocular reflex is influenced by input from the otolithic organs.     

318例良性阵发性位置性眩晕的诊治分析

目的:研究不同类型良性阵发性位置性眩晕(BPPV)的诊断、治疗及疗效。方法:回顾性分析318例BPPV患者的资料,根据变位试验诱发的眼震特点进行分型,并采用相应的耳石复位技术治疗,对治疗1次无效者间隔7d重复治疗,重复3次无效者采用Brandt-Daroff习服练习;完成治疗后随访观察总有效率。结果:①后半规管BPPV患者221例(69.5%),采用Epley管石复位法;②水平半规管BPPV患者62例(19.5%),采用Bar-becue翻滚加强迫侧卧体位疗法;③前半规管BPPV患者23例(7.2%),采用Epley管石复位法;④混合型BPPV患者12例(3.8%),采用Epley加Barbecue翻滚联合治疗。1周后随访总有效率为82.1%(261/318),3个月后随访总有效率为91.8%(292/318)。结论:结合病史,根据不同变位试验诱发的眼震特征对BPPV患者进行诊断并采用相应手法复位治疗是一种非常有效的方法,能有效缩短病程,减轻患者痛苦,可在临床广泛应用。     

以持续性眩晕为表现的水平半规管良性阵发性位置性眩晕的诊治

目的　探讨以持续性眩晕为表现的良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）患者的诊治。方法　回顾性分析2例以持续性眩晕为表现的BPPV患者的临床资料。结果　此2例患者在坐位及平躺位见方向向患侧的水平自发持续性眼震,甩头试验健侧阳性,平卧侧头试验双侧均诱发出水平离地性眼震,平躺后头部向患侧连续转360°时分别出现2个眼震消失点和2个眼震最强点,给予手法复位后患者眩晕症状缓解。结论　水平半规管BPPV患者偶可表现为持续性眩晕发作,其病因为壶腹嵴帽耳石症,临床表现与耳石重力因素和水平半规管空间位置相关。     

A novel maneuver for diagnosis and treatment of torsional-vertical down beating positioning nystagmus: anterior canal and apogeotropic posterior canal BPPV

IntroductionIn patients with benign paroxysmal positional vertigo, BPPV; a torsional-vertical down beating positioning nystagmus can be elicited in the supine straight head-hanging position test or in the Dix-Hallpike test to either side. This type of nystagmus can be explained by either an anterior canal BPPV or by an apogeotropic variant of the contralateral posterior canal BPPV Until now all the therapeutic maneuvers that have been proposed address only one possibility, and without first performing a clear differential diagnosis between them.ObjectiveTo propose a new maneuver for torsional-vertical down beating positioning nystagmus with a clear lateralization that takes into account both possible diagnoses (anterior canal-BPPV and posterior canal-BPPV).MethodsA prospective cohort study was conducted on 157 consecutive patients with BPPV. The new maneuver was performed only in those with torsional-vertical down beating positioning nystagmus with clear lateralization.ResultsTwenty patients (12.7%) were diagnosed with a torsional-vertical down beating positioning nystagmus. The maneuver was performed in 10 (6.35%) patients, in whom the affected side was clearly determined. Seven (4.45%) patients were diagnosed with an anterior canal-BPPV and successfully treated. Two (1.25%) patients were diagnosed with a posterior canal-BPPV and successfully treated with an Epley maneuver after its conversion into a geotropic posterior BPPV.ConclusionThis new maneuver was found to be effective in resolving all the cases of torsional-vertical down beating positioning nystagmus-BPPV caused by an anterior canal-BPPV, and in shifting in a controlled way the posterior canal-BPPV cases of the contralateral side into a geotropic-posterior-BPPV successfully treated during the followup visit. Moreover, this new maneuver helped in the differential diagnosis between anterior canal-BPPV and a contralateral posterior canal-BPPV.     

Benign Paroxysmal Positional Vertigo without nystagmus: diagnosis and treatment

Nystagmus tests to diagnose BPPV are still relevant in the clinical evaluation of BPPV. However, in everyday practice, there are cases of vertigo caused by head movements, which do not follow this sign in the Dix-Hallpike maneuver and the turn test.AimTo characterize BPPV without nystagmus and treatment for it.Materials and methodsA non-systematic review of diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) without nystagmus in the PubMed, SciELO, Cochrane, BIREME, LILACS and MEDLINE databases in the years between 2001 and 2009.ResultsWe found nine papers dealing with BPPV without nystagmus, whose diagnoses were based solely on clinical history and physical examination. The treatment of BPPV without nystagmus was made by Epley maneuvers, Sémont, modified releasing for posterior semicircular canal and Brandt-Daroff exercises.ConclusionFrom 50% to 97.1% of the patients with BPPV without nystagmus had symptom remission, while patients with BPPV with nystagmus with symptom remission ranged from 76% to 100%. These differences may not be significant, which points to the need for more studies on BPPV without nystagmus.     

Efficacy of postural restriction in treating benign paroxysmal positional vertigo

OBJECTIVE: To investigate the efficacy of postural restriction after canalith repositioning in treating benign paroxysmal positional vertigo (BPPV). DESIGN: Prospective trial of patients with postural restriction vs those without postural restriction after treatment. PATIENTS: Patients with classic BPPV and with BPPV without nystagmus were treated using the modified Epley canalith repositioning procedure. Patients were randomly separated into 2 groups. The first group was instructed to wear a cervical collar and to maintain an upright head position for 2 days. The second group had no motion restriction. After 5 days, the patients were followed up and evaluated using the Dix-Hallpike test. RESULTS: In the first group, 56 of 62 ears healed after the first maneuver, and the remaining ears healed after the second. In the second group, 45 of 57 ears healed after the first maneuver, 6 after the second, and 5 (with subsequent postural restriction) after the third (1 ear did not improve). Five patients in the first group and 3 patients in the second group had BPPV without nystagmus; all of these patients healed after a single maneuver. The difference between the 2 groups in the number of maneuvers required for treatment was statistically significant (P<.05). The number of patients who required a third maneuver was significantly higher in the second group (P<.05). CONCLUSIONS: Postural restriction enhances the therapeutic effect of canalith repositioning in the treatment of posterior semicircular canal BPPV. The long-term efficacy of postural restriction in preventing BPPV recurrence has not been demonstrated.     

Vertigo during the Epley maneuver and success rate in patients with BPPV

To investigate whether reported vertigo during the Epley maneuver predicts therapeutic success in patients with benign paroxysmal positioning vertigo of the posterior semicircular canal (pc-BPPV). Fifty consecutive adult patients with pc-BPPV, based on a positive Dix–Hallpike test (DHT), were treated with the Epley maneuver and retested after 2 days. Patients were asked to report the presence of vertigo upon assuming each of the four positions of the maneuver. Thirty seven patients (74 %) were treated successfully in one session. Twenty out of 23 patients who reported vertigo at turning the head to the opposite side (2nd position) had a negative DHT on follow-up. These patients had a higher chance of a successful outcome compared to patients who did not report vertigo in the 2nd position (Odds ratio 5.3, 95 % CI: 1.3–22.2, p = 0.022). Report of vertigo at the other positions was not associated with the outcome. Report of vertigo at the second position of a single modified Epley maneuver is associated with therapeutic success.     

Success of the modified Epley maneuver in treating benign paroxysmal positional vertigo.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is a common condition seen by otolaryngologists. The purpose of this study is to determine the ability of the modified Epley maneuver to treat BPPV. STUDY DESIGN: Retrospective review. METHODS: A retrospective chart review of 107 patients diagnosed with BPPV at our institution between March of 1993 and June of 1995. Each patient was diagnosed with isolated BPPV by history and Hallpike-Dix maneuver. There were no other vestibular symptoms or electronystagmogram abnormalities. Patients diagnosed with BPPV received modified Epley maneuvers, were instructed to remain upright for 48 hours, and wore a soft collar for a week. Patients were followed up with repeat Hallpike-Dix maneuvers at 1 to 2 weeks. If symptoms persisted, the maneuver was repeated for up to a maximum of three times, at which point patients were considered to have failed treatment. RESULTS: The average age of patients was 57.8 years old. Thirty percent were male and the right ear was affected in 54%. The posterior semicircular canal was affected in 105 ears. The average patient received 1.23 Epley maneuvers, with a success rate of 93.4%. No successfully treated patients received mastoid vibration. Seven out of 107 patients failed after three Epley maneuvers. Two failure patients had a history of temporal bone fracture. Two failure patients were treated with posterior semicircular canal block surgery. CONCLUSION: The modified Epley maneuver is an excellent treatment for BPPV.     

Treatment variations on the Epley maneuver for benign paroxysmal positional vertigo

PURPOSE: To determine if using more head rotation during the Epley maneuver or specific posttreatment instructions for sleeping position would affect treatment effectiveness, compared with the usual maneuver without extra instructions. MATERIALS AND METHODS: Patients with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal were randomized to a standard Epley maneuver group, a group that received an additional 45 degrees head rotation during the maneuver (Augmented Epley), and a group that received instructions about sleeping position after treatment. RESULTS: Posttests from 1 week to 6 months showed no differences in vertigo intensity or frequency or responses to the Dix-Hallpike maneuver. All groups showed significant decreases in vertigo and Dix-Hallpike responses. Some subjects in each group had abnormal pretreatment scores on computerized dynamic posturography. Those subjects in the Augmented Epley group who had abnormal pretreatment posturography scores had significantly better posttreatment scores than those subjects in the Home Instruction group who had abnormal pretreatment scores. All subjects with abnormal responses, however, showed improvement. CONCLUSIONS: Although clinicians continue to give patients home instructions and to use additional head rotation during the maneuver, these variations are not essential for achieving improvement in symptoms.     

360°滚转复位法治疗良性阵发性位置性眩晕

目的明确在后半规管平面360&#176;旋转患者对治疗典型的后半规管良性阵发性位置性眩晕是否有效。方法回顾分析了46例后半规管良性阵发性位置性眩晕患者,其中25例采用三维滚轮360&#176;滚转复位法进行复位治疗,21例采用Epley手法复位治疗,对其疗效进行比较。结果采用三维滚轮360。滚转复位法治疗的患者中第一次治疗后有23例患者（92％）治愈,2例患者经过第二次治疗治愈;采用Epley手法复位的患者中第一次治疗后有19例患者（91.5％）治愈,2例患者经过第二次治疗治愈。应用X^2检验（α=0.05,X^2=0.1173,P=0.7319）二者的差异没有统计学意义。结论三维滚轮360&#176;滚转复位法能有效的治疗后半规管良性阵发性位置性眩晕,其成功率及效果与Epley法一致,且操作简便、舒适度优于传统方法。     

Benign paroxysmal positional vertigo of the horizontal semicircular canal

ObjectiveAssesment of 8 new cases of benign paroxysmal positional vertigo of the horizontal semicircular canal (BPPV-HC), since this variant of benign positional vertigo occurs rarely. An oculographic study of features in the positional response was carried out. Electrooculograpy (EOG) allows an exhaustive study of positional nystagmus.Material and methodsWe have studied retrospectively 8 patients with BPPV-HC and positive head rotation manoeuvre registered by EOG techniques. Possible alterations in other EOG tests in the group of patients were analyzed.ResultsMost of the patients (7/8) expressed bilateral horizontal geotropic changing-direction nystagmus. One patient exhibited apogeotropic horizontal nystagmus. 5/8 cases showed caloric hypofunction.ConclusionsWe have proven that BPPVHC is an uncommon disorder. In most of the cases, provocative manoeuver generates bilateral horizontal geotropic changing-direction nystagmus that probably is due to canalitiasis of the horizontal semicircular canal. The rest, a few cases, exhibit apogeotropic horizontal response that can be secondary to cupulolitiasis or location particles in the anterior portion of the horizontal canal. A caloric test showed abnormal in many and can help to locatize the affected ear.