Benign paroxysmal positional vertigo of the horizontal and superior semicircular canals

The incidence of benign paroxysmal positional vertigo (BPPV) of the horizontal and superior semicircular canals is much less than that of BPPV due to affection of the posterior semicircular canal. Their diagnosis is however much more difficult and still prone to controversies. The provocative manoeuvre of the BPPV of the horizontal canal (BPPV-HSC) is the manoeuvre of rotation of the head in dorsal position. A horizontal positional nystagmus is obtained. There are two forms of BPPV-HSC: the geotropic form and the ageotropic form. In the geotropic form, the liberatory manoeuvre is a "barbecue" rotation of 180 with 360 degrees towards the healthy side. In the ageotropic form, there is no universal liberatory manoeuvre. Moreover as some cases of neurological aetiology have been recognized, it is not appropriate to apply ineffective manoeuvres. The BPPV of the superior canal (BPV-SSC) is very rare. The provocative manoeuvre is the Dix and Hallpike's manoeuvre. It causes positional torsional and vertical nystagmus with an opposite direction to that obtained for a BPPV of the contra-lateral posterior canal. The liberatory manoeuvre is a Semont manoeuvre, which is identical to that we would make for a contra-lateral BPPV of the posterior canal.     

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.     

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。     

水平半规管良性阵发性位置性眩晕的诊断

目的探讨水平半规管良性阵发性位置性眩晕（BPPV）的诊断。方法自2003年1月至2006年9月，本眩晕中心共确诊为水平半规管BPPV（HSC BPPV）患者46例。诊断依据为典型的病史及用红外视频眼震电图仪记录患者在Dix—Hallpike试验和滚转试验中的眼震结果，并排除其他疾病。研究HSC BPPV的眼震特点。结果441例诊断为BPPV患者中，46例（10．43％）为水平半规管BPPV。其中38例（82．61％）为单侧病变，5例（10．87％）患者合并同侧后半规管病变，3例（6．52％）为双侧病变。35例患者通过两种试验诱发出水平眼震，11例患者仅通过滚转试验诱发出水平眼震。25例患者眼震方向向地，13例患者眼震方向背地，3例患者眼震方向不固定，5例患者各种手法诱发出同一方向的眼震。29例患者在双侧手法中出现眼震，17例患者在一侧手法中出现眼震。结论HSC BPPV眼震为完全水平性且多为快相向地。通常受累耳在双侧手法中均可出现眼震，以向患侧为重。一侧水平半规管和后半规管可同时受累。滚转试验在HSC BPPV检查中比Dix—Hallpike试验更加敏感。Dix—Hallpike试验结合滚转试验可使更多的HSCBPPV患者得到确诊．     

Benign positional paroxysmal vertigo of horizontal semicircular canal in the child: case report

The authors report on a 10-year-old with benign positional paroxysmal vertigo (BPPV) of the horizontal semicircular canal (HSC). To date, no case of BPPV of HSC in the child has been reported in the literature. The authors define the features of the disease, describe its evolution, and compare it with the other vestibular diseases affecting children.     

Benign paroxysmal positional vertigo of the horizontal canal

The benign positional vertigo of the horizontal canal seems to find its origins in a canalolithiasis. The diagnosis is usually easy when its characteristics are perfectly known. A horizontal nystagmus does not always mean that the vertigo is of a central origin. This canal is exclusively connected, via the brainstem, to the external and internal oculomotor muscles so that the movement obtained by its stimulation can only be horizontal! This is quite different from what is obtained for the posterior canal, which is connected to various oculomotor muscles. Specific therapeutic maneuvers have to be carried out to be efficient: if properly performed, the otoconias, heavy particles sensitive to gravity, are easily mobilized. This paper describes the pathophysiology of the positional vertigo of the horizontal canal, diagnosis of its two presentations, and therapeutic possibilities.     

水平半规管良性阵发性位置性眩晕的临床特点

目的 探讨水平半规管良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的临床特点.方法 回顾性分析2003年8月至2010年12月诊治的239例水平半规管BPPV患者的临床表现.结果 水平半规管BPPV占同期全部BPPV患者的25.7％(239/931).平卧侧头试验见水平向地性眼震者197例,眼震的平均潜伏期为(0.88±0.72)s,持续时间(26.36±19.71)s;水平离地性眼震者42例,平均潜伏期(2.69±1.83)s,持续时间(53.48±43.12)s;其中39例眼震表现为水平略带扭转向上而非纯水平,占16.3％(39/239).离地组眼震潜伏期明显长于向地组(t=-6.33,P＜0.001),眼震持续时间亦明显长于向地组(t=-3.99,P＜0.001).水平向地性眼震者予以Barbecue翻滚法治疗,192例经(1.6±0.8)个循环复位成功;水平离地性眼震者经左右侧头训练后,40例眼震转化为向地性,经(1.9±0.8)个循环后复位成功.结论 水平半规管BPPV占同期BPPV的比例较预期高.水平向地性眼震患者可直接给予Barbecue翻滚法治疗,水平离地性眼震患者应先行左右侧头训练,再给予Barbecue翻滚法复位.     

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.     

同时性后半规管与水平半规管性良性位置性眩晕

目的：探讨同时性后半规管与水平半规管性良性位置性眩晕（混合性良性位置性眩晕）的诊治方法。方法：联合应用Epley手法和Barbecue翻滚法对4例患者进行治疗，两次治疗间隔1d。结果：4例患者眩晕症状完全消失，随访至今无复发。结论：混合性良性位置性眩晕兼有后半规管与水平半规管性良性位置性眩晕的临床表现，联合采用Epley手法和Barbecue翻滚法治疗该病是可行的。     

外半规管良性阵发性位置性眩晕的诊疗

良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)是最常见的周围性眩晕,主要表现为随头位变化出现的短暂性眩晕发作,该病分为后半规管型、外半规管型、上半规管型及多半规管.其中后半规管BPPV最常见,其次为外半规管BPPVo外半规管BPPV根据发病机制、原理、眼震方向等有多种分类方法.近年来外半规管BPPV的手法复位逐渐被熟悉,但一些患者复位后效果不佳,如外半规管嵴帽结石症,部分患者行常规手法复位后发作性眩晕仍然存在.我们将这部分手法复位后眩晕症状改善不明显的类型归结为难治型外半规管嵴帽结石症.本文主要围绕外半规管BPPV的概念及分类、流行病学、病因、发病机制、诊断及复位方法,尤其对于难治型外半规管嵴帽结石症的复位方法做一综述.     

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。     

Benign paroxysmal positional vertigo simultaneously affecting several canals: a 46-patient series

Although it is uncommon for benign paroxysmal positional vertigo (BPPV) to affect more than one canal simultaneously, it is not exceptional. We attempt to determine whether these patients present differences relative to “single-canal” cases. A prospective study was done in patients with BPPV, divided into three groups: single-canal BPPV, multi-canal BPPV in one ear and multi-canal BPPV in both ears. Diagnosis was by Dix and Hallpike, supine roll and cephalic hyperextension tests. Treatment was according to the affected canals, by Semont, Epley, Lempert and Yacovino manoeuvres. Aetiology, sex, age, response to treatment, recurrence and final status in each of the three groups was evaluated. Five hundred and eighty-three patients were diagnosed with BPPV: 537 single-canal (92 %) and 46 multi-canal (8 %); of the latter, 36 bilateral and 10 unilateral cases. Basic differences between groups were: greater percentage of idiopathic cases in single-canal (p < 0.0001, Chi-square), greater percentage of post-traumatic cases in bilateral multi-canals (p = 0.006, Chi-square) and prior history of BPPV was more common in unilateral multi-canal (p = 0.006, Chi-square). No differences between groups in response to treatment, recurrence and final status were detected. There are aetiological differences between patients with single-canal BPPV, unilateral multi-canal BPPV and bilateral multi-canal BPPV. Response to therapeutic manoeuvres, however, shows that over 90 % of the patients in all the groups are cured.     

水平半规管良性阵发性位置性眩晕患者眼震参数客观特征

目的 探讨水平半规管良性阵发性位置性眩晕(BPPV)眼震的方向、强度、时间等参数的客观特征及机制.方法 水平半规管BPPV患者233例,其中水平半规管管石症(horizontal semicircular canalithasis,HSC-Can) 179例,水平半规管壶腹嵴顶结石症(horizontal semicircular canal cupulolithiasis,HSC-Cup)54例.应用视频眼震图仪分别记录滚转试验诱发眼震,比较各个试验头位的眼震方向、强度、时间等参数特点.采用SPSS17.0统计软件进行数据处理.结果 水平半规管BPPV患者滚转试验在左侧、右侧转头位均可诱发出水平性眼震.HSC-Can诱发眼震方向与转头方向相同,向患侧和健侧转头位诱发眼震的潜伏期(-x±s,下同)为(1.922±1.501)s和(1.447±0.855)s,持续时间为(25.620±10.409)s和(22.110±10.931)s,强度为(56.441±33.168)°/s和(24.239±13.892)°/s,向患侧转头诱发眼震的潜伏期、持续时间及强度均大于健侧,差异均具有统计学意义(t值分别为3.715、15.219和4.070,P值均＜0.01),其中眼震强度之比约为2∶1.HSC-Cup诱发眼震方向与转头方向相反,向健侧转头诱发眼震的强度明显大于向患侧转头,其强度之比约为2∶1,差异具有统计学意义(t=-7.634,P＜0.01);而向健侧和向患侧转头诱发眼震的潜伏期,差异则无统计学意义(t=1.670,P=0.101).HSC-Can滚转试验中向患侧转头诱发眼震的潜伏期、强度均大于HSC-Cup向健侧转头,但差异无统计学意义(t值分别为1.554和0.305,P值均＞0.05).结论 水平半规管BPPV患者滚转试验向左右侧转头诱发眼震的强度均遵循Ewald定律,强弱之比约为2∶1;潜伏期、持续时间及强度等眼震图参数可作为BPPV的客观诊断指标.     

水平半规管良性阵发性位置性眩晕的眼震特点和治疗

目的:探讨水平半规管良性阵发性位置性眩晕(HSC-BPPV)的眼震特点和治疗方法.方法:对43例HSC-BPPV患者应用红外线视频眼动记录仪分析其变位试验诱发的眼震特点,进行分型、定侧,并采用相应的耳石复位法治疗.结果:43例患者中:①水平向地性眼震患者27例,其中19例接受Barbecue翻滚疗法,或结合强迫侧卧体位疗法,8例不适于翻滚或体位维持困难者接受AspreUa法治疗;②水平背地性眼震16例,其中自行或采用Gufoni疗法后转变为水平向地性眼震12例,方向不能转换4例,采用Barbecue翻滚和(或)强迫侧卧体位疗法.1周后随访总有效率为72.1%,3个月后总有效率为81.4%.结论:HSC-BPPV的诊断和治疗应根据不同变位试验诱发的眼震特征判别耳石位于半规管的不同部位及不同发病机制类型,并选择合适的耳石复位技术治疗.     

水平半规管良性阵发性位置性眩晕

良性阵发性位置性眩晕(Benign Paroxysm Positional Vertigo,BPPV)是一种阵发性、由头位变动引起的伴有特征性眼震的短暂发作性眩晕,是最常见的前庭疾病。后半规管BPPV(Benign Paroxysmal Positional Vertigo ofPosterior Semicircular Canal,PSC-BPPV)是最常见的BPPV类型,临床上推荐Dix-Hallpike试验作为诊断PSC-BPPV的"金标准",Epley法是目前治疗PSC-BPPV最有效的复位方法。水平半规管BPPV(Benign Paroxysmal Positional Vertigoof Horizontal Semicircular Canal,HSC-BPPV)发病机制复杂,是仅次于PSC-BPPV的常见BPPV亚型,其实际发病率可能被低估。临床实践中,HSC-BPPV其诊断与复位治疗方法与PSC-BPPV均不相同。本文即围绕HSC-BPPV研究的发展史及流行病学、分类、病因、发病机制、诊断及治疗复位方法的相关进展做一综述。     

病程对后半规管良性阵发性位置性眩晕疗效的影响

目的探究病程是否会影响后半规管良性阵发性位置性眩晕（PC BPPV）患者的疗效。方法收集2009年10月~2017年12月确诊的428例原发性PC BPPV,其中男155例,女273例;年龄16~89岁,中位年龄53岁;病程0.5 d至7年,中位病程7 d。按照1周、1个月、半年为时间节点,将患者分为短期组、中期组、中长期组及长期组。并经Epley或李氏复位法治疗的患者,记录患者治疗3 d及治疗1周的疗效,并统计复位治疗的有效率。结果通过手法复位,4组患者治疗后3 d有效率分别为：94.55%（208/220）、90.80%（132/147）、86.27%（44/51）、90.00%（9/10）;治疗1周后有效率分别为：97.73%（215/220）、97.28%（143/147）、96.08%（49/51）、100%（10/10）;两个时间点的治疗效果差异均无统计学意义（P>0.05）。结论BPPV的病程或自愈性并不会引起手法复位的短期疗效,BPPV的自愈性可能与患者的年龄相关。