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.     

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.     

上半规管良性阵发性位置性眩晕的临床分析

目的探讨上半规管良性阵发性位置性眩晕（anterior semicircular canal benign paroxysmal positional vertigo,AC-BPPV）的临床特点。方法回顾性分析16例AC-BPPV患者临床特点,并对耳石复位的疗效进行评估。结果①在Dix-Hallpike检查中,16例患者都诱发出垂直向下的眼震,其中11例双侧出现眼震,5例单侧出现眼震。②13例患者能明确受累侧别,其中5例为左侧AC受累,8例为右侧AC受累;3例受累侧别难以判断。③对13例受累侧别明确的患者采取反向颗粒复位手法治疗,5例痊愈,4例有效、4例无效;对4例无效患者再行Semont方法治疗,其中2例有效,2例仍无效。对3例受累侧别难以判断的患者采用Yacovino方法治疗后均痊愈。结论 AC-BPPV在临床中并不少见,耳石复位法疗效明确,可根据患者实际情况选择适当的复位方式。     

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。     

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.     

上半规管良性阵发性位置性眩晕的诊断及治疗

目的探讨上半规管良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）的诊断和治疗。方法回顾性分析了上半规管BPPV患者31例，并对所有患者采用管石复位法治疗后的效果进行评估。结果在Dix-Hallpike检查中，所有患者均诱发出垂直向下的眼震。22例（70．97％）患者一侧诱发出眼震，其中17例眼震伴有扭转成分，5例眼震不伴扭转成分。其余9例（29．03％）患者双侧诱发出现眼震，眼震伴有扭转成分的7例，其中2例眼震扭转方向指向同一侧，4例眼震的扭转方向不固定，1例患者仅一侧出现扭转成分。另外2例患者眼震不伴扭转成分。受累侧别明确诊断的19例（61．29％），其中11例为左侧上半规管受累，8例为右侧上半规管受累。受累侧别未明确诊断的12例（38．71％）。所有患者中，11例（35．48％）患者同时合并后半规管受累。对所有患者采取管石复位法治疗，21例（67．74％）痊愈，29例（93．55％）有效、2例（6．45％）无效。其中首次治愈14例（45．16％），平均治愈次数为1．71次。随访期间5例复发。结论上半规管BPPV临床中少见。在变位检查中，眼震的扭转成分较弱，临床中不易观察。在部分单侧上半规管BPPV患者中，双侧检查均能诱发眼震。管石复位法是治疗上半规管BPPV简单有效的手段。     

Anterior semicircular canal benign paroxysmal positional vertigo and positional downbeating nystagmus

PURPOSE: The aim of this study was to describe the clinical features and video-oculographic findings in patients with anterior semicircular canal benign paroxysmal positional vertigo (BPPV). MATERIALS AND METHODS: STUDY DESIGN: This is a prospective case series. SETTING: The study was set at an outpatient clinic in a general hospital. PATIENTS: Fourteen individuals with symptoms of BPPV and positional downbeating nystagmus (pDBN) were included in the study. The diagnosis was based on a history of brief episodes of vertigo and the presence of pDBN confirmed in the video-oculographic examination during Dix-Hallpike test (DH) or head-hanging maneuver. INTERVENTION: Patients were treated by particle repositioning maneuver and the effectiveness was evaluated at 7, 30, and 180 days posttreatment. The treatment was repeated up to 4 times if pDBN was persistent. MAIN OUTCOME MEASURES: The main outcome measure is the number of patients without pDBN at 30 and 180 days. RESULTS: Video-oculography showed a predominant pDBN in response to DH. Of the 14 patients, 7 had arterial hypertension, and 5 of 14 cases presented abnormalities on the caloric test. Horizontal spontaneous nystagmus was found in 3 of 14 individuals. Positional nystagmus at different positional test was observed in 5 of 14 individuals, suggesting the involvement of several canals. Of the 14 patients, 10 (71%) did not present vertigo, and the positional tests were negative at 30 days. However, 3 cases presented a positive DH with persistence of BPPV episodes and pDBN at 30 days, and another developed a contralateral posterior canal affectation. One of the patients maintained a persistent pDBN at 180 days despite the repeated maneuvers. CONCLUSIONS: Video-oculography demonstrates that anterior canal BPPV is characterized by a predominant downbeating nystagmus in response to DH. These individuals may show alterations in the vestibular caloric, and they can have multicanal affectation.     

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 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.     

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.     

上半规管良性阵发性位置性眩晕41例

目的 探讨上半规管良性阵发性位置性眩晕(BPPV)诊断和治疗的最佳方案。方法 回顾性分析41例上半规管BPPV患者的病历资料,并对所有患者的诊断及复位进行评估分析。结果 SRM-Ⅳ模拟Dix-Hallpike试验诱发出典型垂直向下眼震28例(68.3%),其中眼震伴有向地扭转的成分19例,不伴有扭转成分9例;SRM-Ⅳ上半规管BPPV诱发试验诱发出典型垂直向下眼震35例(84.6%),其中眼震伴有向地扭转的成分30例,不伴有扭转成分5例。在所有41例患者中有38例能通过两种诱发试验对受累侧别做出判断,其中因诱发眼震伴有扭转成分而判断侧别30例,单侧诱发诱发出垂直向下眼震且不伴有扭转成分3例,双侧诱发出垂直向下眼震5例,且不伴有扭转成分,但因眩晕及眼震的强度有明显差别而判断出侧别,患者对受累侧别不能判断3例。在能判断出侧别的38例患者中有左侧上半规管受累25例,右侧上半规管受累13例。对41例采用SRM-Ⅳ上半规管BPPV复位法进行治疗,通过一次治疗痊愈28例,有效12例,无效1例。结论 上半规管BPPV 临床上被越来越重视,应用SRM-ⅣBPPV诊疗系统对上半规管BPPV进行诊治效果好,应该在临床得到推广。     

上半规管良性阵发性位置性眩晕诱发试验的研究

目的　探讨运用自主研制的SRM- IV良性阵发性位置性眩晕（benign paroxysmal posit ional ver t igo,BPPV）诊疗系统在上半规管BPPV的诱发试验中的临床应用价值。方法　本研究中将367例高度怀疑BPPV患者随机分成两组,一组181例依序进行Dix-Hallpike试验及SRM-IV BPPV诊疗系统采用后半规管BPPV诱发试验和上半规管BPPV诱发试验检查,有20例被确诊为上半规管BPPV;另一组186例检查顺序相反,共有21例被确诊为上半规管BPPV,观察并记录该41例确诊为上半规管BPPV的每位患者每种体位下的特异性眼震,计算每种检查方法的检出率,并运用SPSS13.0软件进行统计分析。结果　Di x-Hal lpike试验中有26（63.4%）例患者诱发出典型垂直向下眼震;SRM-IV后半规管BPPV诱发试验中有28例（68.3%）患者诱发出典型垂直向下眼震;SRM-IV上半规管BPPV中有35例（85.4%）患者诱发出典型垂直向下眼震。Dix-Hallpike试验与SRM-IV后半规管BPPV诱发试验检出率的差异无统计学意义（P >0.05）;SRM-IV上半规管BPPV诱发试验对上半规管BPPV检出率高于其余两种方法,差异均有统计学意义（P <0.05）。结论　SRM-IV上半规管BPPV诱发试验对上半规管可产生有效的刺激,对诊断上半规管BPPV敏感性高,此方法应该在临床得到推广。     

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     

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。     

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.     

Benign paroxysmal positional vertigo of the horizontal canal: A multicenter study

ObjectiveBPPV localized in the horizontal semicircular canal is an infrequent entity. Nowadays there are controversies about the different treatments available. The objective of this study is to present our results.Material and Methodsa multicenter and retrospective study was performed in 31 patients diagnosed of BPPV-HSC between January 1996 and May 2004.Resultscupulolithiasis was diagnosed in 48% on the patients. Symptoms disappeared before signs (p 0.05). Global cure rate was 85%, while relapses were 16% at one year. No relations were found between cure rate and relapses and age, gender, duration of symptoms, canalithiasis and cupulolithiasis.ConclusionOur results support that there are not differences between the treatments performed in the BPPV-HSC. Symptoms disappeared before signs when canalith repositioning particles (CRP) maneuver was performed.