Treatment of benign positional vertigo in the elderly: a randomized trial

OBJECTIVES/HYPOTHESIS: The objective of the study was to evaluate the efficacy of three therapeutic strategies (Semont maneuver, flunarizine, and no treatment) in patients with benign paroxysmal positional vertigo. STUDY DESIGN: Randomized prospective trial. METHODS: One hundred fifty-six consecutive patients older than 60 years of age who were affected by benign paroxysmal positional vertigo of the posterior semicircular canal were enrolled. The diagnosis was made on the basis of the history of recurrent sudden crisis of vertigo and positional-induced typical nystagmus after Dix-Hallpike positioning maneuver. Patients were randomly allocated to receive Semont liberatory maneuver (intended as a statoconia-detachment maneuver), flunarizine, or no treatment. A post-treatment negative Dix-Hallpike test result was considered as a proof of vertigo resolution. RESULTS: Cure rates with Semont maneuver were significantly higher (94.2%) than those obtained with flunarizine (57.7%) and no treatment (36.4%) (P <.001). Within a 6-month follow-up, relapse rates were lower among patients treated with Semont maneuver (3.8%) than those obtained with flunarizine (5.8%) and no treatment (21.1%). All patients with resolution of symptoms and negative Dix-Hallpike test results showed a great improvement in daily activities and quality of life (P <.001). CONCLUSION: Semont liberatory maneuver is the most successful therapy for benign paroxysmal positional vertigo and improves patients' quality of life. Diagnostic and therapeutic maneuvers are easy to perform and should be part of the medical knowledge of every general practitioner and geriatrician.     

Benign positional paroxysmal vertigo in the general ear, nose, and throat clinic

Benign positional paroxysmal vertigo is a common disease which may be caused by abnormal movement of utricular debris in the posterior semicircular canal. It is diagnosed by the Dix-Hallpike positional maneuver eliciting vertigo and nystagmus. Treatment generally consists of physical exercises with the Epley or Semont maneuvers. We review 43 consecutive patients diagnosed as BPPV in the last year and treated with physical therapy (Epley maneuvers). Results were very good, with a cure rate of 88.37% (53.5% after a single maneuver). Physical therapy is an effective treatment for BPPV.     

Effectiveness of treatment techniques in 923 cases of benign paroxysmal positional vertigo

OBJECTIVE: To present treatment effectiveness of 923 consecutive cases of benign paroxysmal positional vertigo (BPPV) using canalith repositioning, liberatory, and log roll maneuvers combined with redistribution exercises. STUDY DESIGN: Retrospective case review. METHODS: Patients presented with either posterior semicircular canal (P-SCC) BPPV or horizontal semicircular canal (H-SCC) BPPV. Diagnosis was based on patient history of transient paroxysmal vertigo and a positive Dix-Hallpike response with either torsional or horizontal nystagmus. Patients with P-SCC BPPV numbered 840, and 83 patients had H-SCC BPPV. In the original study, there were 1,000 patients; however, 77 patients were dropped from the study because of lack of follow-through. Intervention was canalith repositioning, liberatory maneuvers, log roll maneuvers, and redistribution exercises. Patients numbering 607 were treated with canalith repositioning, 233 patients had liberatory maneuvers, and 83 received log roll maneuvers. All patients received redistribution exercises before treatment maneuvers. After intervention, patients were reassessed at 6 months. RESULTS: There were 601 women and 322 men from ages 12 to 94 (median 55) years. The average duration of symptoms before intervention was 30 months. Outcome measures were considered met when symptoms of BPPV had abated and patients demonstrated a negative Dix-Hallpike response. In the repositioning group, 94% of patients were symptom free or improved, 98% in the liberatory maneuver group and 100% in the log roll group. The average number of sessions was three for all groups. Recurrence of symptoms was demonstrated in 140 (16%) patients at 6 months. CONCLUSIONS: Treatment of BPPV can be effective using either repositioning, liberatory, or log roll maneuvers in combination with redistribution exercises.     

不同类型良性阵发性位置性眩晕的诊断和治疗

目的探讨不同类型良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）的诊断和治疗方法。方法对我科2004年4月-2006年3月就诊的BPPV病人131例．应用红外线视频眼动记录分析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技术治疗。结果（1）后半规管BPPV94例（71．8％），随机分组采用Epley管石复位法和Semont管石解脱法各47例。（2）水平半规管BPPV29例（22．1％），水平向地性眼震者16例，另13例为水平背地性眼震者，自行或采用Gufoni疗法后转换为水平向地性9例，方向不能转换4例。采用barbecue翻滚和／或强迫侧卧体位疗法。（3）前半规管BPPV6例（4．6％），采用Epley管石复位法。（4）混合型BPPV2例（1．5％），行上述相应半规管的疗法。1周后随访总有效率85．5％（112／131），3个月后92.4％（121／131）。结论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不同半规管及不同发病机理类型，并选择合适的耳石复位技术治疗。     

Prospective study of positional nystagmus in 100 consecutive patients

OBJECTIVES: The purpose of this study was to investigate the various diagnoses of patients who present with positional nystagmus. METHODS: Positional maneuvers were systematically performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position) on 490 consecutive patients essentially referred for vertigo and/or gait unsteadiness. RESULTS: One hundred patients (20%) presented positional nystagmus. This nystagmus had a peripheral origin in 83 patients, including 80 patients with benign paroxysmal positional vertigo (BPPV). In BPPV, the PC was involved in 61 patients, the HC in 18 patients (geotropic horizontal nystagmus in 11 and ageotropic in 7; changing from geotropic to ageotropic or the reverse in 4 patients), and both the PC and HC in 1 patient. There was evidence of central positional nystagmus in 12 patients, including positional downbeat nystagmus during the Dix-Hallpike maneuver in 7 patients with various neurologic disorders, and ageotropic horizontal nystagmus during the HC maneuver in 2 patients with, respectively, cerebellar ischemia and definite migrainous vertigo. The peripheral or central origin of the positional nystagmus could not be ascertained in 5 patients, including 1 patient with probable migrainous vertigo and another with possible anterior canal BPPV. CONCLUSIONS: A rotatory-upbeat nystagmus in the context of PC BPPV, a horizontal nystagmus, whether geotropic or ageotropic, due to HC BPPV, and a positional downbeat nystagmus related to various central disorders are the 3 most common types of positional nystagmus. Geotropic horizontal positional nystagmus and, most certainly, horizontal positional nystagmus changing from geotropic to ageotropic or the reverse point to HC BPPV. In contrast, an ageotropic horizontal positional nystagmus that is not changing (from ageotropic to geotropic) may indicate a central lesion.     

手法复位治疗良性阵发性位置性眩晕

目的回顾性分析60例良性阵发性位置性眩晕（BPPV）诊断和治疗方法,为提高BPPV疗效提供参考依据。方法60例患者（男34例,女26例）通过常规神经耳科学检查、Dix—Hallpike和滚转试验确诊为BPPV。40例在发病10天内就诊,6N在发病1月内就诊,10例在5月内就诊,4例在6月以上就诊。采用Semont摆动手法、Epley颗粒复位法和Barbecue翻滚疗法治疗。对治疗1次无效者间隔7天重复治疗,重复3次无效者采用其它方法治疗。完成冶疗后2周复查评定疗效。结果后半规管BPPV54例,22例采用Semont手法复位治疗,14例痊愈,4例改善,4例无效。4例无效改用Epley颗粒复位法。Epley颗粒复位法治疗36例,28例痊愈,4例改善,4例无效。6例外半规管BPPV采用Barbecue翻滚疗法治疗4例痊愈,2例无效。40例10天内就诊者治愈32例,8例改善。6例发病1月内就诊者治愈2例,改善4例。10例5月内就诊者4例痊愈,4例改善,2例无效。4例6月以上就诊者治疗3次均无效。46例治疗1次有效,4例患者治疗2次有效,4例患者治疗3次有效。结论手法复位治疗BPPV有效率高,BPPV治疗效果与发病至就诊时间相关。     

不同变位试验在良性阵发性位置性眩晕的诊断价值

目的：探讨不同变位试验在诊断良性阵发性位置性眩晕（BPPV）中的价值。方法：对我科2000年2月～2004年4月诊断的后半规管（PC）源性良性眩晕72例,采用交叉设计,随机将其中36例先行Dix-Hallpike试验,再行侧卧试验;男36例试验排序与其相反。此后再行仰卧侧头位试验。结果：Dix-Hallpike试验和侧卧试验在诊断PC—BPPV中所得结果具有关联性（P〈0．01）,诊断阳性率差异无统计学意义（P〉0．05）;两者裸眼观察到眼震的典型阳性反应分别为77．9％及77．1％,差异亦无统计学意义（P〉0．05）。2种试验诱发眩晕和（或）眼震具有的潜伏期、持续期及性质、方向等特征无差异。1例患者同时仰卧侧头位试验阳性,诊断同时存在PC—BPPV。结论：在诊断PC—BPPV中,侧卧试验与Dix-Hallpike具有相同的客观诊断价值。在活动受限的情形下,侧卧试验更易于操作及更具安全性,可完全取代Dix-Hallpike试验。在前2种试验出现水平眼震时应同时行仰卧头位试验,以确定是否同时伴有或为水平半规管源性病变。     

手法复位治疗良性阵发性位置性眩晕36例

目的 评价体位治疗在良性阵发性位置性眩晕（BPPV）的应用价值。方法 回顾性分析36例原发性或继发性BPPV的临床资料,后半规管BPPV采用改良Epley手法或Semont手法复位,水平半规管采用Barbecue翻滚疗法复位治疗,评价其治疗效果。结果 33例后半规管BPPV患者应用改良Epley手法或Semont手法复位,有效率为93.9%。3例水平半规管BPPV患者采取Barbecue翻滚法复位后症状均明显改善。结论 手法复位治疗良性阵发性位置性眩晕方法简单,疗效可靠,治愈率高。     

Diagnostic problems in patients with benign paroxysmal positional vertigo

The steps of the examination procedure applied for a correct diagnosis of benign paroxysmal positional vertigo (BPPV) are reviewed. A precise diagnosis is important in view of treatment of this type of vertigo by rehabilitation therapy. Clinical experience supports the concept that the diagnosis has to be based not only on a typical history, but also on the presence of a reproducible vertigo and paroxysmal positioning nystagmus. In the procedure applied in the department, this nystagmus can be reproduced by the Dix-Hallpike maneuver under Frenzel's glasses, during electronystagmography (ENG) recording in the position tests, or it can be present in the vestibular habituation training test battery (a battery of 19 maneuvers applied for defining the adequate exercises in the rehabilitation treatment for BPPV). Analysis of the reviewed data in 95 patients showed that one third of the patients described the vertigo in a rather atypical way, while the further testing revealed a typical BPPV. This experience denies any absolute reliability to only history. In fact, only the finding of such a paroxysmal positioning nystagmus is conclusive for confirming BPPV. However, also the presence of such a nystagmus appeared not to be a constant datum, so that in some patients more than one examination was necessary to come to a reliable diagnosis. It is obvious that, for detecting a paroxysmal positioning nystagmus, ENG is less reliable than the Dix-Hallpike maneuver under Frenzel's glasses.     

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．     

Postural restrictions in labyrintholithiasis

Benign paroxysmal positional vertigo (BPPV) is the most frequent labyrinthopathy in humans. Treatment consists mainly of liberatory maneuvers aiming to remove otolithic debris and subsequent postural restrictions in order to prevent debris from returning into the canal. The reappearance of symptoms after an effective liberatory maneuver was studied in a group subjected to restrictions and in a second group free from restrictions. The effects of these restrictions were evaluated. No statistically significant difference was found between the groups. Accordingly, restrictions seem to have no effect upon symptom recurrence. The slight supremacy of the Semont maneuver and the prevalence of subsequent relapse compared with the Epley maneuver suggests that these maneuvers could operate on different disorders (cupulolithiasis versus canalolithiasis). Finally, late recognition of relapse in patients who undergo restrictions might even make the liberatory maneuver less effective.     

Combined horizontal and posterior canal benign paroxysmal positional vertigo in three patients with head trauma

We report 3 patients who complained of positional vertigo shortly after head trauma. Positional maneuvers performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position with the head raised 30 degrees) revealed a complex positional nystagmus that could only be interpreted as the result of combined PC and HC benign paroxysmal positional vertigo (BPPV). Two patients had a right PC BPPV and an ageotropic HC BPPV, and 1 patient had a bilateral PC BPPV and a left geotropic HC BPPV. All 3 patients were rapidly free of vertigo after the PC BPPV was cured by the Epley maneuver and the geotropic HC BPPV was cured by the Vannucchi method. The ageotropic HC BPPV resolved spontaneously. Neuroimaging (brain computed tomography and/or magnetic resonance imaging scans) findings were normal in all 3 patients. From a physiopathological viewpoint, it is easy to conceive that head trauma could throw otoconial debris into different canals of each labyrinth and be responsible for these combined forms of BPPV. Consequently, in trauma patients with vertigo, it is mandatory to perform the Dix-Hallpike maneuver, as well as supine lateral head turns, in order to diagnose PC BPPV, HC BPPV, or the association of both. Early diagnosis and treatment of BPPV may help to reduce the postconcussion syndrome.     

The 360-degree maneuver for treatment of benign positional vertigo.

OBJECTIVE: The purpose of this study was to determine whether rotating a patient 360 degrees in the plane of the posterior semicircular canal is effective in treating classic benign paroxysmal positional vertigo. The study also compares the features of the Epley maneuver and the Semont maneuver and correlates them to the 360-degree maneuver. STUDY DESIGN: A prospective analysis of 31 patients presenting with benign paroxysmal positional vertigo who were treated using the multiaxial positioning device. A questionnaire was administered immediately after each treatment. SETTING: The study was carried out in a private practice referral clinic for benign paroxysmal positional vertigo. PATIENTS: Subjects consisted of 31 adults who ranged in age from 44 to 95 years. INTERVENTION: Thirty-one patients were treated using the 360-degree maneuver. A multiaxial positioning device was used to rotate patients completely upside down and back into the starting position in the proper plane. MAIN OUTCOME MEASURES: Subjective improvement scores, tolerability, objective nystagmus observations, and complications were recorded. RESULTS: Subjective improvement rates were 90% after one treatment; 97% were symptom-free and nystagmus-free after a maximum of three treatment sessions. Eighty-seven percent found the procedure quite tolerable from an ergonomic standpoint. CONCLUSION: The 360-degree maneuver can be effective in treating benign paroxysmal positional vertigo. Its rate of success is comparable to the rate of success of the standard Epley maneuver. On analysis, it is strikingly similar to the Epley and Semont maneuvers.     

Efficacy of the Semont maneuver in benign paroxysmal positional vertigo

OBJECTIVES: To assess the efficacy of the Semont maneuver in the treatment of benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal and to evaluate the possible effect of various factors on the efficacy of this maneuver. DESIGN AND SETTING: Retrospective study in an outpatient clinic. PATIENTS: Two hundred seventy-eight patients presenting with symptomatic, unilateral BPPV of the posterior semicircular canal, exclusively treated with the Semont maneuver. INTERVENTIONS: During the first consultation, each patient was treated with a Semont maneuver. When BPPV persisted, this maneuver was repeated during follow-up visits, performed at weekly intervals. MAIN OUTCOME MEASURES: Patients were considered cured when vertigo disappeared within 30 days (allowing up to 4 maneuvers). RESULTS: More than 90% of patients were cured after a maximum of 4 maneuvers, and 83.5% were cured after only 2 maneuvers. The efficacy of the maneuver decreased each time it was repeated (from 62.6% at the first maneuver to 18.2% at the fourth). The duration of symptoms before initial consultation and the etiology of BPPV had a significant effect on the maneuver's efficacy (P<.001 and P =.002, respectively), whereas age (P =.12), sex (P =.06), and affected side (P =.20) had no effect. CONCLUSIONS: The Semont maneuver demonstrated a 90.3% cure rate after a maximum of 4 sessions. Patients consulting late (>6 months after the beginning of symptoms) or having traumatic BPPV had lower recovery rates than patients without these factors (74.7% vs 96.5%).     

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.     

“Sitting-up vertigo as an expression of posterior semicircular canal heavy cupula and posterior semicircular canal short arm canalolithiasis”

BackgroundVestibular symptoms on sitting-up are frequent on patients seen by vestibular specialists. Recently, a benign paroxysmal positional vertigo (BPPV) variant which elicits vestibular symptoms with oculomotor evidence of posterior semicircular canal (P-SCC) cupula stimulation on sitting-up was described and named sitting-up vertigo BPPV. A periampullar restricted P-SCC canalolithiasis was proposed as a causal mechanism.ObjectiveTo describe new mechanisms of action for the sitting-up vertigo BPPV variant.MethodsEighteen patients with sitting-up vertigo BPPV were examined with a pre-established set of positional maneuvers and follow-up until they resolved their symptoms and clinical findings.ResultsAll patients showed up-beating torsional nystagmus (UBTN) and vestibular symptoms on coming up from either Dix-Hallpike (DHM) or straight head-hanging maneuver. Sixteen out of 18 patients presented a sustained UBTN with an ipsitorsional component to the tested side on half-Hallpike maneuver (HH). A slower persistent contratorsional down-beating nystagmus was found in eleven out 18 patients tested on nose down position (ND).ConclusionsPersistent direction changing positional nystagmus on HH and ND positions indicative of P-SCC heavy cupula was found in 11 patients. A sustained UBTN on HH with the absence of findings on ND, which is suggestive of the presence of P-SCC short arm canalolithiasis, was found on 5 patients. All patients were treated with canalith repositioning maneuvers without success, but they resolved their findings by means of Brandt-Daroff exercises. We propose P-SCC heavy cupula and P-SCC short arm canalolithiasis as two new putative mechanisms for the sitting-up vertigo BPPV variant.     

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。     

Clinical features of benign paroxysmal positional vertigo

Our understanding of the pathomechanism of benign paroxysmal positional vertigo (BPPV) has improved dramatically. A type of BPPV featuring mixed torsional and vertical nystagmus induced by the Dix-Hallpike maneuver involves the posterior semicircular canal (P-BPPV). The other type of BPPV featuring horizontal nystagmus induced by spine-to-lateral head positioning involves the horizontal canal BPPV (H-BPPV). In complaints of vertigo or dizziness, 619 patients visited our department last year. Of these, 142 (23%) was had positional nystagmus consistent with a diagnosis of BPPV, 118 (19%) had no nystagmus but were suspected of BPPV due to vertigo episodes. BPPV was the most frequent diagnosis. H-BPPV was not rare, but accounted for 30% of BPPV. Of H-BPPV, 73% featured direction changing geotropic nystagmus, and 27% direction changing apogeotropic nystagmus. H-BPPV resolved faster than P-BPPV. Most cases caused by head trauma were P-BPPV. Transition between P- and H-BPPV was found in 6 cases. Women outnumbered men by about 3 to 2 in both P- and H-BPPV. Peak incidence was found in the those in their 60s and 70s, suggesting that the etiologies of both types of BPPV are essentially the same.     

良性阵发性位置性眩晕的眼震图研究

目的:探讨视频眼震图(VNG)在良性阵发性位置性眩晕(BPPV)中的应用价值。方法:回顾126例BPPV患者的VNG资料,分析总结各型BPPV在Dix-Hallpike和滚转试验中VNG上的眼震特点。结果:126例BPPV患者中,后半规管BPPV(PSC-BPPV)98例(77.8%),水平半规管BPPV(HSC-BPPV)17例(13.5%),前半规管BPPV(ASC-BPPV)5例(3.9%),混合型BPPV6例(4.8%);28例PSC-BPPV记录到反转相眼震。VNG上显示PSC和ASC管石症Dix-Hallpike悬头位垂直相眼震分别向上、向下,水平相眼震均向对侧,回到坐位时眼震反向。HSC-BPPV滚转试验向两侧转头均可诱发出眼震,眼震与转头方向相同时,可判断为HSC管石症,以能够诱发较强眼震的转头侧为患侧;眼震与转头方向相反时,则为HSC嵴顶结石症,以能够诱发较弱眼震的转头侧为患侧。结论:VNG能够客观地记录BPPV患者的眼震情况,准确判断耳石所在的半规管,并且保存了眼震数据资料,可以进一步指导临床实践,值得推广。     

The treatment of horizontal canal positional vertigo: our experience in 66 cases.

OBJECTIVES/HYPOTHESIS: The horizontal semicircular canal variant of paroxysmal positional vertigo (HSC-PPV) shows three subtype nystagmic patterns: 1) bilateral geotropic nystagmus, 2) bilateral apogeotropic nystagmus that may switch into bilateral geotropic, and 3) bilateral apogeotropic nystagmus that never switches into bilateral geotropic. In recent years, many methods of physical treatment have been proposed for HSC-PPV, yet no standard protocol has been defined. We studied the effects of different methods according to each different form of HSC-PPV after a precise definition of the nystagmic and clinical features. STUDY DESIGN: A prospective trial of 66 patients with horizontal canal paroxysmal positional vertigo treated with a combination of rotational maneuver and forced prolonged position. METHODS: We evaluated 66 patients with HSC-PPV in its three subtypes. For patients with bilateral geotropic nystagmus, the "barbecue" method was combined with "forced prolonged position." Patients with bilateral geotropic nystagmus were submitted to maneuvers aimed at a switch to bilateral geotropic. The cases that did not switch were submitted to a modified fourth step of the Semont maneuver. RESULTS: Eighty percent of the patients with bilateral geotropic nystagmus became symptom free within the second session, and in 90% of the patients, symptoms were resolved by the third session. In the bilateral apogeotropic cases, the modified fourth step of the Semont maneuver resulted in 75% of the patients being symptom free. CONCLUSIONS: The correct identification of both nystagmic pattern and site of the lesion is crucial for the choice of physical treatment of HSC-PPV and its success. We have standardized the treatment protocol consisting of a "barbecue" maneuver followed by "forced prolonged position" in cases of geotropic nystagmus and a modified fourth step of the Semont maneuver for apogeotropic nystagmus. Our results appear encouraging because 90% of the entire study group was symptom free after three sessions.