Progressive cochleo-vestibular labyrinthitis

OBJECTIVE: We report a rare case of sudden deafness and benign paroxysmal positional vertigo (BPPV) corresponding to a canalithiasis of the ipsilateral left posterior semicircular canal (PSC). CASE REPORT: The initial examination showed intact lateral semicircular canal (LSC) function. Cerebral MRI results were normal. However evoked otoacoustics emissions were absent in the left ear. The patient developed, in the course of one week, symptoms and signs of an acute unilateral vestibulopathy in the same ear. However there were no change in hearing loss after it. CONCLUSION: The association of BPPV acute vestibulopathy and sudden deafness is uncommon but usually the former develops well after the second and third. This case is best explained by a vestibulocochlear labyrinthitis.     

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.     

165例良性阵发性位置性眩晕患者管石复位治疗疗效观察

目的评估BPPV患者管石复位治疗短期和长期疗效。方法回顾分析了后半规管和上半规管BPPV患者165例，男53例、女112例，年龄范围18岁至84岁（平均53岁），分为2组，手法复位治疗（治疗组）125例，非手法复位（对照组）40例。结果治疗组中，后半规管BPPV患者81例，上半规管BPPV患者31例，双侧后半规管BPPV13例。65岁以上老年BPPV患者41例。治疗结果分析．治疗组首次治愈83人（66．4％），其中后半规管BPPV60人（74．1％），上半规管BPPV14人（45．2％），双侧后半规管BPPV9人（69．2％），老年BPPV32人（78．0％）。对照组16人（40％）在一周后症状消失。在4个月至41个月的随访中，治疗组和对照组治愈率分别为92％和82．5％。有30人（24％）在随访中复发。有2例病史超过40个月的患者，手法复位治疗无效而进行后半规管阻塞术。结论手法复位治疗BPPV患者是一种非常有效的方法，它能有效的缩短病程，减轻患者痛苦，其方法简单、易行且费用低，可以在临床广泛使用。     

190例特发性良性阵发性位置性眩晕患者半规管功能分析

目的分析特发性良性阵发性位置性眩晕(benign paroxysmal position vertigo,BPPV)患者半规管功能的特征,为患者的治疗提供进一步帮助。方法选择本院2019年8月至2020年2月收治的单侧特发性BPPV患者190例,包括后半规管BPPV患者162例,水平半规管BPPV患者28例。行冷热试验和视频头脉冲试验(video head impulse test,vHIT)检查,分析其检测结果。结果190例特发性BPPV患者行冷热试验异常者146例(76.84%),其中后半规管BPPV异常者129例(79.63%),水平半规管BPPV异常者17例(60.71%),二者比较差异有统计学意义(χ²=4.800,P=0.028)。146例异常患者中与BPPV患者同侧半规管异常者61例(41.78%),对侧半规管异常者54例(36.99%),双侧半规管均异常31例(21.23%)。后半规管BPPV患者与水平半规管BPPV患者冷热试验异常侧别分布情况比较,差异无统计学意义(χ²=0.475,P=0.789)。26例特发性BPPV患者行视频头脉冲试验,异常者17例(65.38%),其中后半规管BPPV异常者12例(70.59%),水平半规管BPPV异常者5例(55.56%),二者比较,差异无统计学意义(P=0.667);17例异常患者中与BPPV患者同侧半规管异常者10例(58.82%),对侧半规管异常7例(41.18%)。后半规管BPPV患者与水平半规管BPPV患者vHIT检查结果异常侧别分布情况比较,差异无统计学意义(P=1.000)。结论部分特发性BPPV患者存在广泛的半规管损伤,异位耳石不是其损伤的主要原因;冷热试验联合视频头脉冲试验能提高BPPV患者半规管损伤的检出率,有助于患者的治疗与康复。     

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．     

Particle repositioning maneuver for benign paroxysmal positional vertigo

The recent demonstration of free-floating particles in the endolymph of the posterior semicircular canal in patients with benign paroxysmal positional vertigo (BPPV)¹ has renewed interest in the physiology and treatment of this entity. The particle repositioning maneuver (PRM) relocates the free-floating particles from the posterior semicircular canal back into the utricle, relieving the patient of bothersome, often long-standing vertigo. This report represents a prospective study of 27 consecutive patients seen with a diagnosis of BPPV. Eighty-four percent of the patients treated with the particle repositioning maneuver who had no other associated pathology were cured or significantly improved with this new technique. Two patients who failed conservative management went on to surgical intervention with the posterior semicircular canal occlusion. The authors find the particle repositioning maneuver effective for many patients with benign positional vertigo and recommend it as the first-line treatment modality for BPPV.     

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.     

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。     

红外视频眼震检查在良性阵发性位置性眩晕诊断的应用

目的探讨眼震视图(VNG)应用于诊断良性阵发性位置性眩晕(BPPV)的价值。方法对50例拟诊BPPV患者,在视频眼动观察记录下完成DIX_Hallpike变位及ROLL滚转试验,判别受累半规管并采取相应手法复位。结果 (1)依据眼震特点和方向判断受累半规管[1]:后半规管(PSC-BPPV)39例,占78%;水平半规管(HSC-BPPV)6例,占12%;前半规管(ASC-BPPV)1例,占2%;2个或2个以上半规管同时受累及4例,占8%;(2)以此为基础选择适当的手法进行复位治疗,1周后随访疗效:痊愈43例,有效6例,无效1例,总有效率98%。结论眼震视图对BPPV患者眼震情况的客观记录,提高了受累半规管的准确判别率,对于良性阵发性位置性眩晕诊断可以提供一种更为客观、精确的方法。     

New treatment strategy for cupulolithiasis associated with benign paroxysmal positional vertigo of the lateral canal: the head-tilt hopping exercise

This study was performed to determine whether a novel treatment was effective against cupulolithiasis associated with benign paroxysmal positional vertigo (BPPV) of the lateral semicircular canal, which is characterized by apogeotropic direction-changing nystagmus. We herein describe our head-tilt hopping (HtH) exercise, which is designed to release otoconial debris strongly adhered to the cupula. The subjects were trained to hop while tilting their heads laterally. They completed 3 to 5 exercise sessions per day over a 4-week period. Each session ended with a 20-hop trial. The HtH exercises were performed by 27 patients with intractable lateral canal BPPV who exhibited positional vertigo and persistent nystagmus beating toward the uppermost ear for more than 4 weeks, despite performing therapeutic head shaking in the horizontal plane maneuver. All the patients were subjected to the supine roll test before and immediately after the first trial as well as after 1 and 4 weeks of the program to evaluate the effect of the treatment on their apogeotropic nystagmus. Nystagmus of 9 (33.3 %) patients disappeared immediately after the first training session. After 1 and 4 weeks of the training, the number of patients that had experienced either of these improvements had increased to 15 (55.6 %) and 19 (70.4 %) subjects, respectively. These results suggest that HtH exercises aimed at releasing otoconial debris from the cupula are feasible as a new therapy for cupulolithiasis associated with intractable lateral canal BPPV. However, further studies for comparison with control are required to confirm these preliminary results.     

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.     

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.

体位限制对手法复位后良性阵发性位置性眩晕的疗效观察

目的 探讨手法复位后体位限制对良性阵发性位置性眩晕(BPPV)患者的疗效。 方法 2015年12月至2016年6月共收治BPPV患者210例,随机分为手法复位后联合体位限制组(观察组)105例和单纯手法复位组(对照组)105例,其中后半规管BPPV(PSC-BPPV)患者两组各70例,向地性水平半规管BPPV(HSC-BPPV)患者两组各25例,背地性HSC-BPPV患者两组各10例。 结果 PSC-BPPV两组短期7 d和3个月疗效差异均无统计学意义(P=0.515, P=0.967); 向地性HSC-BPPV和背地性HSC-BPPV患者两组短期7 d疗效差异均有统计学意义(P=0.030, P=0.040),长期疗效评价无统计学意义(P=0.972)。 结论 PSC-BPPV患者行手法复位后可不予体位限制,HSC-BPPV患者手法复位后需要行体位限制,待患者无任何症状后可以自由体位。     

Benign paroxysmal positional vertigo secondary to vestibular neuritis

The aim of this study was to present the demographic, pathogenetic and clinical features of benign paroxysmal positional vertigo (BPPV) secondary to vestibular neuritis (VN). The medical records of 22 patients, who presented with BPPV within 12 weeks after the onset of VN, were reviewed. Data of a complete otolaryngological, audiological, neurotologic and imaging evaluation were available for all patients. Two hundred and eighty-four patients with idiopathic BPPV were used as a control group. The patients with BPPV secondary to VN presented the following features, in which they differed from the patients with idiopathic BPPV: (1) a lower mean age; (2) involvement of the posterior semicircular canal; (3) presence of canal weakness; (4) more therapeutic sessions needed for cure and a higher rate of recurrence. It may be, thus, concluded that BPPV associated with VN differs from idiopathic BPPV in regard to several epidemiological and clinical features, it responds less effectively to treatment and may follow a protracted course, having a tendency for recurrence.     

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.     

Caloric tests in clinical practice in benign paroxysmal positional vertigo

Background: The value of caloric tests in benign paroxysmal positional vertigo (BPPV) patients is unclear.

Objectives: To analyze the features and clinical significance of caloric tests in BPPV patients.

Materials and methods: About 2192 patients (256 BPPV and 1936 non-BPPV) who complained of dizziness triggered by movement, accompanied by the symptom of hearing loss or a history of vertigo, participated in this prospective clinical study. All subjects received a caloric test, 213 BPPV patients underwent follow-up for at least 6 months after canalith repositioning procedures (CRPs).

Results: (1) The abnormal canal paresis (CP) prevalence of BPPV was 57%. (2) The curative rate of single CRP decreased during follow-up from 90.1% after 7 days to 61% after 6 months and was significantly lower in patients with (54.1%) than in those without (70.1%) an abnormal CP at 6 months post-treatment (p?=?.01). (3) The recurrent rate was significantly higher in BPPV patients with abnormal CP (25.2%) than with normal CP (12.5%; p?=?.017).

Conclusions and significance: Patients with abnormal CP needed more CRPs and were more prone to relapse. The value of the caloric test in treatment planning and predicting recurrence in BPPV patients should be emphasized.     

Canalolithiasis of the superior semicircular canal: an anomaly in benign paroxysmal vertigo

According to the canalolithiasis theory, benign paroxysmal vertigo (BPPV) is caused by gravity-dependent movements of otoconial debris that collects in the endolymph of the posterior semicircular canal. Other parts of the vestibular organ are rarely affected, and it is mainly the horizontal canal that is affected by this atypical form of BPPV. Canalolithiasis of the superior semicircular canal must be considered an anomaly because the superior semicircular canal is the highest point of the vestibular organ and debris normally cannot collect in this special location. Until now, BPPV of the superior canal has mainly been dealt with theoretically in the literature. The authors present three patients with canalolithiasis of the superior semicircular canal and offer direct proof of the condition using high-resolution 3D MRI.     

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。     

Canalolithiasis of the superior semicircular canal: an anomaly in benign paroxysmal vertigo

According to the canalolithiasis theory, benign paroxysmal vertigo (BPPV) is caused by gravity-dependent movements of otoconial debris that collects in the endolymph of the posterior semicircular canal. Other parts of the vestibular organ are rarely affected, and it is mainly the horizontal canal that is affected by this atypical form of BPPV. Canalolithiasis of the superior semicircular canal must be considered an anomaly because the superior semicircular canal is the highest point of the vestibular organ and debris normally cannot collect in this special location. Until now, BPPV of the superior canal has mainly been dealt with theoretically in the literature. The authors present three patients with canalolithiasis of the superior semicircular canal and offer direct proof of the condition using high-resolution 3D MRI.