scholarly journals Persistent Down-Beating Torsional Positional Nystagmus: Posterior Semicircular Canal Light Cupula?

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Akihide Ichimura ◽  
Koji Otsuka
Keyword(s):  
Supine Position ◽  
Semicircular Canal ◽  
Sitting Position ◽  
Positional Nystagmus ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Light Cupula ◽  
Lying Down

A 16-year-old boy with rotatory positional vertigo and nausea, particularly when lying down, visited our clinic. Initially, we observed vertical/torsional (downward/leftward) nystagmus in the supine position, and it did not diminish. In the sitting position, nystagmus was not provoked. Neurological examinations were normal. We speculated that persistent torsional down-beating nystagmus was caused by the light cupula of the posterior semicircular canal. This case provides novel insights into the light cupula pathophysiology.

scholarly journals Intractable Persistent Direction-Changing Geotropic Nystagmus Improved by Lateral Semicircular Canal Plugging

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Toru Seo ◽  
Kazuya Saito ◽  
Katsumi Doi
Keyword(s):  
Hearing Loss ◽  
Supine Position ◽  
Semicircular Canal ◽  
Sudden Hearing Loss ◽  
Neutral Point ◽  
Positional Nystagmus ◽  
Lateral Semicircular Canal ◽  
Positional Vertigo ◽  
Light Cupula ◽  
The Right

Antigravitational deviation of the cupula of the lateral semicircular canal, which is also called light cupula, evokes persistent direction-changing geotropic nystagmus with a neutral point. No intractable cases of this condition have been reported. In our case, a 67-year-old man complained of positional vertigo 3 months after developing idiopathic sudden hearing loss in the right ear with vertigo. He showed a persistent direction-changing geotropic nystagmus with a leftward beating nystagmus in the supine position. The nystagmus resolved when his head was turned approximately 30° to the right. He was diagnosed with light cupula of the right lateral semicircular canal and was subsequently treated with an antivertiginous agent. However, his symptoms and positional nystagmus did not improve, so the right lateral semicircular canal was plugged by surgery. One month after surgery, his positional vertigo and nystagmus were completely resolved. We speculated that the cause of the patient’s intractable light cupula was an enlarged cupula caused by his idiopathic sudden hearing loss.

scholarly journals Benign Paroxysmal Positional Vertigo and Positional Vertigo Variants

2012 ◽  
Vol 4 (1) ◽  
pp. 25-40 ◽  
Author(s):  
Giacinto Asprella Libonati
Keyword(s):  
Differential Diagnosis ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Positional Nystagmus ◽  
Posterior Semicircular Canal ◽  
Diagnosis And Therapy ◽  
Positional Vertigo ◽  
Peripheral Origin ◽  
Paroxysmal Positional Vertigo

ABSTRACT This article reviews the causes of positional vertigo and positional nystagmus of peripheral origin. Benign paroxysmal positional vertigo is described in all its variants, its diagnosis and therapy are highlighted. In addition, nonparoxysmal positional vertigo and nystagmus due to light/heavy cupula of lateral and posterior semicircular canal is focused on. The differential diagnosis between positional vertigo due to otolithic and nonotolithic causes is discussed. How to cite this article Asprella Libonati G. Benign Paroxysmal Positional Vertigo and Positional Vertigo Variants. Int J Otorhinolaryngol Clin 2012;4(1):25-40.

scholarly journals Effect of Sitting Position vs. Supine Position With the Head Turned to the Affected Side on Benign Paroxysmal Positional Vertigo Fatigue

2021 ◽  
Vol 12 ◽  
Author(s):  
Takao Imai ◽  
Suetaka Nishiike ◽  
Tomoko Okumura ◽  
Noriaki Takeda ◽  
Takashi Sato ◽  
...  
Keyword(s):  
Supine Position ◽  
Benign Paroxysmal Positional Vertigo ◽  
Head Position ◽  
Sitting Position ◽  
Positional Nystagmus ◽  
Positional Vertigo ◽  
Affected Side ◽  
Group A ◽  
Group B ◽  
Paroxysmal Positional Vertigo

Objective: In benign paroxysmal positional vertigo (BPPV), positional nystagmus becomes generally weaker when the Dix–Hallpike test is repeated. This phenomenon is termed BPPV fatigue. We previously reported that the effect of BPPV fatigue deteriorates over time (i.e., the positional nystagmus is observed again after maintaining a sitting head position). The aim of this study was to investigate whether the effect of BPPV fatigue attenuates after maintaining a supine position with the head turned to the affected side.Methods: Twenty patients with posterior-canal-type BPPV were assigned to two groups. Group A received Dix–Hallpike test, were returned to the sitting position (reverse Dix–Hallpike test) with a sitting head position for 10 min, and then received a second Dix–Hallpike test. Group B received Dix–Hallpike test, were kept in the supine position with the head turned to the affected side for 10 min, and then received reverse Dix–Hallpike test followed by the second Dix–Hallpike test. The maximum slow phase eye velocity (MSPEV) of positional nystagmus induced by the first, reverse, and second Dix–Hallpike test were analyzed.Results: The ratio of MSPEV of the positional nystagmus induced by the second Dix–Hallpike test relative to the first Dix–Hallpike test was significantly smaller in group B than that in group A. There was no difference in the MSPEV of the positional nystagmus induced by the reverse Dix–Hallpike test between group A and B.Conclusions: The effect of BPPV fatigue is continued by maintaining a supine position with the head turned to the affected side, while the effect is weakened by maintaining a sitting head position. On the basis of the most widely accepted theory of the pathophysiology of BPPV fatigue, in which the particles become dispersed along the canal during head movement in the Dix–Hallpike test, we found an inconsistency whereby the dispersed otoconial debris return to a mass during the sitting position but do not return to a mass in the supine position with the head turned to the affected side. Future studies are required to determine the exact pathophysiology of BPPV fatigue.Classification of Evidence: 2b.

scholarly journals Effect of the Epley Maneuver and Brandt-Daroff Exercise on Benign Paroxysmal Positional Vertigo Involving the Posterior Semicircular Canal Cupulolithiasis: A Randomized Clinical Trial

2020 ◽  
Vol 11 ◽  
Author(s):  
Seo-Young Choi ◽  
Jae Wook Cho ◽  
Jae-Hwan Choi ◽  
Eun Hye Oh ◽  
Kwang-Dong Choi
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Therapeutic Effect ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Positional Nystagmus ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Epley Maneuver ◽  
Paroxysmal Positional Vertigo

Objective: To investigate the therapeutic efficacies of the Epley maneuver and Brandt-Daroff (BD) exercise in patients with benign paroxysmal positional vertigo involving the posterior semicircular canal cupulolithiasis (PC-BPPV-cu).Methods: We conducted a randomized clinical trial to evaluate the therapeutic effect of the Epley maneuver and BD exercise in patients with PC-BPPV-cu. Patients were randomly assigned to undergo the Epley maneuver (n = 29) or BD exercise (n = 33). The primary outcome was an immediate resolution of positional nystagmus within 1 h after a single treatment of each maneuver on the visit day. Secondary outcomes included the resolution of positional nystagmus at 1 week, the change of maximal slow phase velocity (mSPV) of positional nystagmus, and dizziness handicap inventory (DHI) immediately and at 1 week.Results: Immediate resolution occurred in none of 29 patients in the Epley maneuver group and only 1 of 33 patients in the BD exercise group. The Epley maneuver and BD exercise had an equivalent effect at 1 week in treating PC-BPPV-cu in terms of resolving positional nystagmus (48 vs. 36%, p = 0.436) and the decrease of mSPV and DHI.Conclusion: Neither the Epley maneuver nor BD exercise has an immediate therapeutic effect in treating PC-BPPV-cu. Clear classification of PC-BPPV should be required at the time of different pathology and different treatment response.

scholarly journals Unveiling Positioning Nystagmus in Patients of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo by Diagnostic Head-Shaking in the Yaw Plane

2019 ◽  
Vol 2 (02) ◽  
pp. 85-88
Author(s):  
Ajay Kumar Vats
Keyword(s):  
Successful Treatment ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Sitting Position ◽  
Precise Localization ◽  
Positional Nystagmus ◽  
Horizontal Semicircular Canal ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Abstract Introduction The diagnosis of benign paroxysmal positional vertigo (BPPV) is largely dependent on elicitation of positioning nystagmus on the diagnostic positional tests, namely Dix-Hallpike and supine roll tests (DHT and SRT, respectively), in patients complaining of vertigo, which occurs when patient’s head moves relative to the gravity. The pattern of elicited positioning nystagmus localizes as well as lateralizes the diseased canal, and the therapeutic positioning maneuver is accordingly undertaken. Objective The diagnostic positional tests, at times fail to elicit positional nystagmus, leaving clinician in a state of dilemma, when examining a patient who is currently experiencing paroxysms of vertigo triggered by positional change. In two patients with history consistent with BPPV but with negative positional tests initially, head shaking for 10 seconds in the yaw axis was done, and Dix-Hallpike and supine roll tests were repeated. The aim of head shaking for 10 seconds was to unveil positional nystagmus, to precisely localize and lateralize the diseased semicircular canal. Results and Discussion In the two cases of horizontal semicircular canal BPPV (HSC-BPPV) reported here, the DHT and/or SRT initially failed to elicit positional nystagmus but head shaking for 10 seconds in the left Dix–Hallpike position in case one and with the head anteflexed 30-degrees in the sitting position in the case two, unveiled horizontal positional nystagmus on ensuing SRT. The use of head-shaking in the yaw plane to unveil a horizontal positioning nystagmus in cases where a conventional positional test (DHT and SRT) has failed to elicit the PN, has not been reported in the literature hitherto. Conclusion After precise localization and lateralization of the diseased canal, both patients successfully underwent successful treatment with Gufoni maneuver. A verifying SRT done at 1 hour and/or at 24 hours follow-up was negative. In patients, who are currently experiencing paroxysms of vertigo triggered by the change of position of head relative to the gravity; head-shaking for few seconds just prior to the positioning test, can unveil positional nystagmus not elucidated with the conventionally performed positional tests.

scholarly journals Behavior of the posterior semicircular canal after Dix-Hallpike maneuver

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Francisco Carlos Zuma e Maia ◽  
Pedro Luiz Mangabeira Albernaz ◽  
Renato Valério Cal
Keyword(s):  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Biomechanical Model ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

The objective of the present study is to analyze the quantitative vestibulo-ocular responses in a group of patients with benign paroxysmal positional vertigo (BPPV) canalolithiasis and compare these data with the data of the tridimensional biomechanical model. This study was conducted on 70 patients that presented idiopathic posterior semicircular canal canalolithiasis. The diagnosis was obtained by Dix- Hallpike maneuvers recorded by videonystagmograph. The present study demonstrates that there is a significant correlation between the intensity of the nystagmus and its latency in cases of BPPV-idiopathic posterior semicircular canal canalolithiasis type. These findings are in agreement with those obtained in a tridimensional biomechanical model and are not related to the patients’ age.

scholarly journals The efficacy of Epley and Semont maneuvers in posterior semicircular canal benign paroxysmal positional vertigo treatment: A short-term comparative study

2021 ◽  
Vol 9 (3) ◽  
pp. 75-80
Author(s):  
Mustafa Caner Kesimli
Keyword(s):  
Comparative Study ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Posterior Semicircular Canal ◽  
Short Term ◽  
Positional Vertigo ◽  
Epley Maneuver ◽  
The One ◽  
Paroxysmal Positional Vertigo

OBJECTIVE: This study aimed to compare the effectiveness of the Epley maneuver with the Semont maneuver in the treatment of posterior semicircular canal benign paroxysmal positional vertigo and observe differences in the resolution time of symptoms in the short-term follow-up. METHODS: Sixty patients with posterior semicircular canal benign paroxysmal positional vertigo (23 males, 37 females; median age: 44.9 years; range, 14 to 80 years) were included in the prospective randomized comparative study conducted in our clinic between April 2019 and October 2019. Diagnosis and treatment maneuvers were performed under videonystagmography examination. Participants were randomly selected after the diagnostic tests for the Epley maneuver and the Semont maneuver treatment groups. RESULTS: In the evaluation of vertigo with videonystagmography, 25 (83.3%) patients in the Epley maneuver group and 20 (66.6%) patients in the Semont maneuver group recovered in the one-week follow-up, and 28 (93.3%) patients in the Epley maneuver group and 24 (80%) patients in the Semont maneuver group recovered in the two-week follow-up. All patients in the Epley maneuver group recovered at the end of one month; four patients in the Semont maneuver group still had vertiginous symptoms (100% vs. 86.6%, p=0.04). There was a statistically significant difference between the Epley and Semont groups regarding visual analog scores at the one-week, two-week, and one-month follow-ups (p=0.002, p<0.001, p=0.001, respectively). CONCLUSION: The Epley maneuver was significantly more effective than the Semont maneuver in resolving vertigo in the short-term treatment of posterior semicircular canal benign paroxysmal positional vertigo.

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