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Peng H, Wang L, Song H, Gao B, Yang Y, Lyu F. Clinical Characteristics of persistent geotropic horizontal direction-changing positional nystagmus: Experience in 189 participants. J Vestib Res 2023; 33:203-211. [PMID: 36776085 DOI: 10.3233/ves-220086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND The etiology and mechanism of persistent geotropic horizontal direction-changing positional nystagmus (DCPN) are still unclear. Whether this pattern of nystagmus is a subtype of benign paroxysmal positional vertigo (BPPV) remains controversial. OBJECTIVE The goal of this study was to observe the clinical characteristics of persistent geotropic horizontal DCPN involving the lateral semicircular canal. METHODS The analysis was performed to participants with episodic positional vertigo in our clinic from 2014 to 2021. Participants were included via positional test. We observed and summarized the distribution data, vertigo history, follow-up tests, and recurrence situations of 189 persistent geotropic horizontal DCPN participants. RESULTS The mean age at the first time showing of persistent geotropic horizontal DCPN was 56±14.7 and more women than men were affected by persistent geotropic horizontal DCPN (female-to-male ratio 2.4 : 1). Overall, 58.7% (57/94) of participants who came for the first-week follow-up test were asymptomatic. Thirty-three participants experienced recurrence (female-to-male ratio: 4.5 : 1). Fifty-three (28.0%) participants experienced the conversion of the patterns of DCPN in the history, the follow-up tests and the recurrence compared to the first showing of persistent geotropic horizontal DCPN. 24(12.1%) participants still experienced persistent geotropic horizontal DCPN attack in the follow-up tests and the recurrences without benign paroxysmal positional vertigo history. CONCLUSION Persistent geotropic horizontal DCPN affected more women than men. The persistent geotropic horizontal DCPN that with conversion to transient geotropic horizontal DCPN or to persistent apogeotropic horizontal DCPN might be a subtype of BPPV or in a stage of BPPV process. However, the persistent geotropic horizontal DCPN without conversion might be an independent disease that is not related to BPPV.
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Affiliation(s)
- Hao Peng
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Liyi Wang
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Haitao Song
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Bo Gao
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Yi Yang
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Fan Lyu
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
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邢 娟, 张 婷, 张 姝, 程 子, 张 少, 韩 鹏. [Significance of rapid axial roll test in determining the responsible semicircular canal for horizontal canal benign paroxysmal positional vertigo]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:419-422. [PMID: 35822358 PMCID: PMC10128487 DOI: 10.13201/j.issn.2096-7993.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Indexed: 06/15/2023]
Abstract
Objective:To compare the diagnostic performance of the rapid axial roll test(RART) and the traditional roll test(SRT)in determining the responsible semicircular canal for horizontal canal benign paroxysmal positional vertigo(HC-BPPV). Methods:A total of 400 patients diagnosed with HC-BPPV from January 2020 to December 2020 were collected and randomly divided into two groups. Among them, there were 202 cases in the RART group and 198 cases in the SRT group. The patients in the two groups performed corresponding positional test respectively, and the following treatment was based on the types of induced nystagmus. The patients with typical HC-BPPV nystagmus underwent two rounds of modified Barbecure procedure. The diagnostic accuracies of the two positional tests in locating the responsible semicircular canal were evaluated by the elicitation rate of typical nystagmus. Finally, the effects of the two tests were evaluated by comparing the recovery rate of nystagmus between the two groups after repositioning procedures. Results:The elicitation rate of nystagmus in HC-BPPV patients by RART was significantly higher than that by SRT(χ²=10.73,P<0.01 ). The effectiveness of repositioning procedure by RART in HC-BPPV patients was significantly higher than that of SRT(χ²=6.08,P<0.05). Conclusion:RART could significantly improve the accuracy in determining the responsible semicircular canal in HC-BPPV, and future studies are warranted.
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Affiliation(s)
- 娟丽 邢
- 西安交通大学第一附属医院耳鼻咽喉头颈外科(西安,710048)Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710048, China
| | - 婷 张
- 西安交通大学第一附属医院耳鼻咽喉头颈外科(西安,710048)Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710048, China
| | - 姝 张
- 内蒙古医科大学附属第一医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Inner Mongolia Medical University
| | - 子君 程
- 西安交通大学第一附属医院耳鼻咽喉头颈外科(西安,710048)Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710048, China
| | - 少强 张
- 西安交通大学第一附属医院耳鼻咽喉头颈外科(西安,710048)Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710048, China
| | - 鹏 韩
- 西安交通大学第一附属医院耳鼻咽喉头颈外科(西安,710048)Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, 710048, China
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3
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Libonati GA, Martellucci S, Castellucci A, Malara P. Minimum Stimulus Strategy: A step-by-step diagnostic approach to BPPV. J Neurol Sci 2022; 434:120158. [DOI: 10.1016/j.jns.2022.120158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/15/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
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4
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Yetiser S, Ince D. Pseudo-spontaneous nystagmus in patients with lateral canal benign paroxysmal positional vertigo. Acta Otolaryngol 2022; 142:43-47. [PMID: 34955085 DOI: 10.1080/00016489.2021.2018136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pseudo-spontaneous nystagmus (PSN) can be detected in patients with lateral canal benign paroxysmal positional vertigo (LC-BPPV). Its frequency, and correlation with the therapeutic outcome have been less described and conflicting results have been reported. OBJECTIVE This study aims to investigate its clinical and prognostic significance. MATERIAL AND METHOD One hundred and eighty-four patients with LC BPPV (98 apogeotropic, 86 geotropic type) were enrolled for the study. Clinical parameters were reviewed in patients with or without PSN. The Chi-square and one way ANOVA tests were used to compare the difference between study groups. Statistical significance was set at p < .05. RESULTS Twenty-two patients with apogeotropic (22.4%; 98/22) and 17 patients with geotropic nystagmus (19.7%; 86/17) had PSN. The incidence, age, male-female ratio, mean slow phase velocity (SPV), duration of BPPV and the rate of recurrence were not significant in patients with LC-BPPV whether they have PSN or not. CONCLUSION Prognostic role of PSN in patients with LC BPPV seems to be questionable. SIGNIFICANCE Appearance and disappearance of PSN with regard to head position helps to differentiate BPPV from other acute vestibular disorders. Additionally, direction of nystagmus assists to determine the site of the affected canal. However, prognostic significance is obscure.
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Affiliation(s)
- Sertac Yetiser
- Clinical Professor, Department of ORL & HNS, Anadolu Medical Center, Kocaeli, Turkey
- Medical Audiologist, Physiotherapist, Department of ORL & HNS, Anadolu Medical Center, Kocaeli, Turkey
| | - Dilay Ince
- Clinical Professor, Department of ORL & HNS, Anadolu Medical Center, Kocaeli, Turkey
- Medical Audiologist, Physiotherapist, Department of ORL & HNS, Anadolu Medical Center, Kocaeli, Turkey
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5
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Lee H, Kim HA. The association of head shaking nystagmus with head-bending and lying-down nystagmus in horizontal canal benign paroxysmal positional vertigo. J Vestib Res 2021; 30:95-100. [PMID: 32310200 DOI: 10.3233/ves-200696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In benign paroxysmal positional vertigo (BPPV), the otolithic debris may alter the dynamics of the endolymph or cupula during head-shaking. This dynamic may generate head-shaking nystagmus (HSN) but exact pathomechanism of HSN in BPPV has not been elucidated. The association of positional nystagmus induced by head-bending or lying-down with HSN may help to understand the dynamics of HSN. OBJECTIVE To assess the presence, pattern, and relationship with head-bending nystagmus (HBN) and lying-down nystagmus (LDN) of HSN in horizontal canal (HC)-BPPV. METHODS We recruited 173 patients with HC-BPPV (76 geotropic and 97 apogeotropic). We analyzed the pattern of HSN, and correlation with HBN and LDN. RESULTS Half of patients (83/173, 48%) with HC-BPPV showed HSN. The directional preponderance of HSN was also not found in patients with geotropic or apogeotropic HC BPPV (p = 0.488). The presence of HSN was related with the occurrence of HBN in both geotropic (p = 0.005) and apogeotropic type (p = 0.001). The direction of HSN was same with HBN and was opposite to LDN in both geotropic and apogeotropic type. CONCLUSIONS HSN was frequently found in patients with HC-BPPV and related with HBN and LDN. HSN in BPPV might be contributed by the otolith movements related with endolymph dynamics.
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Affiliation(s)
- Hyung Lee
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Hyun Ah Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea
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6
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Martellucci S, Castellucci A, Malara P, Pagliuca G, Clemenzi V, Stolfa A, Gallo A, Libonati GA. Spontaneous Jamming of Horizontal Semicircular Canal Combined with Canalolithiasis of Contralateral Posterior Semicircular Canal. J Audiol Otol 2021; 26:55-60. [PMID: 33562956 PMCID: PMC8755438 DOI: 10.7874/jao.2020.00507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022] Open
Abstract
Spontaneous canalith jam is an uncommon form of benign paroxysmal positional vertigo mimicking acute vestibular neuritis. We described for the first time a spontaneous horizontal semicircular canalith jam associated with a typical canalolithiasis involving contralateral posterior semicircular canal (PSC), illustrating how the latter condition modified direction-fixed nystagmus during head movements. An 81-year-old woman with persistent vertigo referred to our center. Video-Frenzel examination showed horizontal direction-fixed right-beating nystagmus in primary gaze position, inhibited by visual fixation. She exhibited corrective saccades after leftward head impulses. Chin-to-chest positioning at the head-pitch test did not modify spontaneous nystagmus, whereas slight torsional components with the top pole of the eye beating toward the right ear appeared in backward head-bending, resulting in mixed horizontal-torsional nystagmus. At supine positioning tests, direction-fixed nystagmus turned into direction-changing geotropic horizontal nystagmus, which was stronger on the left side, while overlapping upbeat nystagmus with torsional right-beating components appeared on the right. Primary clinical findings were consistent with a left horizontal semicircular canalith jam, inducing a persistent utriculofugal cupular displacement, combined with a typical right-sided PSC-canalolithiasis. Once canalith jam crumbled, resulting in a non-ampullary arm canalolithiasis of the horizontal semicircular canal, both involved canals were freed by debris with appropriate repositioning procedures.
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Affiliation(s)
| | - Andrea Castellucci
- ENT Unit, Arcispedale Santa Maria Nuova, AUSL-IRCCS, Reggio Emilia, Italy
| | - Pasquale Malara
- Audiology and Vestibology Service, Centromedico Bellinzona, Bellinzona, Switzerland
| | | | - Veronica Clemenzi
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Italy
| | - Andrea Stolfa
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Italy
| | - Andrea Gallo
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Italy
| | - Giacinto Asprella Libonati
- U.O.S.D. "Vestibologia e Otorinolaringoiatria" Presidio Ospedaliero "Giovanni Paolo II", Policoro, Italy
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7
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Martellucci S, Malara P, Castellucci A, Pecci R, Giannoni B, Marcelli V, Scarpa A, Cassandro E, Quaglieri S, Manfrin ML, Rebecchi E, Armato E, Comacchio F, Mion M, Attanasio G, Ralli M, Greco A, de Vincentiis M, Botti C, Savoldi L, Califano L, Ghidini A, Pagliuca G, Clemenzi V, Stolfa A, Gallo A, Asprella Libonati G. Upright BPPV Protocol: Feasibility of a New Diagnostic Paradigm for Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo Compared to Standard Diagnostic Maneuvers. Front Neurol 2020; 11:578305. [PMID: 33329319 PMCID: PMC7711159 DOI: 10.3389/fneur.2020.578305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The diagnosis of benign paroxysmal positional vertigo (BPPV) involving the lateral semicircular canal (LSC) is traditionally entrusted to the supine head roll test, also known as supine head yaw test (SHYT), which usually allows identification of the pathologic side and BPPV form (geotropic vs. apogeotropic). Nevertheless, SHYT may not always allow easy detection of the affected canal, resulting in similar responses on both sides and intense autonomic symptoms in patients with recent onset of vertigo. The newly introduced upright head roll test (UHRT) represents a diagnostic maneuver for LSC-BPPV, supplementing the already-known head pitch test (HPT) in the sitting position. The combination of these two tests should enable clinicians to determine the precise location of debris within LSC, avoiding disturbing symptoms related to supine positionings. Therefore, we proposed the upright BPPV protocol (UBP), a test battery exclusively performed in the upright position, including the evaluation of pseudo-spontaneous nystagmus (PSN), HPT and UHRT. The purpose of this multicenter study is to determine the feasibility of UBP in the diagnosis of LSC-BPPV. Methods: We retrospectively reviewed the clinical data of 134 consecutive patients diagnosed with LSC-BPPV. All of them received both UBP and the complete diagnostic protocol (CDP), including the evaluation of PSN and data resulting from HPT, UHRT, seated-supine positioning test (SSPT), and SHYT. Results: A correct diagnosis for LSC-BPPV was achieved in 95.5% of cases using exclusively the UBP, with a highly significant concordance with the CDP (p < 0.000, Cohen's kappa = 0.94), regardless of the time elapsed from symptom onset to diagnosis. The concordance between UBP and CDP was not impaired even when cases in which HPT and/or UHRT provided incomplete results were included (p < 0.000). Correct diagnosis using the supine diagnostic protocol (SDP, including SSPT + SHYT) or the sole SHYT was achieved in 85.1% of cases, with similar statistical concordance (p < 0.000) and weaker strength of relationship (Cohen's kappa = 0.80). Conclusion: UBP allows correct diagnosis in LSC-BPPV from the sitting position in most cases, sparing the patient supine positionings and related symptoms. UBP could also allow clinicians to proceed directly with repositioning maneuvers from the upright position.
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Affiliation(s)
| | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico Bellinzona, Bellinzona, Switzerland
| | - Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rudi Pecci
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Beatrice Giannoni
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | | | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Silvia Quaglieri
- ENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, Italy
| | | | | | - Enrico Armato
- ENT Unit, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Francesco Comacchio
- Department of Neurosciences, Regional Specialized Vertigo Center, Institute of Otolaryngology, University of Padua, Padua, Italy
| | - Marta Mion
- ENT Unit, Department of Surgery, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Giuseppe Attanasio
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy
| | - Massimo Ralli
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Marco de Vincentiis
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy.,Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Luisa Savoldi
- Department Infrastructure Research and Statistics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Califano
- Departmental Unit of Audiology and Phoniatrics, G. Rummo Hospital Group, Benevento, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulio Pagliuca
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy
| | - Veronica Clemenzi
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Andrea Stolfa
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Andrea Gallo
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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Gufoni M, Vianini M, Casani AP. Analysis of the Skew Deviation to Evaluate the Period of Onset of a Canalolithiasis After Macular Damage. Front Neurol 2020; 11:572531. [PMID: 33193020 PMCID: PMC7644908 DOI: 10.3389/fneur.2020.572531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular end-organ disease, and it is one of the first causes of access to the emergency room. The moment of migration of the otoconial debris in a semicircular canal does not necessarily coincide with the moment of detachment of the debris themselves. Consequently, the paroxysmal positional vertigo could arise with a variable delay with respect to the mechanical damage suffered by the macula. The aim of this work is to try to identify objective criteria to establish whether a canalolithiasis is synchronous or diachronic to the damage. The analysis of skew deviation in the context of ocular tilt reaction in patients with canalolithiasis could provide useful information to understand if macular damage occurred at the origin of the disease and when the damage may have occurred. In this study, 38 patients with BPPV were analyzed based on the type of skew deviation that was presented. We found that if the eye on the side of the canalolithiasis is hypotropic the damage of the utriculus is likely recent (last 10 days), if it is hypertropic the damage is not recent (20 days before) and finally if the eyes are at the same height it could be an utricular damage in compensation (occurring the last 10–20 days) or a secondary labyrinth canalolithiasis, without associated utricular damage. Our results show that the evaluation of skew deviation in patients suffering from BPPV could be useful to evaluate: (a) if a positional paroxysmal nystagmus can be related to an previous relevant injury event (for example a head injury that occurred days before the crisis); (b) if it is a BPPV of recent onset or a re-entry of the debris into the canal.
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Affiliation(s)
- Mauro Gufoni
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Otolaryngology Section, University of Pisa, Pisa, Italy
| | - Matteo Vianini
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Otolaryngology Section, University of Pisa, Pisa, Italy
| | - Augusto Pietro Casani
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Otolaryngology Section, University of Pisa, Pisa, Italy
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9
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Scarpa A, Cassandro C, Gioacchini FM, Viola P, Cuofano R, Kaleci S, Ralli M, Chiarella G, Cassandro E. Lateralization of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) with the latency test: a pilot study. Acta Otolaryngol 2019; 139:854-859. [PMID: 31282790 DOI: 10.1080/00016489.2019.1635712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The treatments of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) have low remission rates ranging between 60% and 90%, connected to the difficulty in correctly identifying the affected side of HSC-BPPV. Objective: To propose and compare the efficacy of the latency test (LT) in identifying the affected ear in patients with HSC-BPPV. Materials and methods: Twenty-one subjects diagnosed with HSC-BPPV, as ascertained by head rolling test (HRT), were prospectively identified. Lateralization was assessed with pseudo-spontaneous nystagmus, lying-down nystagmus, bow and lean (BLT), HRT and LT tests. LT is a novel technique involving a 180° movement of the head and the analysis of the time required to reverse the nystagmus. Results: About 57% of patients were diagnosed with geotropic, and 43% with apogeotropic type HSC-BPPV. LT achieved a correct side diagnosis in 86%. Efficacy analysis of the tests compared to HRT revealed a substantial fair level of agreement for lying-down test (κ = 0.32, p < .05), a slight level of agreement for BLT (κ = 0.19, p < .05) and a substantial level of agreement for LT (κ = 0.071, p < .001). Conclusions and significance: LT was proven to show a substantial level of agreement compared to HRT in identifying the affected ear in patients with HSC-BPPV in this pilot study.
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Affiliation(s)
- Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Federico Maria Gioacchini
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Pasquale Viola
- Unit of Audiology, Regional Centre for Cochlear Implants and ENT diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Rossella Cuofano
- Department of Otorhinolaryngology, University Hospital ‘San Giovanni di Dio e Ruggi d’Aragona’, Salerno, Italy
| | - Shaniko Kaleci
- Department of Diagnostic Medicine, Clinical and Public Health, University Hospital of Modena, Modena, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University Rome, Rome, Italy
| | - Giuseppe Chiarella
- Unit of Audiology, Regional Centre for Cochlear Implants and ENT diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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10
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Pérez-Vázquez P, Franco-Gutiérrez V, Soto-Varela A, Amor-Dorado JC, Martín-Sanz E, Oliva-Domínguez M, Lopez-Escamez JA. Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.otoeng.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Maslovara S, Butkovic Soldo S, Sestak A, Milinkovic K, Rogic-Namacinski J, Soldo A. 25 (OH) D3 levels, incidence and recurrence of different clinical forms of benig paroxysmal positional vertigo. Braz J Otorhinolaryngol 2018; 84:453-459. [PMID: 28655524 PMCID: PMC9449225 DOI: 10.1016/j.bjorl.2017.05.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 11/27/2022] Open
Abstract
Introduction Objectives Methods Results Conclusions
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12
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Pérez-Vázquez P, Franco-Gutiérrez V. Treatment of benign paroxysmal positional vertigo. A clinical review. J Otol 2017; 12:165-173. [PMID: 29937852 PMCID: PMC6002633 DOI: 10.1016/j.joto.2017.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/04/2017] [Accepted: 08/07/2017] [Indexed: 11/12/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most frequent episodic vestibular disorder. It is due to otolith rests that are free into the canals or attached to the cupulas. Well over 90% of patients can be successfully treated with manoeuvres that move the particles back to the utriculus. Among the great variety of procedures that have been described, the manoeuvres that are supported by evidenced-based studies or extensive series are commented in this review. Some topics regarding BPPV treatment, such as controlling the accuracy of the procedures or the utility of post-manoeuvre restrictions are also discussed.
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Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:345-366. [PMID: 28826856 DOI: 10.1016/j.otorri.2017.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 11/21/2022]
Abstract
Benign Paroxysmal Positional Vertigo is the most frequent episodic vestibular disorder. The purpose of this guide, requested by the committee on otoneurology of the Spanish Society of Otolaryngology and Head and Neck Surgery, is to supply a consensus document providing practical guidance for the management of BPPV. It is based on the Barany Society criteria for the diagnosis of BPPV. This guideline provides recommendations on each variant of BPPV, with a description of the different diagnostic tests and the therapeutic manoeuvres. For this purpose, we have selected the tests and manoeuvres supported by evidence-based studies or extensive series. Finally, we have also included a chapter on differential diagnosis and a section relating to general aspects in the management of BPPV.
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