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Diagnosis of Single- or Multiple-Canal Benign Paroxysmal Positional Vertigo according to the Type of Nystagmus.

Balatsouras DG, Koukoutsis G, Ganelis P, Korres GS, Kaberos A - Int J Otolaryngol (2011)

Bottom Line: Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder encountered in primary care and specialist otolaryngology and neurology clinics.It is associated with a characteristic paroxysmal positional nystagmus, which can be elicited with specific diagnostic positional maneuvers, such as the Dix-Hallpike test and the supine roll test.Probably, the most significant factor in diagnosis of the type of BPPV is observation of the provoked nystagmus, during the diagnostic positional maneuvers.

View Article: PubMed Central - PubMed

Affiliation: ENT Department, Tzanio General Hospital of Piraeus, Afentouli 1 and Zanni, 18536 Piraeus, Greece.

ABSTRACT
Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder encountered in primary care and specialist otolaryngology and neurology clinics. It is associated with a characteristic paroxysmal positional nystagmus, which can be elicited with specific diagnostic positional maneuvers, such as the Dix-Hallpike test and the supine roll test. Current clinical research focused on diagnosing and treating various types of BPPV, according to the semicircular canal involved and according to the implicated pathogenetic mechanism. Cases of multiple-canal BPPV have been specifically investigated because until recently these were resistant to treatment with standard canalith repositioning procedures. Probably, the most significant factor in diagnosis of the type of BPPV is observation of the provoked nystagmus, during the diagnostic positional maneuvers. We describe in detail the various types of nystagmus, according to the canals involved, which are the keypoint to accurate diagnosis.

No MeSH data available.


Related in: MedlinePlus

Stimulation of the right anterior semicircular canal during the right Dix-Hallpike maneuver (c). On (a,b), the semicircular canals of the left and right ears, respectively, are shown. When otoconia is present in the ipsilateral (right) anterior canal (b), the head rotates orthogonally to the plane of the affected anterior canal. However, due to the almost vertical orientation of the its ampullary segment, displacement of otoconia is induced as well and the test will be positive, although the provoked pressure against the cupula and the corresponding symptoms are expected to be less pronounced.
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fig6: Stimulation of the right anterior semicircular canal during the right Dix-Hallpike maneuver (c). On (a,b), the semicircular canals of the left and right ears, respectively, are shown. When otoconia is present in the ipsilateral (right) anterior canal (b), the head rotates orthogonally to the plane of the affected anterior canal. However, due to the almost vertical orientation of the its ampullary segment, displacement of otoconia is induced as well and the test will be positive, although the provoked pressure against the cupula and the corresponding symptoms are expected to be less pronounced.

Mentions: Anterior canal BPPV is quite rare and its incidence has been reported to range from 1-2% to 15% [6, 22]. It has been found that anterior canal BPPV produces bilaterally positive Dix-Hallpike maneuvers [23]. During a contralateral Dix-Hallpike maneuver (Figure 5), the head rotates in the plane of the affected anterior canal whereas during an ipsilesional Dix-Hallpike maneuver the head rotates orthogonally to the plane of the anterior canal (Figure 6). On both instances, the maneuver will be positive, due to the almost vertical orientation of the ampullary segment of the anterior canal. During the contralateral Dix-Hallpike test, the affected anterior canal is stimulated due to the movement of endolymph that takes place in its rotation plane. During the ipsilesional Dix-Hallpike test, the ampullary segment of the canal will also point downwards at about 40° off vertical. Consequently, displacement of otoconia in the involved anterior canal is induced and the test will be positive as well, although the provoked pressure against the cupula and the corresponding symptoms are expected to be less pronounced.


Diagnosis of Single- or Multiple-Canal Benign Paroxysmal Positional Vertigo according to the Type of Nystagmus.

Balatsouras DG, Koukoutsis G, Ganelis P, Korres GS, Kaberos A - Int J Otolaryngol (2011)

Stimulation of the right anterior semicircular canal during the right Dix-Hallpike maneuver (c). On (a,b), the semicircular canals of the left and right ears, respectively, are shown. When otoconia is present in the ipsilateral (right) anterior canal (b), the head rotates orthogonally to the plane of the affected anterior canal. However, due to the almost vertical orientation of the its ampullary segment, displacement of otoconia is induced as well and the test will be positive, although the provoked pressure against the cupula and the corresponding symptoms are expected to be less pronounced.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3139887&req=5

fig6: Stimulation of the right anterior semicircular canal during the right Dix-Hallpike maneuver (c). On (a,b), the semicircular canals of the left and right ears, respectively, are shown. When otoconia is present in the ipsilateral (right) anterior canal (b), the head rotates orthogonally to the plane of the affected anterior canal. However, due to the almost vertical orientation of the its ampullary segment, displacement of otoconia is induced as well and the test will be positive, although the provoked pressure against the cupula and the corresponding symptoms are expected to be less pronounced.
Mentions: Anterior canal BPPV is quite rare and its incidence has been reported to range from 1-2% to 15% [6, 22]. It has been found that anterior canal BPPV produces bilaterally positive Dix-Hallpike maneuvers [23]. During a contralateral Dix-Hallpike maneuver (Figure 5), the head rotates in the plane of the affected anterior canal whereas during an ipsilesional Dix-Hallpike maneuver the head rotates orthogonally to the plane of the anterior canal (Figure 6). On both instances, the maneuver will be positive, due to the almost vertical orientation of the ampullary segment of the anterior canal. During the contralateral Dix-Hallpike test, the affected anterior canal is stimulated due to the movement of endolymph that takes place in its rotation plane. During the ipsilesional Dix-Hallpike test, the ampullary segment of the canal will also point downwards at about 40° off vertical. Consequently, displacement of otoconia in the involved anterior canal is induced and the test will be positive as well, although the provoked pressure against the cupula and the corresponding symptoms are expected to be less pronounced.

Bottom Line: Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder encountered in primary care and specialist otolaryngology and neurology clinics.It is associated with a characteristic paroxysmal positional nystagmus, which can be elicited with specific diagnostic positional maneuvers, such as the Dix-Hallpike test and the supine roll test.Probably, the most significant factor in diagnosis of the type of BPPV is observation of the provoked nystagmus, during the diagnostic positional maneuvers.

View Article: PubMed Central - PubMed

Affiliation: ENT Department, Tzanio General Hospital of Piraeus, Afentouli 1 and Zanni, 18536 Piraeus, Greece.

ABSTRACT
Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder encountered in primary care and specialist otolaryngology and neurology clinics. It is associated with a characteristic paroxysmal positional nystagmus, which can be elicited with specific diagnostic positional maneuvers, such as the Dix-Hallpike test and the supine roll test. Current clinical research focused on diagnosing and treating various types of BPPV, according to the semicircular canal involved and according to the implicated pathogenetic mechanism. Cases of multiple-canal BPPV have been specifically investigated because until recently these were resistant to treatment with standard canalith repositioning procedures. Probably, the most significant factor in diagnosis of the type of BPPV is observation of the provoked nystagmus, during the diagnostic positional maneuvers. We describe in detail the various types of nystagmus, according to the canals involved, which are the keypoint to accurate diagnosis.

No MeSH data available.


Related in: MedlinePlus