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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

Mechanism of cupulolithiasis of bilateral apogeotropic horizontal canal BPPV (the involved horizontal canals are colored black). (a) Patient in supine position with debris adherent to the cupula of both horizontal canals. (b) Supine roll test on either side would result in inhibition of the horizontal canal of the lowermost ear, due to ampullofugal (inhibitory) deflection, triggering an apogeotropic horizontal nystagmus. At the same time, excitation of the horizontal canal of the uppermost ear would occur, due to ampullopetal (stimulatory) deflection of the cupula. Vectorial summation would result in an intense, more or less symmetric, apogeotropic nystagmus.
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fig8: Mechanism of cupulolithiasis of bilateral apogeotropic horizontal canal BPPV (the involved horizontal canals are colored black). (a) Patient in supine position with debris adherent to the cupula of both horizontal canals. (b) Supine roll test on either side would result in inhibition of the horizontal canal of the lowermost ear, due to ampullofugal (inhibitory) deflection, triggering an apogeotropic horizontal nystagmus. At the same time, excitation of the horizontal canal of the uppermost ear would occur, due to ampullopetal (stimulatory) deflection of the cupula. Vectorial summation would result in an intense, more or less symmetric, apogeotropic nystagmus.

Mentions: In a hypothetical case of bilateral horizontal BPPV with apogeotropic nystagmus, supine roll test on either side would result in inhibition of the horizontal canal of the lowermost ear, due to ampullofugal cupular movement, triggering an apogeotropic horizontal nystagmus. At the same time, excitation of the horizontal canal of the uppermost ear, due to ampullopetal movement of the cupula, would occur (Figure 8). Vectorial summation would result in an intense, more or less symmetric, apogeotropic nystagmus. It may be assumed that the nystagmus would be more intense in apogeotropic bilateral horizontal canal BPPV because of a dual pathogenetic mechanism: inhibition of the horizontal canal of the lower ear and, concurrently, excitation of the horizontal canal of the upper ear. In comparison, in cases with unilateral involvement of the horizontal canal, only one mechanism contributes to the produced apogeotropic nystagmus: either inhibition of the affected ear on turning towards its direction or excitation of the affected ear on turning towards the healthy ear. The same mechanism is valid in cases with canalolithiasis of the ampullary arm of the horizontal canal.


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)

Mechanism of cupulolithiasis of bilateral apogeotropic horizontal canal BPPV (the involved horizontal canals are colored black). (a) Patient in supine position with debris adherent to the cupula of both horizontal canals. (b) Supine roll test on either side would result in inhibition of the horizontal canal of the lowermost ear, due to ampullofugal (inhibitory) deflection, triggering an apogeotropic horizontal nystagmus. At the same time, excitation of the horizontal canal of the uppermost ear would occur, due to ampullopetal (stimulatory) deflection of the cupula. Vectorial summation would result in an intense, more or less symmetric, apogeotropic nystagmus.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3139887&req=5

fig8: Mechanism of cupulolithiasis of bilateral apogeotropic horizontal canal BPPV (the involved horizontal canals are colored black). (a) Patient in supine position with debris adherent to the cupula of both horizontal canals. (b) Supine roll test on either side would result in inhibition of the horizontal canal of the lowermost ear, due to ampullofugal (inhibitory) deflection, triggering an apogeotropic horizontal nystagmus. At the same time, excitation of the horizontal canal of the uppermost ear would occur, due to ampullopetal (stimulatory) deflection of the cupula. Vectorial summation would result in an intense, more or less symmetric, apogeotropic nystagmus.
Mentions: In a hypothetical case of bilateral horizontal BPPV with apogeotropic nystagmus, supine roll test on either side would result in inhibition of the horizontal canal of the lowermost ear, due to ampullofugal cupular movement, triggering an apogeotropic horizontal nystagmus. At the same time, excitation of the horizontal canal of the uppermost ear, due to ampullopetal movement of the cupula, would occur (Figure 8). Vectorial summation would result in an intense, more or less symmetric, apogeotropic nystagmus. It may be assumed that the nystagmus would be more intense in apogeotropic bilateral horizontal canal BPPV because of a dual pathogenetic mechanism: inhibition of the horizontal canal of the lower ear and, concurrently, excitation of the horizontal canal of the upper ear. In comparison, in cases with unilateral involvement of the horizontal canal, only one mechanism contributes to the produced apogeotropic nystagmus: either inhibition of the affected ear on turning towards its direction or excitation of the affected ear on turning towards the healthy ear. The same mechanism is valid in cases with canalolithiasis of the ampullary arm of the horizontal canal.

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