Diagnosis and treatment of the short-arm type posterior semicircular canal BPPV / Diagnóstico e tratamento da VPPB de braço curto do canal semicircular posterior

Abstract Introduction The Epley maneuver is useful for the otoconia to return from the long arm of the posterior semicircular canal into the utricle. To move otoconia out of the posterior semicircular canal short arm and into the utricle, we need different maneuvers. Objective To diagnose the short-arm type BPPV of the posterior semicircular canal and treat them with bow-and-yaw maneuver. Methods 171 cases were diagnosed as BPPV of the posterior semicircular canal based on a positive Dix-Hallpike maneuver. We first attempted to treat patients with the bow-and-yaw maneuver and then performed the Dix-Hallpike maneuver again. If the repeated Dix-Hallpike maneuver gave negative results, we diagnosed the patient with the short-arm type of BPPV of the posterior semicircular canal and considered the patient to have been cured by the bow-and-yaw maneuver; otherwise, probably the long-arm type BPPV of the posterior semicircular canal existed and we treated the patient with the Epley maneuver. Results Approximately 40% of the cases were cured by the bow-and-yaw maneuver, giving negative results on repeated Dix-Hallpike maneuvers, and were diagnosed with short-arm lithiasis. Conclusion The short-arm type posterior semicircular canal BPPV can be diagnosed and treated in a convenient and comfortable manner.

Resumo Introdução A manobra de Epley é útil para o retorno da otocônia do braço longo do canal semicircular posterior para o utrículo. Diferentes manobras são necessárias para mover a otocônia para fora do braço curto do canal semicircular posterior e para dentro do utrículo. Objetivo Diagnosticar a VPPB do tipo braço curto do canal semicircular posterior e tratá-la com a manobra de incline and balance. Método Foram diagnosticados 171 casos como VPPB de canal semicircular posterior com base na manobra de Dix-Hallpike positiva. Primeiro tentamos tratar os pacientes com a manobra de incline and balance e, em seguida, executamos a manobra de Dix-Hallpike novamente. Se a repetição da manobra de Dix-Hallpike desse resultados negativos, diagnosticávamos o paciente como VPPB do canal semicircular posterior do tipo braço curto e considerávamos que ele ou ela havia sido curado pela manobra de incline and balance; caso contrário, provavelmente o paciente apresentava VPPB do canal semicircular posterior do tipo braço longo e tratávamos o paciente com a manobra de Epley. Resultados Aproximadamente 40% dos casos foram curados pela manobra de incline and balance, com resultados negativos nas manobras de Dix-Hallpike repetidas, e foram diagnosticados com litíase de braço curto. Conclusão A VPPB de canal semicircular posterior do tipo braço curto pode ser diagnosticada e tratada de maneira conveniente e confortável.

Analysis of the diagnosis maneuver of lateral semicircular canal benign positional paroxysmal vertigo and observation of the otolith movement using physical engine / 解剖学报

Objective To analysis the diagnosis maneuvers of lateral semicircular canal benign positional paroxysmal vertigo (BPPV) and to explore the diagnostic mechanism. Methods The three-dimensional BPPV labyrinth model was established based on the physical engine. The otolith in different positions of the lateral semicircular canal was set up. The otolith movement in different positions during the horizontal roll test was analyzed, and the induced nystagmus could be inferred. Results Horizontal roll test nystagmus manifestations were diverse, including bilateral ageotropic nystagmus, which could be judged as otolith in ampullary and crista, and weak side of nystagmus was the affected side; bilateral geotropic nystagmus could be judged as otolith in the long arm of the lateral semicircular canal, and strong side of nystagmuss was the affected side; Ageotropic nystagmus in one side and geotropic nystagmus in another side, considering otolith in ampullary of long arm. The horizontal roll test may restore otolith to utricle and reduce the sensitivity of the diagnostic tests. The result of 10 repetitions were consistent. Conclusion Sixty degree horizontal roll test effectively corrects the defects of 90 degree horizontal roll test. The analysis of diagnostic tests based on the physical engine is of great significance for us to understand the diagnostic mechanism of BPPV in the lateral semicircular canal and to improve and innovate diagnostic maneuver.

3D visualization of membranous labyrinth from voxel models / 解剖学报

Objective: To explore three dimensional (3D) visualization of membranous labyrinth using a voxel model. Methods: 3D Slicer software was used to deal with MRI images of the temporal bone, volume clipping with the model, three-dimensional display of the membranous labyrinth by both surface rendering and volume rendering. Results With the inner voxel model we explored not only the surface of inner ear,but also the membranous labyrinth inside. The file size of inner ear voxel model file was smaller than surface model file. Conclusion: Inner ear voxel model is invaluable in the study of inner ear anatomy.

Study of BPPV precise manipulation treatment / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the effect of the BPPV precision manipulation treatment. Method:With 3D SLICER software we segment structure such as semicircular canal, eye ball, orbital and ear rod from MRI or CT volume data of patients which underwent MRI or CT scaning of inner ear, for measuring the spatial direction of semicircular canals and building semicircular canal modules with standard space coordinate system and embedding into 3D PDF files. Result:With the slice that divide the semicircular canal equally as the semicircular canal plane and the eyeball as reference object to determine whether it is symmetric, it is not only intuitive but also reliable for measuring the angle between the posterior semicircular canal. 3D PDF is intuitive, rotation angle can be adjusted according to the individual differences in the process of manipulation treatment, to observe and demonstrate the theoretical reduction effect before the actual operation. Conclusion:By reconstruction the three-dimensional semicircular canal structure from the inner ear image data of patients and measurement of the semicircular canal space direction, it is of a certain significance for BPPV precision manipulation treatment.