Clinical Characteristics of Dizziness Associated with Acute Peripheral Facial Palsy

BACKGROUND AND OBJECTIVES: We aimed to assess the clinical significance of dizziness associated with acute peripheral facial palsy (APFP). SUBJECTS AND METHODS: Medical records of patients who visited an otorhinolaryngology clinic at a university hospital and were admitted for treatment of APFP between 2014 and 2016 were thoroughly reviewed. RESULTS: In total, 15.3% (n=15) of patients had dizziness. Continuous, rotatory dizziness without exacerbating factors was most common and frequently accompanied by nausea/vomiting. Dizziness disappeared within 1 week during the hospitalization period. Patients with Ramsay Hunt syndrome (31.0%) had dizziness more frequently than those with Bell’s palsy (8.7%). In addition, higher hearing thresholds and pain around the ear was reported more often in dizzy patients (p < 0.05). Logistic regression analysis revealed that the initial House-Brackmann grade of facial paralysis was solely associated with final recovery, but dizziness was not associated with prognosis. CONCLUSIONS: Patients with APFP may have transient dizziness in the early stage, which may be more frequently accompanied by worse hearing thresholds and/or pain around the ear. However, these symptoms including dizziness seem to be unrelated to final prognosis.

Clinical Significance of Spontaneous Nystagmus in Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo / 대한평형의학회지

OBJECTIVES: We aimed to assess the clinical significance of spontaneous nystagmus (SN) in horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV). METHODS: Twenty-four patients who were diagnosed with HC-BPPV in Eulji University Hospital from January 2015 to December 2016 were recruited. Various bed-side examinations including SN in both sitting and supine position, head roll test, and bithermal caloric test were evaluated. The number of canalith repositioning maneuvers were counted in all patients. RESULTS: SN was observed in 18.2% of geotropic HC-BPPV and 38.5% of apogeotropic HC-BPPV, respectively. There was no significant difference between presence of SN and the direction of initial nystagmus (p=0.386, 2-tailed Fisher exact test). The mean number of otolith repositioning maneuvers in patients with SN was 3.29±1.799 and this was significantly higher than in patients without SN (1.76±0.831) (p=0.009). Although the mean number of repositioning maneuver in patients in apogeotropic HC-BPPV and SN (3.80±1.924) tended to be higher than those who were diagnosed with apogeotropic HC-BPPV without SN (1.88±1.991) (p=0.035), the post hoc analysis with Bonferroni correction revealed that it was not significant because it was higher than the adjusted p-value (p=0.017). The initial direction of nystagmus was changed into the opposite direction in 29.17% of patient. However, this change was not different according to presence of SN (p=0.374, 2-tailed Fisher exact test). CONCLUSIONS: The presence of SN in HC-BPPV may be associated with lower treatment response. In particular, cautions are needed in patients with apogeotropic HC-BPPV.