A Case of Lateral Semicircular Canal Cupulolithiasis Treated with New Cupulolith Repositioning Maneuver

Benign paroxysmal positional vertigo (BPPV) is a commonly presenting problem at the emergency department. Three types have been recognized based on the pathogenesis of BPPV. The first is posterior-canal canalolithiasis, the second is horizontal-canal canalolithiasis, and the last is horizontal-canal cupulolithiasis. With the first two types of BPPV, an otolith-repositioning manuever can be performed quickly at the bedside with rapid results, often providing much satisfaction to both patient and physician. However, in the case of horizontal-canal cupulolithiasis, no established repositioning maneuver existed until recently. In 2000, Jo et al. developed a new repositioning maneuver and reported excellent results. We report a case of BPPV horizontal-canal cupulolithiasis that immediately responded to the maneuver of Jo et al. and strongly recommend use of this repositioning maneuver at the emergency department.

Tooth Injuries in the Emergency Department

PURPOSE: Tooth injuries are common complaints presenting at emergency departments, so emergency physicians (EP) should play an important role in the initial care of dental trauma. However, there has been little interest in and research on this subject. Examining the various clinical factors helpful for the emergency physician's care of tooth injuries, we attempted to acquire basic data for establishing treatment guideline. METHODS: A retrospective analysis was done by reviewing the dental charts of 214 patients who presented to the emergency departments of one secondary hospital and one tertiary hospital following tooth injuries during a 1-year period (Oct. 2000-Sept. 2001). The following variables were extracted and examined: age, mechanism of injury, number and location of injured teeth, radiograph performance, diagnosis, type of treatment. RESULTS: With the 1992-WHO classification, 9 types of tooth injuries were found (multiple response): in adults, concussion (23.5% of cases), subluxation (16.7%), pulp-exposed crown fracture (16.7%), avulsion (10.8%), and non-pulpexposed crown fracture(15.7%); in children, subluxation (20.2%), luxation (17.2%), avulsion (17.2%), and concussion (11.1%), Seven types of treatment were performed based on single most difficult treatment recorded per patient: 91 conservative cares (42.5% of cases), 9 pulp cappings (4.2%), 49 splints (22.9%), 7 replantations (3.3%), 17 pulpectomies (7.9%), 30 extractions (14.0%), and 10 others. CONCLUSION: Considering that the most prevalent treatments were splints and conservative cares, we think emergency medicine could play a wide role in the initial management of tooth injuries and suggest a further co-study with a dentist.

Efficacy of Otolith Repositioning Maneuver and Its Clinical Features in Benign Paroxysmal Positional Vertigo

PURPOSE: Until recently, three variants of benign paroxysmal positional vertigo (BPPV) have been recognized: the first is posterior-canal canalolithiasis, the second is horizontal-canal canalolithiasis, and the last is horizontal-canal cupulolithiasis. However, the last two types of BPPV have not been introduced into the textbook of Emergency Medicine yet. The otolith repositioning maneuvers are effective treatments for BPPV, but in emergency medicine, there has been little interest in and research on them. Our goals were to determine the efficacies of these treatments and to examine the clinical features of each types of BPPV. METHODS: We performed a 6-month prospective study on forty-one patients (47 cases) who presented with a history and physical examination consistent with active BPPV to the emergency departments of a secondary hospital and a tertiary hospital (Dec. 2001-May. 2002). The patients were treated with a modified Epley canalith repositioning maneuver for posterior-canal BPPV, a modified Barbecue rotation for horizontal-canal canalolithiasis, and the maneuver of Jo et al. for horizontal-canal cupulolithiasis. RESULTS: A resolution attributable to the first intervention was obtained in 71.4% of the posterior-canal BPPV cases by using the modified Epley maneuver and in 73.1% of the horizontal-canal BPPV cases by using a modified Barbecue rotation and the maneuver of Jo et al. CONCLUSION: The otolith repositioning maneuvers result in a resolution of vertigo in the majority of patients (84.8% of the cases) immediately after treatment. They are safe and require no special equipment or investigations. They should be established as the treatments of choice for BPPV in emergency department.