Outcome of Canalith Repositioning Procedure in Patients with Persistent and Transient Geotropic Direction-Changing Positional Nystagmus: Short-term Follow-up Evaluation / 대한평형의학회지

OBJECTIVES: Patients, who showed persistent geotropic-direction changing positional nystagmus (p-DCPN) tend to have different clinical manifestations from those who showed transient geotropic DCPN (t-DCPN). We investigated the clinical characteristics between p-DCPN and t-DCPN patients, and its recovery rate after canalith repositioning procedure (CRP). METHODS: Based on the duration of nystagmus, 117 geotropic DCPN patients were classified to 2 groups, p-DCPN and t-DCPN. Barbeque maneuver had been introduced towards the opposite direction of null plane for the p-DCPN patients, and to the opposite direction of stronger nystagmus for the t-DCPN patients. RESULTS: Seventy-four patients showed t-DCPN and 43 patients were classified to the p-DCPN cases. No p-DCPN patient showed prompt improvement after the 1st canalolith reposition therapy. Among the t-DCPN patients, 18 canal switch cases were found , but, there was no canal switch cases found among the p-DCPN The CRP has showed less effective for the p-DCPN patients than the t-DCPN patients (after the 1st CRP, 37 in 74 improved, p < 0.001). CONCLUSIONS: Due to its distinguishing clinical manifestation, p-DCPN may have different pathogenesis and clinical mechanisms from t-DCPN. And for the p-DCPN patients, the CRP seems not an efficient treatment compared to the t-DCPN patients. Further study with larger number of enrolled subjects is necessary.

Positional Vertigo Showing Direction-Changing Positional Nystagmus after Chronic Otitis Media Surgery: Is It Benign Paroxysmal Positional Vertigo? / 대한평형의학회지

This case report describes a patient who developed positional vertigo after surgery for chronic otitis media on the right side. Canal wall up mastoidectomy was performed, and the stapes was moderately mobilized during removal of the inflammatory granulation tissues that were attached to it. Immediately after the surgery, positional vertigo developed. The patient showed weakly left-beating spontaneous nystagmus in a seated position. Examination of positional nystagmus revealed geotropic direction-changing positional nystagmus with a prolonged duration and weak intensity in a supine head-roll test, which may be caused by a change in inner ear fluids due to a disruption of inner ear membrane around the oval window or penetration of toxic materials into the labyrinth during surgery.

A Case of Perilymphatic Fistula Misdiagnosed as Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

Perilymphatic fistula (PLF) is an uncommon disease characterized by abnormal leakage of the perilymph from the inner ear into the middle ear. The symptoms of PLF include sudden-onset hearing loss, tinnitus, ear fullness, and vertigo resulting from inner-ear trauma, stapedial surgery or barotrauma such as valsalva, and nose blowing. As nystagmus can be induced by the affected-ear in down position, benign positional paroxysmal vertigo (BPPV) should be considered for differential diagnosis. About 40-50% of PLF patients have experienced spontaneous healing, but surgical repair should be considered when the hearing symptom and dizziness are not alleviated or are aggravated within a few days. Reported herein, with a review of the relevant literature, is a case of PLF initially misdiagnosed as BPPV but where successful fistula repair was finally achieved.