ABSTRACT
Objective:To investigate the influence of Barbecure combined with Epley on residual dizziness of horizontal canal benign paroxysmal positional vertigo（HC-BPPV） by SRM-vertigo diagnosis system. Methods:A total of 406 patients diagnosed with HC-BPPV from Nov 2021 to Nov 2022 were enrolled by rapid axial roll test and Dix-Hallpike in the department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Xi'an Jiaotong University. The patients were divided into two groups by hospital card numbers, in which the numbers that were odd were considered as group A, and the numbers that were even were considered as group B. The group A underwent two circles of Barbecure repositioning procedure by SRM-vertigo diagnosis system, while the group B underwent two circles Barbecure combined with Epley repositioning procedure by SRM-vertigo diagnosis system. The treatment was stopped on the next day when two groups of patients were cured, and those who were not cured will continue treatment with the same method. Results:The cure rate of group A was 83.41%, and the cure rate of group B was 80.51%, the difference between the two groups was not-statistically significant difference（P>0.05）. The rate of residual dizziness of group A was 23.30%, the rate of residual dizziness of group B was 11.46%, the difference between the two groups was statistically significant（P<0.05）. Conclusion:The Barbecure combined with Epley otoliths repositioning maneuver by SRM-vertigo diagnosis system can significantly reduce the rate of residual dizziness after the treatment of HC-BPPV, and improve the quality of life of patients.
Subject(s)
Humans , Benign Paroxysmal Positional Vertigo/therapy , Dizziness , Quality of Life , Patient Positioning/methods , Semicircular CanalsABSTRACT
Objective:To evaluate the influence of an additional roll test on the repositioning procedure by SRM-vertigo diagnosis system for horizontal canal benign paroxysmal positional vertigo（HC-BPPV）. Methods:A total of 713 patients diagnosed with HC-BPPV in Department of Otolaryngology Head and Neck Surgery，the First Affiliated Hospital of Xi'an Jiaotong University from Jan 2020 to Feb 2022 were enrolled. The patients were divided into two groups by hospital card numbers, in which the number is odd were considered as group A, and the number is even were considered as group B. The group A underwent two circles of Barbecue repositioning procedure by SRM-vertigo diagnosis system, while the group B first performed an additional roll test and then underwent two circles of Barbecue repositioning procedure by SRM-vertigo diagnosis system, to observe the cure rate and compare influence of HC-BPPV by an additional roll test. The quality of life and sleep of patients before and one-month after the treatment were assessed by the dizziness handicap inventory（DHI） and the pittsburgh sleep quality（PSQI）. Results:The cure rate of group A was 63.21%, and the cure rate of group B was 87.68%，the difference between the two groups was statistically significant（P<0.05）; The DHI score of patients after the repositioning was significantly lower than that before the repositioning（P<0.05）. The PSQI score after the repositioning was significantly lower than that before the repositioning（P<0.05）. The DHI and the PSQI scores after the repositioning were significantly lower than that before the repositioning, with a statistically significant difference （P< 0.05）. The total score of DHI in group B after treatment was lower than that in group A, with a statistically significant difference（P<0.05）. The total score of PSQI in group B after treatment was lower than that in group A, with non-statistically significant difference （P< 0.05）. Conclusion:An additional roll test before the repositioning procedure by SRM-vertigo diagnosis system can significantly improve the cure rate of HC-BPPV, relieve anxiety, and improve the quality of life.
Subject(s)
Humans , Benign Paroxysmal Positional Vertigo/diagnosis , Quality of Life , Patient Positioning/methods , Dizziness , Semicircular CanalsABSTRACT
Abstract Objective: Horizontal semicircular canal site pathology of benign paroxysmal positional vertigo demonstrating three types of nystagmi on positional test were studied. We have attempted to design a protocol for its diagnosis and treatment. Methods: 320 patients of HSC-BPPV were subjected to two types of positional tests. Of these, patients with bilateral steady apogeotropic nysatgmus were treated with VAV modification of Semont's maneuver. Patients with unsteady or changing apo/geotropic signs were converted into steady geotropic ones by repetitive positional tests; followed by barbecue maneuver with forced prolong positioning. Results: Overall 88% of patients had a total recovery. 92% of patients with geotropic nystagmus showed no symptoms after second maneuveral sitting. 85% of patients with apogeotropic nystagmus recovered fully after third maneuveral sitting. Conclusion: Correct identification of subtypes of HSC-BPPV is based on provoked nystagmus by positional tests. After locating the site and side on the basis of nystagmic pattern, physician can apply the appropriate PRM. Level of evidence: II a.
ABSTRACT
To analyze the functional change of horizontal semicircular canals after cochlear implantation.Eighteen patients were enrolled in this study.Their vestibular function was evaluated by using the caloric test and video head impulse test before and one week,one month after CI surgery,respectively.The unilateral weakness(UW),slow phase velocity(SPV)in caloric test and gain in video head impulse test(vHIT-G)were observed.Caloric test was abnormal when UW>25% or SPV mean<6°/s,while vHIT was abnormal when vHIT-G<0.8.The SPV of the implanted ear were[(10.36±8.01)°/s;(14.77±14.24)°/s]pre-operatively,[(6.45±7.52)°/s;(5.14±4.67)°/s]1 week post-operatively and[(6.05±3.86)°/s;(6.27±4.17)°/s]1 month post-operatively.Statistically significant difference(<0.05)was found between pre-and post-operative period.The vHIT-G of the implanted ear were(0.73±0.33)pre-operatively,(0.65±0.32)1 week post-operatively and(0.71±0.36)1 month post-operatively.There was no statistically significant difference of vHIT-G between preand post-operative period((pre-operative/1 week post-operative)=0.084,(pre-operative/1 month post-operative)=0.679).Four patients presented with vertigo and one of them manifested slight unsteadiness post-operatively.All symptoms resolved within 7 days.These symptoms had no correlate with age,gender,implantedear and results of vestibular test.Cochlear implantation can affect the horizontal semicircular canal function,and the video head impulse test and caloric test should be used in a complementary fashion.
Subject(s)
Humans , Caloric Tests , Cochlear Implantation , Methods , Head Impulse Test , Semicircular Canals , VertigoABSTRACT
Objective To observe and assess the positive rate and accuracy of 'bow and lean test' in the horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV). Methods Ninety-two HSC-BPPV patients who were diagnosed by head roll test (HRT) were enrolled, and then further tested with 'bow and lean test' (BLT) between Oct 1, 2010 and Sep 30, 2011. They were treated by Barbecue maneuver or Brandt-Daroff exercise on the basis of HRT and BLT tests. The positive rate of BLT test was analyzed, and its accuracy for diagnosis and success rate for treatment of HSC-BPPV were compared between HRT and BLT. Results Among the 92 patients, 83(90.2%) of them showed BLT nystagmus. Fifty-seven of 83 (68.7%) patients showed both bowing nystagmus and leaning nystagmus, and 18(21.7%) and 8(9.6%) respectively showed bowing nystagmus alone or leaning nystagmus alone. Among 92 patients, 74(80.4%) of them the affected side could be determined by HRT with 69 BLT positive and 5 BLT negative. Among the 69 BLT-positive patients, 60 patients showed the same result of HRT, and successful result was achieved by manipulation. 9 patients showed different result between BLT and HRT, in whom manipulation failed according to the result of HRT, but succeeded when manipulation was performed according to BLT. In 18 patients(19.6%) it was not able to determine the affected side by HRT, but in 14 patients manipulation was successful when BLT result was applied. In 4 patients BLT failed to evoke nystagmus, but after practicing Brandt-Daroff exercise, vertigo and HRT nystagmus disappeared 3 days later. Among the 92 patients, 65(70.7%) were cured according to HRT, while 83(90.2%) got successful result according to BLT(P<0.05). Conclusion The positive rate and accuracy for HSC-BPPV by BLT are high. It is a useful method for determining the affected side in HSC-BPPV, and to provide the basis for selecting effective manipulation treatment.
ABSTRACT
Objective To observe and assess the positive rate and accuracy of 'bow and lean test' in the horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV). Methods Ninety-two HSC-BPPV patients who were diagnosed by head roll test (HRT) were enrolled, and then further tested with 'bow and lean test' (BLT) between Oct 1, 2010 and Sep 30, 2011. They were treated by Barbecue maneuver or Brandt-Daroff exercise on the basis of HRT and BLT tests. The positive rate of BLT test was analyzed, and its accuracy for diagnosis and success rate for treatment of HSC-BPPV were compared between HRT and BLT. Results Among the 92 patients, 83(90.2%) of them showed BLT nystagmus. Fifty-seven of 83 (68.7%) patients showed both bowing nystagmus and leaning nystagmus, and 18(21.7%) and 8(9.6%) respectively showed bowing nystagmus alone or leaning nystagmus alone. Among 92 patients, 74(80.4%) of them the affected side could be determined by HRT with 69 BLT positive and 5 BLT negative. Among the 69 BLT-positive patients, 60 patients showed the same result of HRT, and successful result was achieved by manipulation. 9 patients showed different result between BLT and HRT, in whom manipulation failed according to the result of HRT, but succeeded when manipulation was performed according to BLT. In 18 patients(19.6%) it was not able to determine the affected side by HRT, but in 14 patients manipulation was successful when BLT result was applied. In 4 patients BLT failed to evoke nystagmus, but after practicing Brandt-Daroff exercise, vertigo and HRT nystagmus disappeared 3 days later. Among the 92 patients, 65(70.7%) were cured according to HRT, while 83(90.2%) got successful result according to BLT(P<0.05). Conclusion The positive rate and accuracy for HSC-BPPV by BLT are high. It is a useful method for determining the affected side in HSC-BPPV, and to provide the basis for selecting effective manipulation treatment.
ABSTRACT
Congenital inner ear malformations are frequently found in patients with sensorineural hearing loss, but isolated vestibular anomalies with normal cochlear development have been rarely reported. We report a 20-year-old man with recurrent dizziness and disequlibrium without hearing impairment. Neuro-otological evaluations showed a left peripheral vestibulopathy with normal hearing function. Three dimensional volume rendering image using magnetic resonance constructive interference in steady state sequence demonstrated isolated vestibular anomalies involving bilateral horizontal semicircular canals. Isolated vestibular anomalies might not be as rare as previously thought among patients with recurrent dizziness, and should be carefully evaluated through various imaging techniques.
Subject(s)
Humans , Young Adult , Dizziness , Ear, Inner , Hearing , Hearing Loss , Hearing Loss, Sensorineural , Magnetic Resonance Spectroscopy , Semicircular CanalsABSTRACT
BACKGROUND AND OBJECTIVES: One of problems for the management of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is the difficulty of determining the affected ear using Ewald's second law. The purpose of this study is to develop the new "Bow and Lean Test (BLT)" to determine easily the affected ear of HSC-BPPV and evaluate its efficiency. MATERIALS AND METHOD: We compared the efficiency between the classical method and BLT in 26 patients with HSC-BPPV. The classical method is based on Ewald??s second law comparing the intensity of nystagmus or symptoms in head roll test. BLT is based on the direction of both "bowing nystagmus" and "leaning nystagmus" at head's bowing and leaning state on sitting position. The affected ear is the same direction of bowing nystagmus in canalolithiasis and the same direction of leaning nystagmus in cupulolithiasis. RESULTS: In 26 patents (15 canalolithiasis, 11 cupulolithiasis), 3 (11.5%) patients did not show a prominent affected ear in the classical method, and 7 (26.9%) patients showed the different affected ear between two methods. All 10 patients were successfully treated with just one trial of barbecue rotation based on the affected ear in BLT. Three patients did not show any bowing or leaning nystagmus. The side with canal paresis in all 4 patients, who showed significant canal paresis in bithermal caloric tests, was equal to the affected ear based on BLT. CONCLUSION: "Bow and Lean Test" (also called "Choung's test") is a new method which can easily determine the affected ear of HC-BPPV.
Subject(s)
Humans , Caloric Tests , Ear , Head , Jurisprudence , Paresis , Semicircular Canals , VertigoABSTRACT
BACKGROUND AND OBJECTIVES: One of problems for the management of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is the difficulty of determining the affected ear using Ewald's second law. The purpose of this study is to develop the new "Bow and Lean Test (BLT)" to determine easily the affected ear of HSC-BPPV and evaluate its efficiency. MATERIALS AND METHOD: We compared the efficiency between the classical method and BLT in 26 patients with HSC-BPPV. The classical method is based on Ewald??s second law comparing the intensity of nystagmus or symptoms in head roll test. BLT is based on the direction of both "bowing nystagmus" and "leaning nystagmus" at head's bowing and leaning state on sitting position. The affected ear is the same direction of bowing nystagmus in canalolithiasis and the same direction of leaning nystagmus in cupulolithiasis. RESULTS: In 26 patents (15 canalolithiasis, 11 cupulolithiasis), 3 (11.5%) patients did not show a prominent affected ear in the classical method, and 7 (26.9%) patients showed the different affected ear between two methods. All 10 patients were successfully treated with just one trial of barbecue rotation based on the affected ear in BLT. Three patients did not show any bowing or leaning nystagmus. The side with canal paresis in all 4 patients, who showed significant canal paresis in bithermal caloric tests, was equal to the affected ear based on BLT. CONCLUSION: "Bow and Lean Test" (also called "Choung's test") is a new method which can easily determine the affected ear of HC-BPPV.
Subject(s)
Humans , Caloric Tests , Ear , Head , Jurisprudence , Paresis , Semicircular Canals , VertigoABSTRACT
BACKGROUND: There is a little information about the effect of selective vestibular stimulation on the expression of activity-dependent metabolic markers in the vestibular nuclei. The purpose of this study was to evaluate effect of afferent excitation of the horizontal semicircular canal on expression of phosphorylated ERK1/2 (pERK1/2) and cFos proteins in the vestibular nuclei. METHODS: The horizontal semicircular canal of Sprague-Dawley rats was selectively stimulated by using the sinusoidal horizontal stimulator with 10-minute duration of stimulation. Conventional immunohistochemical method was used to visualize pERK1/2 or cFos immunoreactive neurons in the vestibular nuclei following rotation. RESULTS: Five minutes after stimulation of the horizontal semicircular canal there was a high expression of pERK1/2 protein in the medial vestibular nucleus among 4 major subnuclei of the central vestibular nuclear complex. On the contrary, immunoreactivity of cFos protein was observed in the medial and inferior vestibular nucleus 2 hours after horizontal sinusoidal rotation. The lateral vestibular nucleus was free from the expression of pERK1/2 and cFos proteins in response to excitation of the horizontal semicircular canal. However, in the vestibular nuclei of unilaterally labyrinthectomized rats expression of pERK and cFos proteins was markedly suppressed in ipsi-lesional side as well as contra-lesional side following stimulation of the horizontal semicircular canal. Furthermore no expression of pERK1/2 and cFos protein in the bilateral vestibular nuclei of bilaterally labyrinthectomized rats was noted after stimulation of the horizontal semicircular canal. CONCLUSIONS: Therefore these results of present study suggest that excitatory afferent signals from the peripheral vestibular receptors are essential for protein translation for pERK1/2 and cFos in response to stimulation of the semicircular canal.
Subject(s)
Animals , Rats , Neurons , Protein Biosynthesis , Rats, Sprague-Dawley , Semicircular Canals , Vestibular Nuclei , Vestibular Nucleus, LateralABSTRACT
BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular disorders. There have been some reports suggesting that directional changing positional nystagmus occurs due to canalolithiasis and cupulolithiasis of the horizontal semicircular canal (HC). The canalolithiasis theory of HC-BPPV is presented with a transient geotropic direction changing horizontal nystagmus as the pathophysiologic mechanism of BPPV. The HC-BPPV cupulolithiasis is characterized by a positional nystagmus that does not fatigue, but persists as long as the position is held, and changes direction in different head positions. There is still a controversy relating to differentiating the lesion side and the otolith adherent sites on the cupula differentiation. The purpose of this study was to differentiate the lesion side and the otolith adherent site on the cupula, and propose a treatment through analyses of clinical features, electronystagmographic (ENG) results, treatment maneuvers and its effectiveness. SUBJECTS AND METHOD: Fifteen patients who showed ageotropic direction changing horizontal nystagmus were included in this study. Supine head turning test was performed to induce positional nystagmus. Various findings of the nystagmus were recorded with ENG. Other ENG tests (visual tracking tests and bithermal caloric test) and magnetic resonance imaging were checked to exclude the possibility of any central lesion. Cupulolith repositioning maneuver (CuRM) was applied on the all patients and these patients were instructed to keep the healthy side at the lateral decubitus position while sleeping. RESULTS: All patients showed significant differences between the intensity of each side nystagmus, and all of them showed stronger ageotropic direction changing horizontal nystagmus when the head was rotated to the unaffected side in a supine head turning test. The nystagmus had a short latency, no fatigability, and persistency in character. Typical nystagmus and spinning sensation in the supine head turning test had completely subsided after physical therapy. CONCLUSION: In the cupulolithiasis of horizontal semicircular canal, ageotropic nystagmus was stronger when the pathological ear was at the uppermost position, and this excitatory nystagmus beats to the lesion side. The proposed CuRM and post-treatment lateral decubitus position kept during the night (while sleeping on the day of treatment) were effective in differentiating the otolith adherent site on the cupula and treating the cupulolithiasis of the horizontal semicircular canal.
Subject(s)
Humans , Ear , Fatigue , Head , Magnetic Resonance Imaging , Nystagmus, Pathologic , Nystagmus, Physiologic , Otolithic Membrane , Semicircular Canals , VertigoABSTRACT
BACKGROUND AND OBJECTIVE: It is not uncommon to encounter labyrinthine fistulae during cholesteatoma surgeries. The aim of this study is to evaluate the postoperative changes of labyrinthine fistulae after removal of matrix and closure by bone pate with fibrin glue. MATERIALS AND METHODS: We evaluated 25 patients who had operatively closed labyrinthine fistulae of horizontal semicircular canal in the chronic otitis media with cholesteatoma using CT. Seven human temporal bones with labyrinthine fistulae were studied. The fistulae were closed with bone pate using fibrin glue and fascia. RESULTS: Postoperative CTs show that, in all cases, the layer closing the fistulae was indistinguishable from the surrounding bony otic capsule. CONCLUSIONS: Canal down mastoidectomy with closure of fistulae using bone pate with fascia were effective for new bone formation at the fistulae site.
Subject(s)
Humans , Cholesteatoma , Fascia , Fibrin Tissue Adhesive , Fistula , Osteogenesis , Otitis Media , Otitis , Semicircular Canals , Temporal BoneABSTRACT
BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is the most common disease of the peripheral vestibular disorders. Canalithiasis theory of the posterior semicircular canal is widely accepted as the pathophysiologic mechanism of BPPV. Recently, some authors reported that geotropic direction-changing horizontal nystagmus is attributed to the BPPV of the horizontal semicircular canal. The purpose of this study is to aid in the understanding and diagnosis of this disease through the analysis of the clinical features and electronystagmographic (ENG) results. MATERIALS AND METHODS: Nine patients who showed geotropic direction-changing horizontal nystagmus were included in this study. Supine head turning test was performed to induce positional nystagmus. Various findings of the nystagmus were recorded with ENG. Other ENG tests (visual tracking tests and bithermal caloric test) and MRI (4 cases) were checked to exclude the possibility of the central origin. RESULTS: All patients showed geotropic direction-changing horizontal nystagmus in supine head turning test. The nystagmus had a short latency, no fatigabilily and long duration (>1 min). The nystagmus was more intense in diseased ear of down position and changed its direction spontaneously (secondary nystagmus) in 7 cases. CONCLUSION: All patients complaining of paroxysmal positional vertigo should undergo two positional tests: Dix-Hallpike test and supine head turning test. Characteristics of nystagmus can be explained by canalithiasis theory of the horizontal semicircular canal.