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.

Dizzy and Psychological Scales in Benign Paroxysmal Positional Vertigo: Suspicious Patients without Characteristic Nystagmus / 대한평형의학회지

OBJECTIVES: Patients, who have had a history of benign paroxysmal positional vertigo (BPPV)-like symptoms, but no characteristic nystagmus, were often present. They are diagnosed as having a resolved state from BPPV or normal, and tend to be overlooked. We investigated the dizzy and psychological scales in BPPV-suspicious patients. METHODS: Thirty-nine patients, which they had vertigo of a short duration at the specific head position, and clinically suspicious BPPV, but no nystagmus in positional tests, were enrolled. We compared dizzy and psychological scales of suspicious BPPV patients with 138 BPPV patients, using dizziness handicap inventory (DHI), the beck depression inventory (BDI), and the Spielberger state-trait anxiety inventory. Additionally, among the BPPV-suspicious group, patients with a BPPV history were compared with those with no previous BPPV. RESULTS: No differences in the all scales were found between the two groups. However, DHI scores of patients with a previous BPPV attack were significantly higher than those of patients with no BPPV-like symptoms; in particular, there was a significant difference in emotional scores. CONCLUSION: Although the patients had no characteristic nystagmus, if they have a BPPV-like history and symptoms, emotional support and periodic follow up are needed. In particular, careful observation should be performed in patients with previous BPPV attack.

Clinical Analysis of Dizzy Patients with High Levels of Depression and Anxiety

BACKGROUND AND OBJECTIVES: Some patients experiencing dizziness also report psychological distress. However, the association between vestibular deficits and psychological symptoms remains controversial. Thus, the aim of this paper is to report the proportion of patients who complained of dizziness who also had high depression and anxiety indices. Also we investigated the severity of their dizziness and the distribution of the diseases underlying this symptom. SUBJECTS AND METHODS: We assessed the dizziness and psychological distress of 544 patients experiencing dizziness using the Korean versions of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI). We also reviewed the audio-vestibular symtoms of patients with high levels of depression and anxiety. RESULTS: The incidences of high depression and anxiety scores were 11% (60/544) and 18% (98/544), respectively. Patients with vestibular migraine were most likely to have high depression and anxiety indices. Patients in the high-BDI or high-STAI groups (117/544) obtained significantly higher DHI scores than those in neither the high-BDI nor the high-STAI group (427/544). We noticed that about 20% of the patients experiencing dizziness had high levels of psychological distress in this study; this group also suffered from various vestibular diseases and more symptoms of dizziness. CONCLUSIONS: The results of the study suggest that psychological evaluation should be considered when assessing patients with vertigo.

Analysis of Voice and Swallowing Symptoms after Thyroidectomy in Patients without Recurrent Laryngeal Nerve Injury in Early Postoperative Period

BACKGROUND AND OBJECTIVES: After thyroidectomy, many patients experience problems report such things as reduced voice range and vocal fatigue, swallowing problems without superior and recurrent laryngeal nerve injury. The purpose of this study was to evaluate voice and swallowing problems before and after thyroid surgery without laryngeal nerve injury. MATERIALS AND METHODS: Ninety-three patients who underwent thyroidectomy without laryngeal nerve injury and completed the follow-up evaluations were studied between June 2013 and December 2015. Each evaluation was performed preoperatively, as well as 1 week, 1 month postoperatively. Analysis was performed including voice handicap index (VHI), dysphagia handicap index (DHI), and acoustic voice analysis. RESULTS: Patients show significant variation of parameters in the fundamental frequency (F), maximal phonation time (MPT), shimmer, jitter and soft phonation index (SPI) early after operation, and most of them showed recovery of parameters after 1month of operation. Perceptive complaint of voice and swallowing also showed significant decreased after operation (p<0.005). After 1 month of operation, MPT, highest frequency and frequency ranges still showed significant decreased parameters. Comparing acoustic and perceptive parameters of total thyroidectomy and lobectomy, there was no significant changes between them except highest frequency (p=0.042). CONCLUSION: The results from both subjective and objective evaluations show voice and swallowing disturbance after thyroidectomy even in the absence of laryngeal nerve and provide patients information about the recovery process after surgery. Highest frequency parameter showed most significant changes after operation.

Warthin's Tumor with Skin Ulceration Mimicking Parotid Malignancy / 대한이비인후과학회지

Warthin's tumor with skin ulceration is extremely uncommon. We report on a 64-year-old man with Warthin's tumor with skin ulceration in the right parotid gland. The ulceration may have resulted from malignant transformation of either the epithelial or lymphoid component, or, as in very rare cases, an inflammatory process crossing the capsule of the tumor into the adjacent parotid parenchyma and overlying skin. Although Warthin's tumor is a common benign tumor of the parotid area, once ulcerated, it is difficult to make a clinical diagnosis. The gross finding of the case reported herein was close to the malignant form, but because an fine needle aspiration biopsy history existed, the possibility of whether more inflammatory changes might have occurred was considered. Therefore, since complications such as facial nerve injury may arise, extensive surgeries should be avoided.

Vestibular Paroxysmia in a 7-Year-Old Child / 대한평형의학회지

Neurovascular cross-compression of the eighth cranial nerve is characterized by brief attacks of vertigo, unilateral audiologic symptoms such as tinnitus, ear fullness and hearing disturbance and relatively rare disease, in particular, in children. We report a 7-year-old female patient who presented with recurrent spontaneous vertigo, lasting 15 seconds and occuring up to 40 times per day and often associated with physical activity. Her symptoms were developed by hyperventilation. Associated aural symptoms are not founded. Magnetic resonance image showed the eighth cranial nerve compression caused by the vascular loop. She was treated with oxcarbazepine and showed improving symptoms. Therefore we report our clinical experience with a brief review of literature.

A Case of Herpes Zoster Oticus with Intractable Hiccups / 대한이비인후과학회지

Herpes zoster oticus is a common inflammatory disease caused by reactivation of varicella zoster virus in the dorsal root ganglia. Its symtpoms include unilateral distribution of the vesicular eruptions, neuralgia and various type of cranial nerve palsy depending on the involving site of head and neck region. Most commonly affected cranial nerves are facial nerve (VII) and vestibulocochelar nerve (VIII), but on rare occasions cranial nerves V, IX, X, XI are affected as well. Although neurologic symptom of herpes zoster was commonly reported, zoster associated hiccups is very rare. We experienced one case of herpes zoster oticus involving multiple cranial nerve palsy with intractable hiccups. We report our case with a review of literature.

Analysis of Treatment Patterns and Blood Pressure Changes According to Risk Stratification in Hypertensive Subjects / 대한내과학회지

BACKGROUND/AIMS: The aims of this study were to identify real world treatment patterns of hypertension according to cardiovascular risk stratification and to evaluate blood pressure changes with anti-hypertensive treatment in each risk group. METHODS: This study included patients who were newly-diagnosed with hypertension or known hypertensive patients with uncontrolled blood pressure (BP) at seven tertiary hospitals in Busan and Ulsan. World Health Organization/International Society of Hypertension (WHO/ISH) cardiovascular risk stratification was performed through retrospective chart review. RESULTS: Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers were the most frequently prescribed drugs. The higher WHO/ISH risk group received a greater number of drugs at the initial treatment, and one year after treatment. Target BP was achieved less frequently in the higher risk group (68.2% vs. 85.2% vs. 89.0%, p < 0.001). The rate of attaining target BP was lower (50.7% vs. 81.6%, p < 0.001), and the time to attaining target BP was longer (106.5 +/- 79.2 days vs. 82.1 +/- 75.3, p = 0.001), in patients with renal disease or diabetes. Initial systolic BP above 160 mmHg (OR: 4.91, 95% CI: 2.27~10.65), renal disease (3.42, 1.60~7.32), medium or high risk group status (2.27, 1.23~4.20), initial diastolic BP above 100 mmHg (2.11, 1.11~4.04), and diabetes (2.06, 1.29~3.25) were independent factors that predicted failure of attaining the target BP. CONCLUSIONS: BP control was relatively unsatisfactory in patients with higher initial BP, renal disease, higher WHO/ISH risk group status, and diabetes. Individualized approaches for such patients are needed to improve BP control in routine clinical practice.

Effect of Elderly Organized Vestibular Rehabilitation for Presbystasis / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Recently, The number of patients who have been complaining of the vertigo or dizziness has been increasing due to rapid growth of the elderly population and senile change. Aging is associated with decreased balance abilities, resulting in an increased risk of fall. The purpose of this study is to analyze the result of elderly organized vestibular rehabilitation therapy for presbystasis. MATERIALS AND METHODS: A prospective study was performed on elderly population over sixty-five years. 148 dizzy patients who were admitted to Hallym University Medical Center. We recruited 64 consecutive patients with a diagnosis of presbystasis and treatment of rehabilitation. They were asked to complete the Korean vestibular disorders activities of daily living scale (K-VADL) for the functional aspect before and two to twelve weeks after elderly organized vestibular rehabilitation therapy. The result was analyzed by statistical methods. RESULTS: The K-VADL scores were decreased in patient of presbystasis compared with first questionnaire. There were statistically significant differences in the K-VADL scores between before and after rehabilitation therapy. CONCLUSION: Most patients can effectively and safely utilize the modified vestibular rehabilitation therapy. Our results suggest that the vestibular rehabilitation therapy could provide a recovery for dizzy symptoms in presbystasis.

Laryngotracheal Stenosis in Burned Patients with Inhalation Injury: Analysis of Risk Factors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngotracheal stenosis (LTS) in burned patients with inhalation injury have features distinct from other stenosis after intubation or tracheotomy. However, the risk factors for LTS in burned patients with inhalation injury have not been thoroughly assessed. The aim of this study is to identify the risk factors for and evaluate the pattern of LTS in burned patients with inhalation injury. SUBJECTS AND METHOD: From May 2005 to April 2007, 227 burned patients with inhalation injury treated at the Hangang Sacred Heart Hospital, Hallym University Medical Center were investigated retrospectively. The risk factors analyzed for LTS in burned patients with inhalation injury were gender, age, duration of intubation, size of the endotracheal tube, previous tracheotomy, number of intubations, severity of inhalation injury. RESULTS: Among 81 patients who survived and could be followed up until the study period, 10 (12%) patients developed LTS. The stenosis involved the subglottis.cervical trachea (5), subglottis.cervical tracheal and glottis (1), glottis (4). According to Myer-Cotton classification, there were 6 (60%) patients with grade III, IV stenoses on subglottis.cervical trachea. The number of intubations and previous tracheotomy were found to be risk factors for the development of LTS in burned patients with inhalation injury. CONCLUSION: LTS by inhalation injury is usually shown on web at the anterior and posterior glottic areas or circumferential narrowing of the subglottis. Repeated endotracheal intubations and previous tracheotomy in patients with inhalation injury may increase the prevalence of LTS.

Histopathologic Changes of Tracheal Mucosa in Burned Patients with Inhalation Injury / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Inhalation injuries can produce a wide spectrum of negative clinical effects. Respiratory failure remains one of the leading causes of death in burned patients with inhalation injury. Despite advances in understanding of inhalation injury, few studies have focused on histopathologic findings of tracheal mucosa. The purpose of this study is to investigate histopathologic changes of tracheal mucosa in burned patients with inhalation injury. SUBJECTS AND METHOD: Tracheotomy was performed on 31 patients who was admitted to the Hospital center from May 2005 to March 2006. Thirty-one patients were divided into two groups : patients with inhalation injury (group I)(n=16), patients without inhalation injury (group II)(n=15). Tracheal mucosa were taken out during the tracheotomy. The tracheal mucosa were read blindly by one pathologist. RESULTS: Histopathologic examination showed the following finding in the tracheal mucosa of all patients in the group I : epithelial ulceration. Different findings were observed in the group I as time passed by after inhalation injury, such as interstitial edema, inflammatory cell infiltration, capillary dilatation, and increased fibrosis. No abnormal findings were observed in the tracheal mucosa in the group II. CONCLUSION: Inhalation injuries cause histopathologic damages to tracheal mucosa. The different histopathologic findings of tracheal mucosa that take place in time following inhalation injuries suggest to process an inflammatory reaction. The study in related to clinical features should be needed due to tracheal mucosa injury may produce respiratory complications.

Change of Taste and Sensory after Tonsillectomy and Laryngomicrosurgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Postoperative taste and sensory changes are regarded as unusual and minor complications of tonsillectomy and laryngomicrosurgery. This study aimed to identify incidence, cause, and duration of postoperative taste and sensory changes. SUBJECTS AND METHOD: With 20 patients who underwent tonsillectomy and 20 patients who underwent laryngomicrosurgery, we have prospectively studied postoperative taste and sensory changes using questionnaires with regard to symptoms at 1(st), 7(th) , 14(th) and 28(th) days after the surgery. The thresholds of sweet, sour, salty and bitter tastes were measured by spatial taste test. Also, we have checked pre-operatively and post-operatively about the serum level of zinc and copper. RESULTS: Five patients (25%) who underwent tonsillectomy and 3 patients (15%) who underwent laryngomicrosurgery suffered from changes in tastes. Four patients (20%) and 5 patients (25%) showed the sensory change. Especially, the bitter taste threshold changed in the posterior tongue (p<0.05). Post-operative zinc deficiency was detected on 1 patient. Subjective taste and sensory change disappeared within 28 days. In spatial taste test, the threshold for bitter taste increased on the 1st post-operative day at the posterior tongue, but it returned almost to the preoperative level within 28days. CONCLUSION: Taste and sensory change after tonsillectomy and laryngomicrosurgery are not unusual complications. If there were no neural damage, taste and sensory change were transient and disappeared within 28 days. The main cause of transient taste and sensory change seemed to be due to the compression of tongue, and sometimes, to postoperative zinc deficiency.

Clinical Analysis of the Canal Paresis in Patients with Benign Paroxysmal Positional Vertigo

BACKGROUND AND OBJECTIVES: Canal paresis in patients with BPPV has been variously reported to present in 13% to 57%. Should disorders affecting the peripheral vestibular system, such as vestibular neuronitis, head trauma precede or coexist the onset of BPPV, then particle repositioning maneuver (PRM) may be less effective or ineffective and need further vestibular rehabilitation after the particle repositioning maneuver. The purpose of this study is to investigate the clinical feature and importance of vestibular rehabilitation in patients with BPPV associated with canal paresis. MATERIALS AND METHODS: A retrospective review was made of 212 patients who visited and diagnosed as BPPV at Hallym university medical center from March 2004 to September 2006. We evaluated the coexistence of canal paresis, methods of treatment and outcome of 128 patients who performed bithermal caloric test. RESULTS: The vestibular assessment by bithermal caloric test showed the canal paresis in 28 patients. In 21 patients, the canal paresis was ipsilateral, in 2 patients, it was contralateral to the BPPV, and in 5 patients, canal paresis was bilateral. Among 28 patients with canal paresis, 12 patients demonstrated as primary BPPV, 16 patients as secondary BPPV. 28 patients with canal paresis were performed PRM. Vestibular rehabilitation was performed in 18 patients who had ongoing symptoms such as nonspecific continuous dizziness after PRM. Among 18 patients, 14 patients were improved, 4 patients were treatment resistant. CONCLUSION: This study shows the importance of detailed vestibular testing such as bithermal caloric test in BPPV patients. Patients with evidence of concomitant vestibular pathology would be expected to require further vestibular rehabilitation.

Airway Management in Burn Patients with Inhalation Injury / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Respiratory failure remains one of the leading causes of death in burn patients with inhalation injury. Obtaining and maintaining a secure airway are both essential and challenging. Although different airway managements are performed in burn patients with inhalation injury, its exact indications and timing remain controversial. The purpose of this study is to define the principle of airway management in burn patients with inhalation injury. SUBJECTS AND METHOD: A retrospective study was performed on 177 burn patients with inhalation injury who were admitted to Hangang Sacred Heart Hospital at Hallym University Medical Center from July 2002 to June 2005. RESULTS: Severty-seven patients underwent mask O2 supply for initial airway management. A total of 77 patients survived. One hundred patients underwent endotracheal intubation for initial airway management. Of these, 42 patients underwent tracheotomy after endotracheal intubation. A total of 42 patients reported abnormal chest X-ray findings. Of these, 10 patients survived and had significant improvement in PaO2/FiO2 ratios within 3 days following tracheotomy. CONCLUSION: In most cases, laryngotracheal edema subsides within 72 hours, permitting short periods of airway management. Deterioration of respiratory function permits prolonged intubation and ventilator support. Although tracheotomy does not improve general condition, it offers some advantages in terms of pulmonary toilet, patient comfort and airway security. If patients show deterioration of respiratory function, tracheotomy should be performed earlier.

Effects of Preserving the Posterior Branch of the Greater Auricular Nerve at Parotidectomy on Postoperative Peri-Auricular Sensation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The posterior branch of the greater auricular nerve is a sensory nerve that serves the skin over the mastoid process and the postero-inferior region of the auricle. The greater auricular nerve is often sacrificed in parotidectomy, even though its posterior branch can be preserved. By cautious dissection of the greater auricular nerve it is possible to preserve the posterior branch in 69 per cent of the operations. However, the efficiency of this procedure is not clear. So, we have compared the patients whose nerve had been preserved with those sacrificed, to evaluate the validity of the posterior branch of greater auricular nerve preservation during parotidectomy. SUBJECTS AND METHOD: Thirty patients undergoing parotidectomy were divided into two groups. Fifteen patients underwent parotidectomy with preservation of the posterior branch of the greater auricular nerve (group A) and they were compared with fifteen patients who underwent parotidectomy with sacrificing the nerve (group B). Using questionnaire, we have researched about numbness, pain or other subjective symptoms on peri-auricular area after parotidectomy and the function of the nerve has been tested by two point tactile discrimination test and temperature sensitivity test. RESULTS: Postoperatively, twenty-nine patients felt lack of sensitivity, pain, itching or other symptoms. These symptoms recovered within 12 months, subjectively. However, in group B, permanent sensory loss was found in three patients. The two-point discrimination test revealed in group B, the decreased sensitivity on the operated side in comparison with the unoperated side (p=0.008). It also showed the decreased sensitivity on operated side in group B, compare with group A (p=0.012). CONCLUSION: From this study, despites of no significant difference on subjective symptoms, there was objective improvement on function of the greater auricular nerve. It seems reasonable to spare the greater auricular nerve during parotidectomy.

A Case of Salivary Duct Carcinoma Ex Pleomorphic Adenoma of Parotid Gland / 대한이비인후과학회지

Carcinoma ex pleomorphic adenoma of the salivary gland is a relatively uncommon tumor that accounts for roughly 4% of all malignancies at this location. The lesion occurs when a malignant tumor arises in the epithelial component of a pleomorphic adenoma. It usually arises in the parotid gland. Typically, it is a high grade carcinoma, frequently leading to metastasis and disease-related death. We experienced a case of a salivary duct carcinoma that arose in the epithelial component of a pleomorphic adenoma in the parotid gland with neck metastasis. After total parotidectomy and modified radical neck dissection, he was given 10, 980 cGy of radiation postoperatively for 7 weeks. The clinicopathologic feature of this tumor are presented with a review of literatures.

The Effectiveness of Sternocleidomastoid Muscle Flap in Preventing Frey's Syndrome Following Parotidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Frey's syndrome is one of the potential sequelae of parotidectomy. Various medical and surgical treatments have been used in attempt to avoid this embarrassing condition. Recently, interposing barriers between the overlying skin flap and the parotid bed, such as the sternocleidomastoid (SCM) muscle flap, have been used to prevent this condition. The purpose of this study was to evaluate the preventive impact of using this flap on the incidence of Frey's syndrome and to identify the degree of severity in this syndrome between the use of SCM flap and no muscle flap. SUBJECTS AND METHOD: 40 patients who underwent superficial parotidectomy from June 1996 to August 2003 were divided into two groups. One group had SCM flap reconstruction (n=20), and the other did not (n=20). A subjective clinical questionnaire and the objective Minor's starch test were used to evaluate the incidence of this syndrome. A grading system was used to divide Frey's syndrome into mild or severe Frey's syndrome to determine its severity. The test of Pearson-x2 was applied. RESULTS: The association between sweating, flushing, or pain and the use of the flap was not significant. Also, there was no significant association with Minor's starch test and the use of the flap. There was a significant association with mild Frey's syndrome and the presence of the flap (p=0.014). CONCLUSION: It would seem that the sternocleidomastoid muscle flap does not reduce the incidence of Frey's syndrome, but does decrease the degree of severity in Frey's syndrome.

Clinical Consideration of Benign Nasal Neoplasm

There are many different kinds of histological types of nasal masses. But there were few studies based on the clinical consideration of benign nasal neoplasms in comparison with its histologic types. In this study we compare and analyze the benign nasal neoplasm in wish to guide for a diagnosis and management. Twenty-seven patients with benign nasal neoplasms excluding inverted papilloma, antrochoanal polyp and dentigenous cyst from March 1996 and June 2003 were selected for this study. Their clinicopathologic records were reviewed retrospectively. The male-female ratio was 1 : 1.25 and the right to left ratio was 1 : 1.7. Bening nasal neoplasms were frequently found in the fifth decade. Hemangioma was the most common benign nasal neoplasm. Nasal obstruction was the most common symptom. Benign nasal masses were frequently found at the inferior turbinate and vestibule. When the masses were found, they were smaller than 1 cm in most cases. An endoscopic and transnasal approach was the most commonly utilized approach method during surgery. There were no recurrent cases during the average 41 months follow up. In conclusion, there is no statistical significance between benign nasal neoplasm and the patient's sex and age. But, they were frequently found in left side rather than the right side. Surgical treatment seemed to be extremely useful in the case of benign nasal neoplasms.

A Case of Adenoid Cystic Carcinoma Ex Pleomorphic Adenoma of Submandibular Gland / 대한이비인후과학회지

Carcinoma ex pleomorphic adenoma is a rare neoplasm of the salivary gland. This lesion occurs when a malignant tumor arises in the epithelial component of a pleomorphic adenoma. The patient was a 35-year-old male with ovoid shaped and protruding submandibular mass that has been present for 3 weeks. The initial radiologic diagnosis was suspicious of malignancy and the cytologic finding by fine needle aspiration biopsy showed highly malignant cells. After submandibular gland extirpation and supraomohyoid neck dissection, the histologic examination revealed that tumor was composed partly of a benign pleomorphic adenoma and partly of an adenoid cystic carcinoma component with areas of calcification, capsular invasion, and perineural invasion. The adenoid cystic carcinoma component showed a cribriform pattern, also known as "Swiss cheese appearance". We additionally did postoperative radiotherapy for 7 weeks. We present a rare case of carcinoma ex pleomorphic adenoma with adenoid cystic carcinoma in the submandibular gland.

A Case of Atypical Benign Paroxismal Positional Vertigo

Paroxysmal positional nystagmus is a common finding in patients with vertigo and can occur in typical and atypical forms. Atypical forms of paroxismal positional nystagmus are thought to represent conditions which are in fact not "benign". This patient was diagnosed as right posterior semicircular canal BPPV at first. After modified Epley maneuver, the type of nystagmus was changed to atypical forms. After left cupulolith reposition maneuver (CRmM), the nystagmus and dizziness were disappeared finally.