KISEP Otology Korean J Otolaryngol 1999;42: 수평반고리관양성발작성두위현기증 김영기 윤용주 김인 Benign Paroxysmal Positional Vertigo of the Horizontal Semicircular Cana

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1 KISEP Otology Korean J Otolaryngol 1999;42: 수평반고리관양성발작성두위현기증 김영기 윤용주 김인 Benign Paroxysmal Positional Vertigo of the Horizontal Semicircular Canal Young Ki Kim, MD, Yong Joo Yoon, MD and In Kim MD Department of Otolaryngogy-Head and Neck Surgery, College of Medicine, Chonbuk National University, Chonju, Korea ABSTRACT Background and ObjectivesBenign 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 ENGresults. 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 testand MRI 4 caseswere checked to exclude the possibility of the central origin. ResultsAll 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 testsdix-hallpike test and supine head turning test. Characteristics of nystagmus can be explained by canalithiasis theory of the horizontal semicircular canal. Korean J Otolaryngol 1999;42: KEY WORDSBPPV Horizontal semicircular canal Canalithiasis. 836

2 Table 1. Clinical features Patient number Agesex Duration of symptoms Past history Provocative position 1 44F 1 day 4 years ago Head turning 2 58M 5 months Head turning 3 55M 1 day Head turning 4 59F 1 day Head turning 5 60F 3 days Rolling 6 55M 5 days Head turning 7 62F 1 days 4 years ago, 1 year ago Head turning 8 63F 2 days Head turning 9 64M 3 days Head turning 837

3 A B Table 2. Analysis of most prominent nystagmus C D Fig. 1. Benign paroxysmal positional nystagmus of the right horizontal semicircular canal. AElectronystagmographic recording induced by a quick turn of the head to head-right position. An intense right-beating nystagmus is shown. BPlots of slow-phase velocity. Primary nystagmus disappears in about 32 seconds and is followed by a secondary left-beating nystagmus. CElectronystagmo-graphic recording induced by quick turn of the head to head-left position. An less intense left-beating nystagmus is shown. DPlots of slowphase velocity. Left-beating nystagmus disa-ppears in about 55 seconds without inversion. Patient number ead position PSV Duration Latency degsec sec sec Inversion time sec 1 HR HL HR HL HR HL HR HL HR HL HR HL HR HL HR HL HR HL PSVpeak slow-phase velocity, HRhead right, HLhead left 838 Korean J Otolaryngol 1999;42:836-42

4 A A B B Fig. 2. Electronystagmographic recordings of supine head turning test. AQuick turn of the head to head-left position. BRepeat test. No fatigability can be seen. Fig. 3. Electronystagmographic recordings of supine head turning test. AFrom supine to head-right position. BFrom head-left to head-right position. The difference in nystagmus intensity depends on initial head position and the net rotation angle. 839

5 Fig. 4. Drawing illustrating how the canaliths within the endolymph of the right horizontal semicircular canal can produce georopic direction-changing positional nystagmus. Small arrows indicate movement of the canaliths within the endolymph. Large arrows indicate direction of cupula deviation. 840 Korean J Otolaryngol 1999;42:836-42

6 REFERENCES 1) Barany R. Diagnose von Krankheitserscheinungen im Bereiche des Otolithenapparates. Acta Otolaryngol 1921;2: ) Dix R, Hallpike CS. The pathology, symptomatology, and diagn-osis of certain common disorders of the vestibular system. Proc R Soc Med 1952;54: ) Schuknecht HF, Ruby RRF. Cupulolithiasis. Adv Otorhinolary-ngol 1973;20: ) Epley JM. Positional vertigo related to semicircular canalithiasis. Otolaryngol Head Neck Surg 1995;112: ) Kim YK, Jeong WC, Yoon YJ. Treatment of benign paroxysmal positional vertigo- canalith repositioning maneuver-. Korean J Otolaryngol 1996;39: ) Parnes LS. McClure JA. Free-floating endolymph particles; A new 841

7 operative finding during posterior semicircular canal occlu-sion. Laryngoscope 1992;102: ) Lee WS. Chang MS, Lee HK, Hong BK, Kim SC. A case of benign paroxysmal positional vertigo treated by posterior semicircular canal occlusion. Korean J Otolaryngol ) McClure JA. Horizontal canal BPV. J Otolaryngol ) Pagnini P, Nuti D, Vannucchi P. Benign paroxysmal vertigo of the horizontal canal. ORL J Otorhinolaryngol Relat Spec ) Baloh RW, Jacobson KM, Honrubia V. Horizontal semicircular canal variant of benign positional vertigo. Neurology ) Baloh RW, Yue Q, Jacobson KM, Honrubia V. Persistent directionchanging positional nystagmus Another variant of benign positional nystagmus? Neurology ) Hallpike CS. Vertigo of central origin. Proc R Soc Med ) Baloh RW, Honrubia V, Jacobson K. Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology ) Raphan, Matsuo V, Cohen B. Velocity storage in the vestibuloocular reflex arc. Exp Brain Res ) Zucca G, Botta L, Milesi V, Valli P. Sensory adaptation in the frog vestibular organs. Hearing ) Steddin S, Ing D, Brandt T. Horizontal canal benign paroxysmal positioning vertigo h-bppv transition of canalolithiasis to cupulolithiasis. Ann Neurol ) Nuti D, Vannucchi P, Pagnini P. Benign paroxysmal positional vertigo of the horizontal canal A form of canalithiasis with variable clinical features. J Vest Res ) Lempert T. Horizontal benign positional vetigo. Neurology ) Vannucchi P, Giannoni B, Pagnini P. Treatment of horizontal semicircular canal benign paroxysmal positional vertigo. J Vest Res ) Nuti D, Agus G, Barbieri MT, Passali D. The management of horizontalcanal paroxysmal positional vertigo. Acta Otolaryngol Korean J Otolaryngol 1999;42:836-42

KISEP Otology Korean J Otolaryngol 1999;42: 외측반규관기원의양성발작성두위안진 연세대학교의과대학이비인후과학교실 정운교 이원상 김문석 이주환 이세영 Direction Changing Positional Nystagmus from

KISEP Otology Korean J Otolaryngol 1999;42:576-81 외측반규관기원의양성발작성두위안진 연세대학교의과대학이비인후과학교실 정운교 이원상 김문석 이주환 이세영 Direction Changing Positional Nystagmus from Canalolithiasis and Cupulolithiasis of Lateral Semicircular