KISEP Otology Korean J Otolaryngol 1999;42:836-42 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;42:836-42 KEY WORDSBPPV Horizontal semicircular canal Canalithiasis. 836
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
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 80 90 1 29 HL 40 46 1 2 HR 80 75 1 38 HL 15 42 1 3 HR 17 55 1 HL 57 125 1 4 HR 45 120 1 HL 17 50 1 5 HR 80 140 1 28 HL 13 60 1 6 HR 15 55 1 HL 80 115 1 26 7 HR 80 120 1 30 HL 25 70 1 25 8 HR 80 135 1 32 HL 63 55 1 9 HR 80 135 1 32 HL 25 35 1 PSVpeak slow-phase velocity, HRhead right, HLhead left 838 Korean J Otolaryngol 1999;42:836-42
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
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
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