A novel maneuver for diagnosis and treatment of torsional-vertical down beating positioning nystagmus: anterior canal and apogeotropic posterior canal BPPV

Garaycochea, Octavio; Pérez‐Fernández, Nicolas; Manrique-Huarte, Raquel

doi:10.1016/j.bjorl.2020.09.009

Cited by 5 publications

(2 citation statements)

References 26 publications

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“…The short canal repositioning maneuver (short CRP maneuver) works on the basis of a modified form of the Epley maneuver, which can be used in the treatment of ac-BPPV after determining the side of involvement (6). Various other maneuvers described in literature, which require identification of the side of involvement, have been described (17)(18)(19)(20). Based on the orientation of the canal during these maneuvers and the underlying biomechanics, each maneuver theoretically has its advantages and disadvantages similar to treatment maneuvers for posterior and horizontal canal BPPV (4,16,21,22).…”

Section: Therapeutic Maneuversmentioning

confidence: 99%

Diagnostic and Therapeutic Maneuvers for Anterior Canal BPPV Canalithiasis: Three-Dimensional Simulations

Bhandari¹,

Bhandari²,

Kingma

et al. 2021

Front. Neurol.

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Background and Objectives: Anterior canal BPPV is a rare BPPV variant. Various diagnostic and therapeutic maneuvers have been described for its management. The aim of this study was to use three-dimensional simulation models to visualize otoconial debris movement within the anterior canal during diagnostic tests and different liberatory maneuvers. This can help to optimize existing treatment maneuvers and help in the development of better management protocols.Methods: Based on reconstructed MRI images and fluid dynamics, a 3D dynamic simulation model (as a function of time) was developed and applied. Simulations of the supine head-hanging test for diagnosis of ac-BPPV were studied. Three repositioning maneuvers were simulated: 1) the Yacovino maneuver and its modifications, 2) the reverse Epley maneuver and 3) the short canal repositioning (CRP) maneuver.Results: The simulation showed that the supine head-hanging test is a good test for diagnosis of ac-BPPV affecting both labyrinths and demonstrated why there is no inversion of nystagmus on sitting up. The Yacovino maneuver was seen to be an effective treatment option for ac-BPPV without having to determine the side involved. However, simulations showed that the classical Yacovino maneuver carried a risk of canal switch to the posterior canal. To overcome this risk, a modified Yacovino maneuver is suggested. The reverse Epley maneuver was not an effective treatment. Short CRP is useful in ac-BPPV treatment; however, it requires determination of side of involvement.Conclusion: The 3D simulator of the movement of the otoconial debris presented here can be used to test the mechanism of action and the theoretical efficacy of existing diagnostic tests and maneuvers as well as to develop new treatment maneuvers to optimize BPPV treatment.

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Section: Therapeutic Maneuversmentioning

confidence: 99%

Diagnostic and Therapeutic Maneuvers for Anterior Canal BPPV Canalithiasis: Three-Dimensional Simulations

Bhandari¹,

Bhandari²,

Kingma

et al. 2021

Front. Neurol.

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“…Most patients with BPPV present with typical nystagmus patterns and are successfully treated using appropriate canalith repositioning manoeuvres (CRM). However, variant locations of displaced otoconia within the semicircular canals do occur, for example, otoconia in the short arm of the posterior semicircular canal causing downbeat nystagmus,3 4 which makes identification and treatment of the affected semicircular canal difficult. A comprehensive clinical examination including use of video head impulse testing (vHIT) can assist clinicians in correctly identifying the affected semicircular canal and choosing an appropriate repositioning manoeuvre when the positional nystagmus or response to treatment is atypical.…”

Section: Introductionmentioning

confidence: 99%

Resolution of atypical posterior semicircular canal BPPV: evidence for putative short-arm location

Ludwig

Schubert

2023

BMJ Case Rep

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This case demonstrates the successful identification and treatment of atypical posterior semicircular canal benign paroxysmal positional vertigo (BPPV) based on a unique presentation of positional nystagmus, the resultant nystagmus from repositioning manoeuvers, and restored function of the affected semicircular canal. This case illustrates the importance of completing a comprehensive clinical examination and the value for incorporating the video head impulse test as well as adjusting treatment based on testing and patient response when managing variant cases of BPPV.

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