Diagnosis and treatment of the short-arm type posterior semicircular canal BPPV

Lin, Pei; Yi-fei, Zhou; Wu, S. M.; Zheng, Yufeng; Yang, Xiaokai

doi:10.1016/j.bjorl.2020.10.012

Cited by 14 publications

(9 citation statements)

References 17 publications

(24 reference statements)

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“…The intensity of nystagmus triggered by positional maneuvers depends on the number, size, and density of the otoconia, 28 the angle between the plane of the semicircular canals and the force vector of gravity during the positional maneuvers, the moving distance of otolithic debris, 29 the speed of positional maneuvers, 1 and the amplitude of head motion during the positional maneuvers. 29 30 It was not possible to control all of these factors in the present retrospective study, but the higher peak intensity of induced upbeat nystagmus during SHH might be explained by two factors. First, the migration distance of the otolithic debris in the PC is greater during SHH than during the Dix-Hallpike maneuver, since the angle of neck extension below the examination table is mostly larger and the dependent position in the PC is farther from the ampulla during SHH than during the Dix-Hallpike maneuver.…”

Section: Discussionmentioning

confidence: 83%

Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

et al. 2021

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Background and Purpose To determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV). Methods We retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before ( n =29, group A) or after ( n =33, group B) the Dix-Hallpike maneuver. Results Torsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p =0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0–60.0°/s (median=18.5°/s) vs. range=2.7–40.0°/s (median=13.4°/s), p <0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups ( p =0.082). Conclusions SHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.

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Section: Discussionmentioning

confidence: 83%

Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

et al. 2021

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“…This first is a short-arm canalithiasis type BPPV where otoconia are located on the utricular side of the posterior semicircular canal cupula. Examples of short-arm canalithiasis BPPV in the literature report a downbeat nystagmus with contralesional torsion4 18 or typical upbeat nystagmus with ipsilesional torsion 8. In this case, it is theorised that the otoconia in the utricular arm/short arm were situated in a position that resulted in ampullofugal/excitatory endolymph flow as described by Scocco et al ,20 resulting in the typical nystagmus pattern seen in long-arm canalithiasis.…”

Section: Discussionmentioning

confidence: 84%

“…A bow and yaw manoeuvre8 was attempted for treatment of possible short-arm posterior semicircular canal BPPV, followed by an Epley manoeuvre for the right ear. During the Dix-Hallpike position following the bow and yaw manoeuvre, she displayed an upbeating nystagmus with right torsion lasting about 25 s—consistent with her initial testing.…”

Section: Treatmentmentioning

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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“…Short arm variant BPPV is becoming increasingly recognized as a common cause of atypical BPPV [6 ▪▪ ]. In fact, several studies looking at theoretical models of the labyrinth have found a high probability of short arm involvement [8 ▪ ,9 ▪ ,10]. Symptoms experienced when sitting up may include vertigo, strong neurovegetative symptoms including nausea and sweating [6 ▪▪ ,7], and postural retropulsion [8 ▪ ].…”

Section: The Short Arm Variant Of Posterior Canal Benign Paroxysmal P...mentioning

confidence: 99%

“…2). Proposed treatments include repeated DH to seated upright position change [8 ▪ ], a prolonged forward head lean [6 ▪▪ ], and a bow and yaw maneuver [9 ▪ ] to relocate displaced otoconia from the short arm back into the utricle. If there is concern for cupulolithiasis, vibration to the mastoid bone may be helpful [11].…”

Section: The Short Arm Variant Of Posterior Canal Benign Paroxysmal P...mentioning

confidence: 99%

Updates in neuro-otology

Murphy

Hac

Gold

2022

Current Opinion in Neurology

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Purpose of reviewRecent updates with clinical implications in the field of neuro-otology are reviewed.Recent findingsImportant updates relating to several neuro-otologic disorders have been reported in recent years. For benign positional paroxysmal vertigo (BPPV), we provide updates on the characteristics and features of the short arm variant of posterior canal BPPV. For the acute vestibular syndrome, we report important updates on the use of video-oculography in clinical diagnosis. For autoimmune causes of neuro-otologic symptoms, we describe the clinical and paraclinical features of kelch-like protein 11 encephalitis, a newly-identified antibody associated disorder. For cerebellar ataxia, neuropathy, vestibular areflexia syndrome, we report recent genetic insights into this condition.SummaryThis review summarizes important recent updates relating to four hot topics in neuro-otology.

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Diagnosis and treatment of the short-arm type posterior semicircular canal BPPV

Cited by 14 publications

References 17 publications

Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

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

Updates in neuro-otology

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