An Abbreviated Diagnostic Maneuver for Posterior Benign Positional Paroxysmal Vertigo

Michael, Pia; Oliva, Carolina Estibaliz; Nuñez, Marcia; Barraza, Cristian; Faúndez, Juan Pablo; Breinbauer, Hayo A.

doi:10.3389/fneur.2016.00115

Cited by 7 publications

(7 citation statements)

References 27 publications

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“…In addition, some authors have added a 45 tilt of the head to explore the PSC and ASC canals, achieving a major sensitivity of BLT in the diagnosis of vertical canal BPPV. 13,14 Nevertheless, the clinical use of the BLT for the vertical semicircular canals is still controversial due to the variable proportion of patients who show vertical nystagmus in the bowing or leaning position. It has been demonstrated that the vertical head movement produced during the BLT enables the free-floating otoconia to move along the affected PSC 13 ; however, the rate of patients with a positive BLT in PSC-BPPV ranges from 20 to 75.2% of the cases.…”

Section: Discussionmentioning

confidence: 99%

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Bow and Lean Test for Rare Variants of Vertical Semicircular Canal BPPV

Martin‐Sanz,

Chaure‐Cordero,

Riestra‐Ayora

et al. 2023

The Laryngoscope

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ObjectiveThe objective of this study was to assess the clinical significance of the Bow and Lean Test (BLT) for the diagnosis of different variants of vertical canal Benign Paroxysmal Positional Vertigo (BPPV). BLT is commonly used for diagnoses of lateral semicircular canal (LSC) BPPV. However, vertical nystagmus in the BLT may indicate the presence of other variants such as PSC‐BPPV.Methods567 patients with vertical canal BPPV were recruited. Patients with anterior semicircular canal (ASC) or PSC‐BPPV were weekly examined until the negativization of BPPV. Nystagmus characteristics during BLT were analyzed.ResultsOf 567 patients with vertical canal BPPV, 1.4% had ASC‐BPPV. BLT was positive in 155 patients, showing patterns like down‐beating nystagmus in bowing and no nystagmus in leaning (15.52% of patients), and down‐beating in bowing and up‐beating in leaning (6.17%), which was predominantly present in PSC‐canalolithiasis. Statistically significant differences were observed in the direction of nystagmus provoked by BLT in PSC‐BPPV subtypes. No significant differences were found in nystagmus latency or duration during BLT positions. Among BPPV subtypes, there was a significant difference in nystagmus duration and latency, especially between cupulolithiasis and other variants. BLT's sensitivity was 0.93 in bowing and 1 in a leaning position, while specificity was 0.93 and 0.82 respectively.ConclusionBeyond the LSC, the BLT has expanded to other variants. However, study results differ likely due to variations in patient characteristics and test execution. Currently, no specific features for ASC have been found to differentiate it from PSC‐BPPV limiting the test's use for this variant.Level of EvidenceLevel 3, according to Oxford Center for Evidence‐Based Medicine Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 99%

“…On one hand, many patients have difficulties bending their heads backward, especially the elderly, so the population's age is a key factor, which can explain such differences between studies. This can be avoided by applying an inclination to the patient's trunk, but it may also be difficult in some patients 14 …”

Section: Discussionmentioning

confidence: 99%

Bow and Lean Test for Rare Variants of Vertical Semicircular Canal BPPV

Martin‐Sanz,

Chaure‐Cordero,

Riestra‐Ayora

et al. 2023

The Laryngoscope

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“…y, ¿puede realizarse un examen por medios virtuales que puedan ayudar al paciente? Si el interrogatorio del paciente es compatible con un síndrome vestibular episódico con desencadenantes, y estos últimos son los cambios de posición de la cabeza o cuerpo del paciente, y si el abecedario vestibuloespinal es normal, la situación más frecuente, se le puede realizar al paciente una mini Dix-Hallpike (Figura 3) [19] con una razonable sensibilidad y especificidad, para VPPB del canal posterior, el cual es la forma más frecuente de presentación [20] si el paciente refiere síntomas unilaterales, en caso de ser positiva se puede: a) tranquilizar al paciente, o b) sugerir una maniobra autoadministrada [21], o c) citarlo en la consulta o la sala de guardia para hacer una maniobra.…”

Section: Métodounclassified

Abecedario del examen vestibuloespinal. Revisión bibliográfica

Carmona¹,

Zalazar²,

Dachesky³

2020

ORL

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publicación del fascículo: pendiente de publicación Conflicto de intereses: Los autores declaran no tener conflictos de intereses Imágenes: Los autores declaran haber obtenido las imágenes con el permiso de los pacientes Política de derechos y autoarchivo: se permite el autoarchivo de la versión post-print (SHERPA/RoMEO) Licencia CC BY-NC-ND. Licencia Creative Commons Atribución-NoComercial-SinDerivar 4.0 Internacional Universidad de Salamanca. Su comercialización está sujeta al permiso del editor PALABRAS CLAVE examen vestíbulo-espinal; vértigo; patología vestibular; semiología; neurootología

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“…Since its introduction, the Dix-Hallpike maneuver remains the gold-standard positioning maneuver for diagnosing PC-BPPV. However, there have been attempts to develop alternative maneuvers to the Dix-Hallpike maneuver or to modify the original Dix-Hallpike maneuver with the aim of making it easier to apply, including the side-lying test, 11 a chair-based version of the Dix-Hallpike maneuver, 12 and placing a pillow under the shoulders during the Dix-Hallpike maneuver. 13 These attempts have expanded the applicability of the positioning maneuvers for diagnosing PC-BPPV, especially in restricted clinical circumstances or in patients with limitations in neck motion or difficulty relaxing their neck.…”

Section: Introductionmentioning

confidence: 99%

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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An Abbreviated Diagnostic Maneuver for Posterior Benign Positional Paroxysmal Vertigo

Cited by 7 publications

References 27 publications

Bow and Lean Test for Rare Variants of Vertical Semicircular Canal BPPV

Bow and Lean Test for Rare Variants of Vertical Semicircular Canal BPPV

Abecedario del examen vestibuloespinal. Revisión bibliográfica

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

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