Clinical characteristics of patients with multi-canal benign paroxysmal positional vertigo

Si, Lihong; Xia, Ling; Li, Zheyuan; Li, Kangzhi; Shen, Bo; Yang, Xu

doi:10.1016/j.bjorl.2020.05.012

Cited by 8 publications

(14 citation statements)

References 30 publications

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“…Nakahara et al ( 24 ) found that the abnormal rate of oVEMP in BPPV patients was higher than that of the normal population. We previously reported that unilateral vestibular dysfunction and audiological abnormalities assisted the positioning of multitubular BPPV ( 7 ). In this present study, most patients with PC-BPPV-cu had semicircular canal paresis and abnormalities in audiology, cVEMP, and vHIT.…”

Section: Discussionmentioning

confidence: 99%

“…The golden diagnostic standard of PC-BPPV-ca is the Dix-Hallpike test (D-HT). PC-BPPV was diagnosed if vertical upbeat nystagmus with or without torsional component was induced by the Dix-Hallpike test, and the reversal of the nystagmus often occurred when returning to an upright position; if vertical upbeat nystagmus with torsional component was induced, the torsional component involved the beating of the upper pole of the eyes toward the affected side ( 7 ). PC-BPPV-cu is one of the new and controversial BPPV in the BPPV diagnostic criteria proposed by the International Barany Society.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Application of Different Vertical Position Tests for Posterior Canal-Benign Paroxysmal Positional Vertigo-Cupulolithiasis

et al. 2022

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BackgroundPosterior canal-benign paroxysmal positional vertigo-cupulolithiasis (PC-BPPV-cu) is a new and controversial type of benign paroxysmal positional vertigo (BPPV). At present, there are few relevant clinical studies as to whether the Half Dix-Hallpike test (Half D-HT) induces more obvious nystagmus than the Dix Hallpike test (D-HT) and straight head hanging test (SHH) in patients with PC-BPPV-cu.ObjectivesTo investigate the clinical characteristics of PC-BPPV-cu, and analyze the diagnostic significance of the Dix-Hallpike test (D-HT), Half D-HT, and straight head hanging (SHH) test in these patients.MethodsA total of 46 patients with PC-BPPV-cu were enrolled, and divided into two groups (N = 23): a group A (induction order: D-HT, Half D-HT, SHH) and a group B (induction order: Half D-HT, D-HT, SHH).ResultsAmong 46 patients with PC-BPPV-cu, the bilateral and unilateral abnormality rates of the disease side were 5 cases and 41 cases, respectively. There were significant differences in the proportion of torsional-upbeating nystagmus and upbeating nystagmus among the three headhanging positions in 46 patients with PC-BPPV-cu (P < 0.001). The slow phase velocity (SPV) of induced nystagmus at half D-HT supine position was slower than D-HT supine position (P < 0.05) and SHH supine position (P < 0.05). The nystagmus latency of D-HT supine position was significantly shorter than half D-HT (P < 0.05) and SHH (P < 0.05). PC-BPPV-cu patients were accompanied by 53.5% semicircular canal paresis, 69.6% audiological abnormalities, 76% cervical vestibular evoked myogenic potential (cVEMP), and 75% video head impulse test (vHIT) abnormalities, the concordance rates of the four detection methods were similar (χ2 = 0.243, P = 0.970).ConclusionsThe Half D-HT is simple and feasible, but might have a risk of false-negative diagnoses of the torsional-upbeating nystagmus and upbeating nystagmus. The D-HT is still a classic induction method for PC-BPPV-cu. The two complement each other and may aid in the diagnosis of PC-BPPV-cu patients. Future clinical applications of Half D-HT require extensive research to determine its diagnostic efficacy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Application of Different Vertical Position Tests for Posterior Canal-Benign Paroxysmal Positional Vertigo-Cupulolithiasis

et al. 2022

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“…And compared with patients with canalithiasis, canalith repositioning maneuver was not effective in these 2 patients who had cupulolithiasis, and repeated canalith repositioning maneuvers and Brandt-Daroff exercises were needed in order to achieve good results. Si et al 19 performed an analysis of 41 patients with MC-BPPV and found that 46.3% patients had nystagmus that lasted more than 1 min, 14.6% patients had cupulolithiasis, and 31.7% patients had mixed cupulolithiasis and canalithiasis, they also found that canalith repositioning maneuver was more effective in patients with canalolithiasis compared to those with cupulolithiasis and mixed canalolithiasis-cupulolithiasis. In this study, we found that among the 878 patients with SC-BPPV, there were 152 patients of cupulolithiasis and 726 patients of canalolithiasis, with a cupulolithiasis-canalolithiasis ratio of 1: 4.78, while among 49 patients with MC-BPPV, 20 patients had cupulolithiasis and 29 patients had canalolithiasis, the cupulolithiasis-canalolithiasis ratio is 1:1.45, there was a statistical difference in the cupulolithiasis-canalolithiasis ratio between patients with BPPV and MC-BPPV.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] In this study, we found that AC was involved in 9 patients, accounting for 18.37% of all MC-BPPV cases, this result is consisted with the above-mentioned findings. However, Si et al 19 reported that the incidence of MC-BPPV involving the AC was as high as 48.8%, the reason for the high incidence rate may be that patients admitted to vertigo centers of different levels have different disease severity, patients with BPPV who had typical symptoms can be diagnosed and treated in primary vertigo centers, and the proportion of patients with complex nystagmus admitted to higher-level vertigo center is high. Further multi-center studies with large sample sizes are needed to investigate the clinical characteristics of patients with different types of MC-BPPV.…”

Section: Discussionmentioning

confidence: 99%

Objective findings in patients with multi-canal benign paroxysmal positional vertigo

Zhu

et al. 2021

Ear Nose Throat J

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Objective The study aimed to investigate the clinical characteristics of patients with multi-canal benign paroxysmal positional vertigo (MC-BPPV). Methods We performed a retrospective analysis of 927 patients with BPPV who were admitted to our hospital between January 1, 2016 and December 31, 2019. The clinical data of all patients were collected. The Dix-Hallpike, straight head-hanging, and supine Roll tests were performed in all patients. The nystagmus was recorded using videonystagmography. The clinical characteristics of patients with MC-BPPV and single canal BPPV (SC-BPPV) was analyzed and compared. Results Among 927 patients included, 49 (5.29%) patients had MC-BPPV, 878 (94.71%) patients had SC-BPPV. There were significant differences in the male to female ratio (1:3.90 vs 1:1.81, P < .05), mean age (62.47±12.51 vs 59.04±13.72, P < .05), as well as the ratio of cupulolithiasis to canalithiasis (1:1.45 vs 1:4.78, P < .01) between patients with MC-BPPV and SC-BPPV. The frequency of involvement of PC, HC, and AC were involved for 66 (67.35%), 23 (23.47%), and 9 (9.18%) times, respectively, in patients with MC-BPPV, which were involved in 581 (66.17%), 281 (32.0%), and 16 (1.82%) patients, respectively, in patients with SC-BPPV. No significant difference was found in the frequency of involvement of PC and HC between patients with MC-BPPV and SC-BPPV, while there was significant difference in the frequency of AC involvement between 2 groups ( P < .01). Ipsilateral PC-HC-BPPV (n = 18) and bilateral PC-BPPV (n=19) were the most common among patients with MC-BPPV. Twenty-six (53.06%) patients had ipsilateral MC-BPPV, 23 (46.94%) had bilateral MC-BPPV. Of the 26 patients with ipsilateral MC-BPPV, 7 patients combined with unilateral peripheral vestibular disorder. Conclusion Patients with MC-BPPV had a significantly older mean age at disease onset and a higher proportion of females compared with patients with SC-BPPV. Cupulolithiasis was more common in MC-BPPV. AC involvement was also much more common in MC-BPPV than in SC-BPPV.

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“…MC-BPPV cases might be underdiagnosed due to their complex anatomical structure and complicated, atypical nystagmus forms. It can be manifested with combinations of different semicircular canal involvement (e.g., both vertical and H-SSCs) [Traboulsi and Teixido, 2017;Si et al, 2022].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Treatment of Multicanal Benign Paroxysmal Positional Vertigo by Means of TRV Chair

et al. 2022

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Introduction: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of peripheral vertigo and can manifest in different forms. Multicanal BPPV is rare and difficult to treat. TRV Chair is a method that offers diagnosis and treatment at the same time. The aim was to analyze the outcomes of treatment of multicanal BPPV by means of TRV Chair and compare those results with manual maneuvers. Methods: Forty-nine subjects aged 26–73 and diagnosed with multicanal BPPV were included. Appropriate maneuvers were performed on affected canals either by TRV Chair or manually. The number of maneuvers required by TRV Chair and manual maneuver were analyzed and compared. Results: The mean number of maneuvers performed until the treatment was completed in manual treatment group was 2.57 ± 1.03, and in TRV group, it was 2.25 ± 1.16. No significant difference was observed between the number of maneuvers performed in either group until the end of the treatment (p > 0.05). Discussion/Conclusions: Neither TRV Chair nor manual maneuvers were superior to the other in the treatment of multicanal BPPV cases.

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Clinical characteristics of patients with multi-canal benign paroxysmal positional vertigo

Cited by 8 publications

References 30 publications

Clinical Application of Different Vertical Position Tests for Posterior Canal-Benign Paroxysmal Positional Vertigo-Cupulolithiasis

Clinical Application of Different Vertical Position Tests for Posterior Canal-Benign Paroxysmal Positional Vertigo-Cupulolithiasis

Objective findings in patients with multi-canal benign paroxysmal positional vertigo

Outcomes of Treatment of Multicanal Benign Paroxysmal Positional Vertigo by Means of TRV Chair

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