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

Abstract

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.

A Rare Presentation of Multicanal Benign Paroxysmal Positional Vertigo in a Premenopausal Woman With Osteopenia: A Case Report

“…This is due to the anatomical location of the PC semicircular canal at the most dependent position in a standing person, which frequently causes the deposition of otoconia into the canal [ 13 ]. In rare cases, multiple semicircular canals, known as multicanal BPPV, may be involved, which has a lower prevalence compared to single canal BPPV [ 4 , 8 ].…”

“…Mixed torsional geotropic-vertical upbeating nystagmus in Dix-Hallpike maneuvers reveals involvement of PC, whereas, geotropic or apogeotropic horizontal nystagmus during supine roll test reveals involvement of HC [ 3 ]. The combination of HC and AC canalithiasis BPPV is incredibly rare due to the involvement of the AC, which occurs in 2-3% of all cases [ 4 ]. For this case study, the patient was first presented with unilateral single BPPV in the PC of the left side but progressed to a multicanal presentation (HC and AC).…”

“…In rare cases, multiple canals may be affected, accounting for 4.7-12.2% of BPPV cases [ 4 ]. Compared to single canal BPPV, multicanal BPPV is more commonly associated with head trauma [ 4 , 5 ]…”

“…BPPV is believed to be caused by the dislodgement of otoconia into the semicircular canals, with the posterior canal (PC) most affected [3]. In rare cases, multiple canals may be affected, accounting for 4.7-12.2% of BPPV cases [4]. Compared to single canal BPPV, multicanal BPPV is more commonly associated with head trauma [4,5] There is an increased incidence of BPPV in women, corresponding with increased age and menopause [6].…”

The horizontal and vertical components of nystagmus evoked by the supine roll test in horizontal semicircular canal canalolithiasis

“…With the in-depth study of BPPV and the application of VNG, the diagnosis and treatment of BPPV have gradually developed from subjective analysis to objective positioning ( Zhu et al, 2021 ). Previous studies on HSC-Can nystagmus mostly focused on the analysis of horizontal nystagmus ( Vats, 2021 ; Zhang et al, 2021 ).…”