Utility of the bow and lean test in predicting subtype of benign paroxysmal positional vertigo

Choi, Seo-Youn; Choi, Hye Rang; Nahm, Hyunjoo; Han, Kyujin; Shin, Jung Eun; Kim, Chang-Hee

doi:10.1002/lary.27142

Cited by 25 publications

(20 citation statements)

References 17 publications

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“…To examine bowing and leaning nystagmus, the patients were subjected to bowing (90°) and leaning (45°) in a sitting position. The direction of bowing nystagmus corresponded to the affected side while that of leaning nystagmus was opposite to the affected side, which was consistent with previous observations [2,8,9,11].…”

Section: Resultssupporting

confidence: 92%

Positional Audiometry in Patients with Light Cupula: A Preliminary Study

Lee¹,

Shin²,

Kim³

2020

Res Vestib Sci

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Objectives: Light cupula is characterized by persistent geotropic direction-changing positional nystagmus in a supine head-roll test. The purpose of this study is to investigate if hearing level is influenced by the change of head position in light cupula under the assumption that relative density difference similarly occurs between the tectorial membrane and endolymph. Methods: Twelve patients with unilateral light cupula who underwent positional audiometry were included in this study. Pure tone thresholds were compared among three head positions. Results: Hearing threshold in pure tone audiometry (PTA) of the affected ear was not different from that of the healthy ear. PTA thresholds of the affected side were not significantly different in three head positions; upright seating, cochlear apex-up, and cochlear apex-down positions. Conclusions: Although positional change of nystagmus direction is the most significant clinical feature of light cupula, positional change of hearing level was not observed in those patients. The lack of positional influence on hearing may be explained as follows: (1) the heavier endolymph phenomenon occurs only in the vestibular end organ without involving the cochlea; (2) the light cupula phenomenon is more likely to occur due to light debris mechanism rather than heavier endolymph or lighter cupula mechanism; and (3) the effects of light cupula could be modified by outer hair cells, which work for tuning in the cochlea, even though light tectorial membrane or heavy endolymph occurs.

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Section: Resultssupporting

confidence: 92%

Positional Audiometry in Patients with Light Cupula: A Preliminary Study

Lee¹,

Shin²,

Kim³

2020

Res Vestib Sci

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“…The same reasoning could be applied in the interpretation of nystagmus behavior in the last patient during head movements along the pitch plane. In this case, vertical/torsional positional nystagmus due to simultaneous left-sided PSC BPPV evoked by head bending likely superimposed underlying baseline paretic spontaneous nystagmus (57). In the same patient, paroxysmal nystagmus could be elicited despite PSC VOR-gain loss on vHIT, strengthening the assumption of spared or recovered lowvelocity afferents (58).…”

Section: Discussionmentioning

confidence: 50%

Case Report: Could Hennebert's Sign Be Evoked Despite Global Vestibular Impairment on Video Head Impulse Test? Considerations Upon Pathomechanisms Underlying Pressure-Induced Nystagmus due to Labyrinthine Fistula

et al. 2021

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We describe a case series of labyrinthine fistula, characterized by Hennebert's sign (HS) elicited by tragal compression despite global hypofunction of semicircular canals (SCs) on a video-head impulse test (vHIT), and review the relevant literature. All three patients presented with different amounts of cochleo-vestibular loss, consistent with labyrinthitis likely induced by labyrinthine fistula due to different temporal bone pathologies (squamous cell carcinoma involving the external auditory canal in one case and middle ear cholesteatoma in two cases). Despite global hypofunction on vHIT proving impaired function for each SC for high accelerations, all patients developed pressure-induced nystagmus, presumably through spared and/or recovered activity for low-velocity canal afferents. In particular, two patients with isolated horizontal SC fistula developed HS with ipsilesional horizontal nystagmus due to resulting excitatory ampullopetal endolymphatic flows within horizontal canals. Conversely, the last patient with bony erosion involving all SCs developed mainly torsional nystagmus directed contralaterally due to additional inhibitory ampullopetal flows within vertical canals. Moreover, despite impaired measurements on vHIT, we found simultaneous direction-changing positional nystagmus likely due to a buoyancy mechanism within the affected horizontal canal in a case and benign paroxysmal positional vertigo involving the dehiscent posterior canal in another case. Based on our findings, we might suggest a functional dissociation between high (impaired) and low (spared/recovered) accelerations for SCs. Therefore, it could be hypothesized that HS in labyrinthine fistula might be due to the activation of regular ampullary fibers encoding low-velocity inputs, as pressure-induced nystagmus is perfectly aligned with the planes of dehiscent SCs in accordance with Ewald's laws, despite global vestibular impairment on vHIT. Moreover, we showed how pressure-induced nystagmus could present in a rare case of labyrinthine fistulas involving all canals simultaneously. Nevertheless, definite conclusions on the genesis of pressure-induced nystagmus in our patients are prevented due to the lack of objective measurements of both low-acceleration canal responses and otolith function.

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“…BN and LN usually appear in the opposite directions, but they can also appear in the same direction in some patients. 7 18 19 42 43 44 Kim et al 44 showed that the rate of positive BLT findings was as high as 100% in patients with light and heavy cupulae. However, we observed BN in 70.5% of the patients with pAG-DCPN, with most of those patients showing nystagmus with the fast phase directed toward the unaffected side, and LN in 75.0% of the patients with pAG-DCPN, with most of those patients showing nystagmus with the fast phase directed toward the affected side.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Patients with Persistent Apogeotropic and Persistent Geotropic Direction-Changing Positional Nystagmus

Shen

et al. 2021

J Clin Neurol

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Background and Purpose This study aimed to determine the clinical features, diagnosis, and treatment of patients with persistent geotropic (pG) and persistent apogeotropic (pAG) direction-changing positional nystagmus (DCPN). Methods This retrospective study included 30 patients with pG-DCPN and 44 patients with pAG-DCPN. All patients underwent neurological and neurotological examinations, including an evaluation of gaze-evoked nystagmus, eye-movement tests, and assessments of limb ataxia and balance, as well as magnetic resonance imaging to exclude central causes. The characteristics of positional nystagmus were detected using the supine roll test (SRT) and bow-and-lean test (BLT). The null point (NP) at which the nystagmus disappeared was determined. All patients were treated with the barbecue maneuver, and treatment efficacy was evaluated immediately, 1 week, and 1 month after treatment. Results The history of diseases associated with atherosclerosis, peripheral vestibular disorders, otological disease, and migraine differed significantly between patients with pG-DCPN and pAG-DCPN. The affected sides of persistent horizontal DCPN can be determined using the SRT and the BLT, while determining the second NP and vestibular function as well as performing an audiological evaluation can be used to assist in identifying the affected side. The efficacy rates immediately and 1 week after treatment with the barbecue maneuver were higher in patients with pAG-DCPN than in patients with pG-DCPN. Conclusions pAG-DCPN was more compatible with the characteristics of cupulolithiasis, and pG-DCPN was more likely to be associated with a light cupula rather than canalolithiasis. pAG-DCPN was more likely to be accompanied by a disease associated with atherosclerosis, while pG-DCPN was often accompanied by autoimmune-related diseases and a history of migraine. The associations between pAG-DCPN, pG-DCPN, and the above-mentioned diseases need to be clarified further. The canalith-repositioning maneuver was effective in patients with pAG-DCPN and ineffective in patients with pG-DCPN, but most cases of pG-DCPN are self-limiting.

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Utility of the bow and lean test in predicting subtype of benign paroxysmal positional vertigo

Abstract: 4 Laryngoscope, 2600-2604, 2018.

Cited by 25 publications

References 17 publications

Positional Audiometry in Patients with Light Cupula: A Preliminary Study

Positional Audiometry in Patients with Light Cupula: A Preliminary Study

Case Report: Could Hennebert's Sign Be Evoked Despite Global Vestibular Impairment on Video Head Impulse Test? Considerations Upon Pathomechanisms Underlying Pressure-Induced Nystagmus due to Labyrinthine Fistula

Clinical Characteristics of Patients with Persistent Apogeotropic and Persistent Geotropic Direction-Changing Positional Nystagmus

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