后半规管BPPV嵴帽结石症

关键词： posterior canal-benign paroxysmal positional vertigo cupulolithiasis

== Title: Treatment Maneuvers in Cupulolithiasis of the Posterior Canal Benign Paroxysmal Positional Vertigo

 = 嵴帽结石解脱方法：Head-shaking and mastoid oscillation maneuvers

== 入组标准

 = The inclusion criteria consisted of (1) repetitive episodes of positional vertigo or dizziness; (2)positional nystagmus beating torsionally with the upper pole of the eye to the lower ear and vertically upward (to the forehead) and lasting longer than 1 minute, which was evoked by Dix-Hallpike or half Dix-Hallpike maneuver; and (3) absence of accompanying neurologic symptoms or signs suggesting central nervous system disorders. Patients were excluded who declined to participate or had cervical spine problems, multicanal BPPV, or cognitive dysfunction.

问题：有没有重复诊断试验

== head-shaking maneuver

 = For the head-shaking maneuver,11 patients were placed in a sitting position. After pitching the head forward by 30°, the head was moved laterally at a sinusoidal rate of approximately 3 Hz for 15 seconds 

低头30度正确吗，应该低头60度

== 复位效果评估

 = The primary outcome was the short-term resolution rate of positional vertigo and nystagmus the following day. The secondary outcome was the immediate efficacy of 2 trials of each maneuver within 30 minutes.

即刻复位效果非常差，也就是并没有能够实现Cupulolithiasis转为管石 For the secondary outcome (the immediate effectiveness of 2 trials of each maneuver compared with sham within 30 minutes), no significant difference was detected (6 of 53 [11.3%] vs 4 of 53 [7.5%] vs 2 of 53 [3.8%]; P = .34; α = .05) 次日复位效果各组之间存在差异的原因值得探讨和分析。 没有Cupulolithiasis转为管石的数据。这个可以通过Epley法复位过程眼震观察来进行判断。

%0 Journal Article %T Effect of the Epley Maneuver and Brandt-Daroff Exercise on Benign Paroxysmal Positional Vertigo Involving the Posterior Semicircular Canal Cupulolithiasis: A Randomized Clinical Trial. %A Seo-Young · Choi/Choi SY %A Jae Wook · Cho/Cho JW %A Jae-Hwan · Choi/Choi JH %A Eun Hye · Oh/Oh EH %A Kwang-Dong · Choi/Choi KD %+ [Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea., Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea., Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea., Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea., Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea.] %J Frontiers in neurology %D 2020 11 %P 603541 %K [Brandt-Daroff exercise,Epley maneuver,benign paroxysmal positional vertigo,cupulolithiasis,nystagmus,posterior semicircular canal,vertigo] %X Objective: To investigate the therapeutic efficacies of the Epley maneuver and Brandt-Daroff (BD) exercise in patients with benign paroxysmal positional vertigo involving the posterior semicircular canal cupulolithiasis (PC-BPPV-cu). Methods: We conducted a randomized clinical trial to evaluate the therapeutic effect of the Epley maneuver and BD exercise in patients with PC-BPPV-cu. Patients were randomly assigned to undergo the Epley maneuver (n = 29) or BD exercise (n = 33). The primary outcome was an immediate resolution of positional nystagmus within 1 h after a single treatment of each maneuver on the visit day. Secondary outcomes included the resolution of positional nystagmus at 1 week, the change of maximal slow phase velocity (mSPV) of positional nystagmus, and dizziness handicap inventory (DHI) immediately and at 1 week. Results: Immediate resolution occurred in none of 29 patients in the Epley maneuver group and only 1 of 33 patients in the BD exercise group. The Epley maneuver and BD exercise had an equivalent effect at 1 week in treating PC-BPPV-cu in terms of resolving positional nystagmus (48 vs. 36%, p = 0.436) and the decrease of mSPV and DHI. Conclusion: Neither the Epley maneuver nor BD exercise has an immediate therapeutic effect in treating PC-BPPV-cu. Clear classification of PC-BPPV should be required at the time of different pathology and different treatment response. %@ 1664-2295 %L 10.3389/fneur.2020.603541 %W HZBOOK

%0 Journal Article %T Cupulolithiasis. %A H F · Schuknecht/Schuknecht HF %A R R · Ruby/Ruby RR %J Advances in oto-rhino-laryngology. %D 1973 20 %P 434-43 %X %@ 0065-3071 %L 10.1159/000393114 %W HZBOOK

%0 Journal Article %T 3D analysis of benign positional nystagmus due to cupulolithiasis in posterior semicircular canal. %A Takao · Imai/Imai T %A Noriaki · Takeda/Takeda N %A Mahito · Ito/Ito M %A Kazunori · Sekine/Sekine K %A Go · Sato/Sato G %A Yoshihiro · Midoh/Midoh Y %A Koji · Nakamae/Nakamae K %A Takeshi · Kubo/Kubo T %+ [Department of Otolaryngology, Osaka Seamen's Insurance Hospital, Osaka, Japan. imaitakao@hotmail.com] %J Acta oto-laryngologica. %D 2009 129 %N 10 %P 1044-9 %X CONCLUSIONS: The characteristic of both the vertical-torsional positional nystagmus with long time constant and its disappearance at the neutral head position could diagnose cupulolithiasis in posterior semicircular canal (PSCC) in the eight patients with the PSCC type of benign paroxysmal positional vertigo (P-BPPV). OBJECTIVE: The aim of the study was to diagnose cupulolithiasis in patients with P-BPPV. PATIENTS AND METHODS: We used three-dimensional rotation axis analysis of nystagmus of the vertical-torsional positional nystagmus in 111 patients with P-BPPV and evaluated its time constant. We then examined whether the vertical-torsional positional nystagmus with long time constant disappeared at the neutral head position where the axis of the heavy cupula of the affected PSCC is aligned with gravity. RESULTS: The first parameter showed a wide variation that could be divided into two groups: one lasting more than 40 s in 8 patients and another below 20 s in 103 patients. Since the time constant of the positional nystagmus induced by cupulolithiasis was much longer than that induced by canalolithiasis, this finding suggests that cupulolithiasis in the PSCC induced the vertical-torsional positional nystagmus with a long time constant in the group of eight patients. The vertical-torsional positional nystagmus disappeared in these patients at the neutral head position, where the axis of the cupula of affected PSCC aligned with gravity. %@ 1651-2251 %L 10.1080/00016480802566303 %W HZBOOK

%0 Journal Article %T The canalith repositioning procedure with and without mastoid oscillation for the treatment of benign paroxysmal positional vertigo. %A Michael J · Ruckenstein/Ruckenstein MJ %A Neil T · Shepard/Shepard NT %+ [Department of Otorhinolaryngology, Head and Neck Surgery and Balance Center, The University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. ruckensm@uphs.upenn.edu] %J ORL; journal for oto-rhino-laryngology and its related specialties. %D 2007 69 %N 5 %P 295-8 %X OBJECTIVE: To evaluate the efficacy of mastoid oscillation performed with a canalith repositioning procedure (CRP) for the treatment of benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: A total of 137 patients with posterior canal BPPV were treated with an Epley CRP with or without mastoid oscillation at a tertiary care, university-based balance center. Data were collected prospectively from all patients via a preprinted diary which they maintained for 14 days after the maneuver. Patients underwent office evaluation at 2 weeks after the maneuver. RESULTS: A total of 137 patients were divided equally between the treatment groups. At 48 h post-treatment, 61% (with vibration) and 64% (without vibration) of patients were free of vertigo. At 2 weeks' post-treatment, 74% (with vibration) and 85% (without vibration) were vertigo-free. Residual symptoms of lightheadedness/imbalance were experienced by 32% of patients with vibration and 40% of patients without vibration. None of these differences between groups were statistically significant. CONCLUSION: The addition of mastoid oscillation to the positioning maneuver does not add any therapeutic benefit. %@ 1423-0275 %L 10.1159/000105265 %W HZBOOK

%0 Journal Article %T Cupulolithiasis. %A H F · Schuknecht/Schuknecht HF %J Archives of otolaryngology. %D 1969 90 %N 6 %P 765-78 %X %@ 0003-9977 %L 10.1001/archotol.1969.00770030767020 %W HZBOOK

%0 Journal Article %T Clinical characteristics and repositioning efficacy analysis of posterior canal-benign paroxysmal positional vertigo-canalolithiasis and vertigo-cupulolithiasis patients. %A Wenting · Wang/Wang W %A Yongci · Hao/Hao Y %A Huimiao · Liu/Liu H %A Sai · Zhang/Zhang S %A Ting · Zhang/Zhang T %A Shuangmei · Yan/Yan S %A Yang · Wang/Wang Y %A Yilin · Lang/Lang Y %A Xu · Yang/Yang X %A Ping · Gu/Gu P %+ [Department of Neurology, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China., Department of Neurology, Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang, Hebei, China., Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China., Department of Neurology, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China., Department of Neurology, Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang, Hebei, China., Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China., Department of Neurology, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China., Department of Neurology, Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang, Hebei, China., Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China., Department of Neurology, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China., Department of Neurology, Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang, Hebei, China., Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China., Department of Neurology, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China., Department of Neurology, Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang, Hebei, China., Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China., Department of Neurology, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China., Department of Neurology, Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang, Hebei, China., Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China., Department of Neurology, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China., Department of Neurology, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China., Department of Neurology, Peking University First Hospital, Beijing, China., Department of Neurology, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China., Department of Neurology, Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang, Hebei, China., Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China., Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, Hebei, China., Department of Vertigo Center, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.] %J Acta oto-laryngologica. %D 2025 145 %N 1 %P 7-15 %K [Canalolithiasis, benign paroxysmal positional vertigo, cupulolithiasis, posterior canal] %X BACKGROUND: Currently, there is a ‌paucity of research‌ comparing the clinical characteristics and repositioning efficacy between ‌posterior canal-benign paroxysmal positional vertigo-canalolithiasis (PC-BPPV-ca)‌ and ‌posterior canal-benign paroxysmal positional vertigo-cupulolithiasis (PC-BPPV-cu)‌. AIMS/OBJECTIVES: To observe the clinical characteristics and compare the efficacy of repositioning maneuvers between PC-BPPV-ca and PC-BPPV-cu patients. MATERIAL AND METHODS: Clinical information of patients was collected. The G-Force BPPV diagnostic apparatus was used to simulate dizziness handicap inventory (DHI) positional test, and the therapeutic effects, DHI, and sentiment indicators of baseline, and 1-week and 1-month treatment were compared. RESULTS: A total of 92 patients were collected, with 46 cases in each group, and PC-BPPV-cu patients were with the longer disease course and have worse sleep quality than that of PC-BPPV-ca patients. Moreover, the PC-BPPV-cu patients had a shorter latency of nystagmus and a greater intensity of nystagmus (p < .05); however, PC-BPPV-ca patients experienced higher proportion of reverse nystagmus. In terms of repositioning efficacy, the PC-BPPV-cu group had poorer initial efficacy compared to the PC-BPPV-ca group (p < .05). CONCLUSIONS: PC-BPPV-cu patients exhibit more extended disease duration, diminished sleep quality, and pronounced nystagmus. Additionally, they tend to experience less effective initial repositioning treatments and continue to present with more pronounced residual depressive symptoms. %@ 1651-2251 %L 10.1080/00016489.2024.2437560 %W HZBOOK

%0 Journal Article %T Efficacy of mastoid oscillation and the Gufoni maneuver for treating apogeotropic horizontal benign positional vertigo: a randomized controlled study. %A Hyun Ah · Kim/Kim HA %A Sang-Won · Park/Park SW %A Jungil · Kim/Kim J %A Bong-Gu · Kang/Kang BG %A Jun · Lee/Lee J %A Byung In · Han/Han BI %A Jung Im · Seok/Seok JI %A Eun-Ji · Chung/Chung EJ %A Jaeyoung · Kim/Kim J %A Hyung · Lee/Lee H %+ [Department of Neurology, Keimyung University Dongsan Hospital, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea., Department of Neurology, Daegu Fatima Hospital, Daegu, South Korea., Department of Neurology, Kyungil Neurologic Clinic and Internal Medicine, Daegu, South Korea., Department of Neurology, Andong Medical Group Hospital, Andong, South Korea., Department of Neurology, Yeungnam University Medical Center, Daegu, South Korea., Department of Neurology, Do Neurology Clinic, Daegu, South Korea., Department of Neurology, School of Medicine, Catholic University of Daegu, Daegu, South Korea., Department of Neurology, Daegu Municipal Medical Center, Daegu, South Korea., Department of Preventive Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea., Department of Neurology, Keimyung University Dongsan Hospital, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea. hlee@dsmc.or.kr.] %J Journal of neurology. %D 2017 264 %N 5 %P 848-855 %K [Benign paroxysmal positional vertigo,Randomized controlled trial,Treatment outcome,Vibration] %X To determine the immediate and short-term efficacies of mastoid oscillation vs. Gufoni maneuver in treating the apogeotropic type of horizontal canal benign paroxysmal positional vertigo (HC-BPPV), we designed a randomized, prospective, sham-controlled study. In eight dizziness clinics in Korea, 209 consecutive patients with apogeotropic HC-BPPV were enrolled. The patients were randomly assigned to receive a single application of Gufoni (n = 70), mastoid oscillation (n = 67), or sham maneuver (n = 72). Immediate and second-day responses were determined based on the results within 1 h after a single trial of each maneuver and the following day, respectively. Second-day response was assessed in patients who were non-responders on the first day. The short-term response was determined based on the cumulative response for 2 days. Successful treatment was defined as a resolution of positional nystagmus or as a transition into geotropic horizontal nystagmus (not requires vertigo symptom resolution). The immediate responses of the Gufoni maneuver (33/70, 47.1%) and mastoid oscillation (32/67, 47.8%) were better than the sham maneuver (14/72, 19.4%) (p = 0.00). The second-day results did not differ among the three groups (p = 0.76). The short-term responses showed better efficacies with the Gufoni maneuver (51/70, 76.1%) and mastoid oscillation (46/67, 71.9%) than with the sham maneuver (38/72, 53.5%) (p = 0.02). Therapeutic efficacies did not differ between the Gufoni and mastoid oscillation groups in terms of both immediate and short-term outcomes (p = 0.94, 0.57). Both the Gufoni maneuver and mastoid oscillation are valid methods for treating apogeotropic HC-BPPV, with a success rate of approximately 70% for a single maneuver during the short-term follow-up. TRIAL REGISTRATION: clinicaltrials.gov identifier number: NCT02046980. %@ 1432-1459 %L 10.1007/s00415-017-8422-2 %W HZBOOK

%0 Journal Article %T Effect of mastoid oscillation on the outcome of the canalith repositioning procedure. %A M · Motamed/Motamed M %A O · Osinubi/Osinubi O %A J A · Cook/Cook JA %+ [Leicester Balance Centre, Department of Otolaryngology, Head and Neck Surgery, Leicester Royal Infirmary, Leicester, UK. motamed2@hotmail.com] %J The Laryngoscope. %D 2004 114 %N 7 %P 1296-8 %X OBJECTIVE: The canalith repositioning procedure (CRP), as described by Epley, is a well-established method of treatment for benign paroxysmal positional vertigo (BPPV). Debate exists as to whether simultaneous application of a mastoid oscillator confers any added benefit. The aim of this study was to examine this question. STUDY DESIGN: Prospective randomized study. METHOD: Eighty-four subjects with unilateral posterior canal BPPV were randomized into two groups. The oscillator group was treated by CRP with mastoid oscillation and the nonoscillator group was treated by CRP alone. Positive outcome was regarded as complete resolution of symptoms and a negative Dix-Hallpike's test after a 4 to 6 week follow-up period. RESULTS: Five patients were lost to follow-up. Twenty-eight (72%) patients from the oscillator group and 26 (65%) patients from the nonoscillator group had a positive outcome. This difference was not significant (chi = 0.17, P =.68) CONCLUSION: For the treatment of posterior canal BPPV, concurrent mastoid oscillation with CRP does not significantly alter the short-term outcome. %@ 0023-852X %L 10.1097/00005537-200407000-00029 %W HZBOOK

%0 Journal Article %T Cupulolithiasis of the posterior semicircular canal. %A Hiroaki · Ichijo/Ichijo H %+ [Ichijo Ear, Nose and Throat Clinic, Hirosaki, Japan. hiro3387@mvj.biglobe.ne.jp] %J American journal of otolaryngology. %D 2013 34 %N 5 %P 458-63 %X BACKGROUND: We sometimes experience patients with persistent torsional/vertical (upbeating) positional nystagmus in the head-hanging position. We have been convinced of the existence of cupulolithiasis of the posterior semicircular canal because such cases reveal persistent torsional/vertical (downbeating) positional nystagmus in the nose-down position. PURPOSE: In order to confirm the validity of Ewald's third law, we quantified the difference between positional nystagmus in the head-hanging position and that in the nose-down position. METHODS: The subjects were 10 patients with posterior cupulolithiasis, 9 female and 1 male, with a mean age of 58.9years. Nystagmus was recorded using an infrared camera and the findings were converted to digital data. Using ImageJ, we performed three-dimensional video-oculography and measured the maximum slow-phase velocity (MSV) of three components. RESULTS: In the horizontal component, the mean value of MSV in the head-hanging position was 3°/s, and that in the nose-down position was 2.7°/s. There was no significant difference between the two positions. In the vertical component, the mean value of MSV in the head-hanging position was 4.3°/s, and that in the nose-down position was 6°/s. There was no significant difference between the two positions. In the torsional component, the mean value of MSV in the head-hanging position was 4.4°/s, and that in the nose-down position was 1.4°/s. The former was significantly greater than the latter (p<0.01). CONCLUSIONS: Although we could not confirm the validity of Ewald's third law, the torsional component in the head-hanging position was significantly greater than that in the nose-down position. %@ 1532-818X %L 10.1016/j.amjoto.2013.04.001 %W HZBOOK

%0 Journal Article %T Pathophysiology and management of cupulolithiasis. %A R R · Gacek/Gacek RR %J American journal of otolaryngology. %D 1985 6 %N 2 %P 66-74 %X Substantial support for the concept that the posterior semicircular canal is responsible for benign paroxysmal positional vertigo comes from four sources: clinical observations, temporal bone histopathology, experimental observations, and results of selective denervation of the posterior canal crista (singular neurectomy). The complete immediate relief of the positional vertigo and nystagmus that resulted from 39 of 40 singular neurectomies establishes this procedure as an effective management for patients with the chronic disabling form of cupulolithiasis. The ocular response in cupulolithiasis and the release nystagmus that follows singular neurectomy are explained by neural pathways that have been previously elucidated by anatomic and physiologic techniques. Although sensorineural hearing loss followed surgery three times among the first 15 patients, hearing loss has not occurred in the last 25 operations for cupulolithiasis. %@ 0196-0709 %L 10.1016/s0196-0709(85)80042-9 %W HZBOOK

%0 Journal Article %T Efficacy of physical therapy for intractable cupulolithiasis in an experimental model. %A K · Otsuka/Otsuka K %A M · Suzuki/Suzuki M %A M · Negishi/Negishi M %A S · Shimizu/Shimizu S %A T · Inagaki/Inagaki T %A U · Konomi/Konomi U %A T · Kondo/Kondo T %A Y · Ogawa/Ogawa Y %+ [Department of Otolaryngology, Tokyo Medical University, Japan. otsukaent@aol.com] %J The Journal of laryngology and otology. %D 2013 127 %N 5 %P 463-7 %X OBJECTIVE: To investigate what kinds of stimuli are effective in detaching otoconia from the cupula in three experimental models of cupulolithiasis. METHODS: Three experimental models of cupulolithiasis were prepared using bullfrog labyrinths. Three kinds of stimuli were applied to the experimental models. In experiment one (gravity), the labyrinth preparation was placed so that the cupula-to-crista axis was in the horizontal plane with the canal side in the downward position. In experiment two (sinusoidal oscillation), the labyrinth preparation was placed 3 cm from the rotational centre of a turntable, which was sinusoidally rotated with a rotational cycle of 1 Hz and a rotational angle of 30°. In experiment three (vibration), mechanical vibration was applied to the surface of the bony capsule around the labyrinth using a surgical drill. RESULTS: In experiments one, two and three, the otoconial mass was respectively detached in 2 out of 10 labyrinth preparations, none of the labyrinth preparations, and all of the labyrinth preparations. CONCLUSION: Vibration was the most effective stimulus for detaching the otoconia from the cupula in these experimental models of cupulolithiasis. %@ 1748-5460 %L 10.1017/S0022215113000698 %W HZBOOK

%0 Journal Article %T Case report: Atypical patterns of nystagmus suggest posterior canal cupulolithiasis and short-arm canalithiasis. %A Janet O · Helminski/Helminski JO %+ [Department of Physical Therapy, Rosalind Franklin University, North Chicago, IL, United States.] %J Frontiers in neurology %D 2022 13 %P 982191 %K [BPPV, benign paroxysmal positional vertigo, case report, cupulolithiasis, downbeat nystagmus, positional nystagmus, posterior canal, short arm canalithiasis] %X BACKGROUND: Atypical posterior canal (PC) positional nystagmus may be due to the changes in cupular response dynamics from cupulolithiasis (cu), canalithiasis of the short arm (ca-sa), or a partial/complete obstruction-jam. Factors that change the dynamics are the position of the head in the pitch plane, individual variability in the location of the PC attachment to the utricle and the position of the cupula within the ampulla, and the location of debris within the short arm and on the cupula. The clinical presentation of PC-BPPV-cu is DBN with torsion towards the contralateral side in the DH positions and SHHP or no nystagmus in the ipsilateral DH position and no nystagmus upon return to sitting from each position. The clinical presentation of PC-BPPV-ca-sa is no nystagmus in the DH position and upbeat nystagmus (UBN) with torsion lateralized to the involved side upon return to sitting from each position. CASE DESCRIPTION: A 68-year-old woman, diagnosed with BPPV, presented with DBN associated with vertigo in both DH positions and without nystagmus or symptoms on sitting up. In the straight head hanging position (SHHP), the findings of a transient burst of UBN with left torsion associated with vertigo suggested ipsicanal conversion from the left PC-BPPV-cu to canalithiasis. Treatment included a modified canalith repositioning procedure (CRP), which resulted in complete resolution. BPPV recurred 17 days later. Clinical presentation of BPPV included no nystagmus/symptoms in both the contralateral DH position and SHHP, DBN in the ipsilateral DH position without symptoms, and UBN with left torsion associated with severe truncal retropulsion and nausea on sitting up from provoking position. The findings suggested the left PC-BPPV-cu-sa and PC-BPPV-ca-sa. Treatment included neck extension, a modified CRP, and demi-Semont before complete resolution. CONCLUSION: An understanding of the biomechanics of the vestibular system is necessary to differentially diagnose atypical PC-BPPV. DH test (DHT) findings suggest that PC-BPPV-cu presents with DBN or no nystagmus in one or two DH positions and sometimes SHHP and without nystagmus or no reversal/reversal of nystagmus on sitting up. The findings suggest PC-BPPV-ca-sa has no nystagmus in DH positions or DBN in the ipsilateral DH position and UBN with torsion lateralized to the involved side on sitting up. %@ 1664-2295 %L 10.3389/fneur.2022.982191 %W HZBOOK

%0 Journal Article %T Clinical Application of Different Vertical Position Tests for Posterior Canal-Benign Paroxysmal Positional Vertigo-Cupulolithiasis. %A Wenting · Wang/Wang W %A Shuangmei · Yan/Yan S %A Sai · Zhang/Zhang S %A Rui · Han/Han R %A Dong · Li/Li D %A Yihan · Liu/Liu Y %A Ting · Zhang/Zhang T %A Shaona · Liu/Liu S %A Yuexia · Wu/Wu Y %A Ya · Li/Li Y %A Xu · Yang/Yang X %A Ping · Gu/Gu P %+ [Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China., Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China., Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China., Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China., Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China., Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China., Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China., Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China., Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China., Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China., Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China., Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China., Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China., Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, China.] %J Frontiers in neurology %D 2022 13 %P 930542 %K [Dix-Hallpike test, benign paroxysmal positional vertigo, cupulolithiasis, nystagmus, posterior semicircular canal, vertigo] %X BACKGROUND: Posterior 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. OBJECTIVES: To 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. METHODS: A 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). RESULTS: Among 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 (χ(2) = 0.243, P = 0.970). CONCLUSIONS: The 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. %@ 1664-2295 %L 10.3389/fneur.2022.930542 %W HZBOOK

%0 Journal Article %T Atypical PC-BPPV - Cupulolithiasis and Short-Arm Canalithiasis: A Retrospective Observational Study. %A Janet O · Helminski/Helminski JO %+ [College of Health Professions, Rosalind Franklin University, North Chicago, Illinois.] %J Journal of neurologic physical therapy : JNPT. %D 2025 49 %N 1 %P 51-61 %X BACKGROUND AND PURPOSE: Atypical posterior canal (pc) benign paroxysmal positional vertigo (BPPV) may be caused by cupulolithiasis (cu), short arm canalithiasis (ca), or jam. The purpose of this study was to describe the clinical presentation and differential diagnosis of pc-BPPV-cu and short arm canalithiasis. METHODS: This retrospective observation study identified persons with atypical pc-BPPV based on history and findings from four positional tests. Patterns of nystagmus suggested canal involved and mechanism of BPPV. Interventions included canalith repositioning procedures (CRP). RESULTS: Fifteen persons, 17 episodes of care, met inclusion criteria, 65% referred following unsuccessful CRPs. Symptoms included persistent, non-positional unsteadiness, "floating" sensation, with half experiencing nausea/vomiting. Downbeat nystagmus with/without torsion in Dix-Hallpike (DH) and Straight Head Hang (SHH) position and no nystagmus upon sitting up, occurred in 76% of persons attributed to pc-BPPV-cu. Upbeat nystagmus with/without torsion and vertigo/retropulsion upon sitting up, occurred in 24% attributed to pc-BPPV-ca short arm. During SHH, canal conversion from pc-BPPV-cu to long arm canalithiasis occurred in 31%. The Half-Hallpike position identified pc-BPPV-cu in 71%. The Inverted Release position identified pc-BPPV-cu adjacent short arm and pc-BPPV-ca short arm. DISCUSSION AND CONCLUSION: Persistent, peripheral nystagmus that is downbeat or downbeat/torsion away from involved ear in provoking positions and no nystagmus sitting up, may be attributed to pc-BPPV-cu, and nystagmus that is upbeat or upbeat/torsion towards involved ear upon sitting up may be attributed to pc-BPPV-ca short arm. Both are effectively treated with canal- and mechanism-specific CRPs. VIDEO ABSTRACT AVAILABLE: for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: (http://links.lww.com/JNPT/A487). %@ 1557-0584 %L 10.1097/NPT.0000000000000494 %W HZBOOK

%0 Journal Article %T Benign paroxysmal positional vertigo and its variants. %A D · Nuti/Nuti D %A M · Masini/Masini M %A M · Mandalà/Mandalà M %+ [Department of Otology and Skull Base Surgery, University of Siena, Siena, Italy. Electronic address: nutidani@gmail.com., Department of Social, Political and Cognitive Sciences, University of Siena, Siena, Italy., Department of Otology and Skull Base Surgery, University of Siena, Siena, Italy.] %J Handbook of clinical neurology. %D 2016 137 %P 241-56 %K [anterior semicircular canal,benign paroxysmal positional vertigo,canalolithiasis,cupulolithiasis,downbeat nystagmus,lateral semicircular canal,positional nystagmus,posterior semicircular canal] %X Benign paroxysmal positional vertigo is a common labyrinthine disorder caused by a mechanic stimulation of the vestibular receptors within the semicircular canals. It is characterized by positional vertigo and positional nystagmus, both provoked by changes in the position of the head with respect to gravity. The social impact of the disease and its direct and indirect costs to healthcare systems are significant owing to impairment of daily activities and increased risk of falls. The first description of a patient with benign paroxysmal positional vertigo is from Robert Bárány in 1921, but the features of the syndrome and the diagnostic maneuver were well described by Dix and Hallpike in 1952. Since then, the gradually increasing interest of otolaryngologists and neurologists has led to a progressive advance in the knowledge of this labyrinthine disorder with regard to its epidemiologic, pathophysiologic, clinical, and therapeutic aspects. Despite the often effective diagnosis and treatment of most cases of benign paroxysmal positional vertigo, the physiopathologic explanations of the disease are mainly speculative. In this chapter, we describe the epidemiologic, pathophysiologic, clinical, and therapeutic aspects of benign paroxysmal positional vertigo. %@ 0072-9752 %L 10.1016/B978-0-444-63437-5.00018-2 %W HZBOOK

%0 Journal Article %T Typical and atypical benign paroxysmal positional vertigo: literature review and new theoretical considerations. %A Béla · Büki/Büki B %A Marco · Mandalà/Mandalà M %A Daniele · Nuti/Nuti D %+ [Department of Otolaryngology, Karl Landsteiner University Hospital Krems, Krems an der Donau, Austria., Otology and Skull Base Surgery Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy., Otology and Skull Base Surgery Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy.] %J Journal of vestibular research : equilibrium & orientation. %D 2014 24 %N 5-6 %P 415-23 %K [Type 2 BPPV,canalolithiasis,cupulolithiasis,ipsicanal switch] %X Atypical variants of benign paroxysmal positional vertigo (BPPV) are often encountered and frequently confusing. The authors present a hypothetical framework that accounts for all classical patterns of BPPV and several unusual variants such as BPPV without nystagmus, BPPV with downbeat nystagmus and BPPV with paradoxically direction-changing nystagmus. The authors introduce new concepts, such as “ipsicanal switch“ and “horizontal short arm canalolithiasis“ and suggest that their use may improve diagnosis and treatment in everyday clinical practice. The possible consequences of saccular otoconia detachment are reviewed according to the literature. %@ 1878-6464 %L 10.3233/VES-140535 %W HZBOOK

%0 Journal Article %T New treatment strategy for cupulolithiasis associated with benign paroxysmal positional vertigo of the lateral canal: the head-tilt hopping exercise. %A Toshiaki · Yamanaka/Yamanaka T %A Yachiyo · Sawai/Sawai Y %A Takayuki · Murai/Murai T %A Hideyuki · Okamoto/Okamoto H %A Nobuya · Fujita/Fujita N %A Hiroshi · Hosoi/Hosoi H %J European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. %D 2014 271 %N 12 %P 3155-60 %X This study was performed to determine whether a novel treatment was effective against cupulolithiasis associated with benign paroxysmal positional vertigo (BPPV) of the lateral semicircular canal, which is characterized by apogeotropic direction-changing nystagmus. We herein describe our head-tilt hopping (HtH) exercise, which is designed to release otoconial debris strongly adhered to the cupula. The subjects were trained to hop while tilting their heads laterally. They completed 3 to 5 exercise sessions per day over a 4-week period. Each session ended with a 20-hop trial. The HtH exercises were performed by 27 patients with intractable lateral canal BPPV who exhibited positional vertigo and persistent nystagmus beating toward the uppermost ear for more than 4 weeks, despite performing therapeutic head shaking in the horizontal plane maneuver. All the patients were subjected to the supine roll test before and immediately after the first trial as well as after 1 and 4 weeks of the program to evaluate the effect of the treatment on their apogeotropic nystagmus. Nystagmus of 9 (33.3 %) patients disappeared immediately after the first training session. After 1 and 4 weeks of the training, the number of patients that had experienced either of these improvements had increased to 15 (55.6 %) and 19 (70.4 %) subjects, respectively. These results suggest that HtH exercises aimed at releasing otoconial debris from the cupula are feasible as a new therapy for cupulolithiasis associated with intractable lateral canal BPPV. However, further studies for comparison with control are required to confirm these preliminary results. %@ 1434-4726 %L 10.1007/s00405-013-2808-2 %W HZBOOK

%0 Journal Article %T Retrospective analysis of nystagmus characteristics and clinical applications of positional testing in patients with cupulolithiasis of the posterior semicircular canal in benign paroxysmal positional vertigo. %A Jing · Wu/Wu J %A Yihuai · Zou/Zou Y %A Wenyan · Xu/Xu W %A Hongming · Ma/Ma H %A Lixian · Huang/Huang L %A Bo · Zhao/Zhao B %A Liman · Sun/Sun L %+ [Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China., Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China., Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China., Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China., Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China., Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China., Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.] %J Frontiers in neurology %D 2024 15 %P 1413929 %K [Half-Hallpike maneuver, Vertigo, benign paroxysmal positional vertigo, positional testing, posterior semicircular canal cupulolithiasis] %X OBJECTIVE: This study aimed to investigate the characteristics of positional nystagmus in patients with cupulolithiasis of the posterior semicircular canal-benign paroxysmal positional vertigo (PC-BPPV-cu) to improve clinical diagnostic accuracy. METHODS: This study retrospectively analyzed 128 cases of PC-BPPV-cu and 128 cases of canalolithiasis of BPPV (PC-BPPV-ca). General data, intensity, distribution, and the correlation of positional nystagmus were compared between the two groups. RESULTS: Compared to the PC-BPPV-ca group, more cases from the PC-BPPV-cu group initially presented in the emergency department (P < 0.05). The most frequent positional nystagmus induced by PC-BPPV-cu was torsional-upbeat nystagmus, characterized by the upper pole of the affected eye beating toward the lower ear and vertically upward (387 cases, 59.7%). It was followed by torsional-downbeat nystagmus, characterized by the upper pole of the unaffected eye beating toward the lower ear and vertically downward (164 cases, 25.3%). The former represented posterior canal excitatory nystagmus (PC-EN), while the latter represented posterior canal inhibitory nystagmus (PC-IN). In the PC-BPPV-cu group, PC-EN was most easily caused by the Half Dix-Hallpike (HH) maneuver on the affected side, while PC-IN was most easily induced by a face-down position (FDP) on the unaffected side at approximately 45° angle (45° FDP). The vertical slow phase velocity (v-SPV) of positional nystagmus was more potent in the affected HH than in other positions with PC-EN (all P < 0.05); the v-SPV of positional nystagmus was greater in the 45° FDP than in different positions with PC-IN (all P < 0.05); the v-SPV of the affected Dix-Hallpike (DH) maneuver in the PC-BPPV-ca group was significantly greater than that of the affected HH maneuver in the PC-BPPV-cu group (P < 0.05). The a priori analysis showed that the strongest correlation with HH positional nystagmus was observed in the affected side roll test, followed by the DH maneuver. CONCLUSION: In the PC-BPPV-cu group, the HH maneuver most easily induced PC-EN on the affected side, and PC-IN was most easily induced by the 45° FDP. In some cases of PC-BPPV-cu, significant nystagmus was not observed to be induced in the DH position on the affected side; however, vertical rotation nystagmus was induced in the roll-test position on the affected side. In such cases, PC-BPPV-cu diagnosis should be considered, and HH and 45° FDP tests should be conducted to support the diagnosis. %@ 1664-2295 %L 10.3389/fneur.2024.1413929 %W HZBOOK

%0 Journal Article %T Effect of applying head-shaking maneuver before Epley maneuver in BPPV. %A Suphi · Bulğurcu/Bulğurcu S %A Eyup · Baz/Baz E %A Selin · Güleryüz/Güleryüz S %A Evren · Erkul/Erkul E %A Engin · Çekin/Çekin E %+ [Sultan Abdulhamid Han Training and Research Hospital, Department of Otorhinolaryngology, İstanbul, Turkey. Electronic address: suphibulg@yahoo.com., Sultan Abdulhamid Han Training and Research Hospital, Department of Otorhinolaryngology, İstanbul, Turkey., Sultan Abdulhamid Han Training and Research Hospital, Department of Otorhinolaryngology, İstanbul, Turkey., Sultan Abdulhamid Han Training and Research Hospital, Department of Otorhinolaryngology, İstanbul, Turkey., Sultan Abdulhamid Han Training and Research Hospital, Department of Otorhinolaryngology, İstanbul, Turkey.] %J Brazilian journal of otorhinolaryngology. %D 2022 88 %N 6 %P 932-936 %K [Canalolithiasis, Dizziness, Otolith, Utricle, Vertigo] %X INTRODUCTION: The Epley maneuver is applied in the treatment of benign paroxysmal positional vertigo, the BPPV. However, dizziness and balance problems do not improve immediately after the treatment. OBJECTIVE: In this study, the effectiveness of the head-shaking maneuver before the Epley maneuver was investigated in the treatment of BPPV. METHODS: Between March 2020 and August 2020, ninety-six patients with posterior semicircular canal BPPV were analyzed prospectively. The patients were divided into two groups: patients who underwent the Epley maneuver only in the treatment (Group 1) and patients who underwent the Epley maneuver after the head-shaking maneuver (Group 2). The results of the Berg balance scale and dizziness handicap index were evaluated before the treatment and at the first week after the treatment. RESULTS: The improvement in functional, emotional, and physical dizziness handicap index and Berg balance scale values after the treatment was found to be statistically significant in both groups. It was determined that the change in functional and physical dizziness handicap index and Berg balance scale values of the patients in Group 2 was statistically higher than those in Group 1. Although, the change in emotional dizziness handicap index values in Group 2 was higher than those in Group 1, no statistical significance was found between the groups. CONCLUSION: As a result of our hypothesis, we think that in the treatment of posterior semicircular canal BPPV, the otoliths adhered to the canal can be mobilized by the head-shaking maneuver, and this will contribute to the increase of the effectiveness of the Epley maneuver. %@ 1808-8686 %L 10.1016/j.bjorl.2020.12.015 %W HZBOOK

%0 Journal Article %T Analysis of 30 patients with cupulolithiasis of the posterior semicircular canal. %A Hiroaki · Ichijo/Ichijo H %+ [Ichijo Ear, Nose and Throat Clinic, 3-2-1, Ekimae, Hirosaki, 036-8002, Japan. hiro3387@mvj.biglobe.ne.jp.] %J European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. %D 2023 280 %N 2 %P 599-603 %K [Benign paroxysmal positional vertigo, Disease duration, Onset time, Positional nystagmus, Video-oculography] %X BACKGROUND: The diagnostic characteristics of patients with cupulolithiasis of the posterior semicircular canal are persistent torsional nystagmus in the supine position and persistent torsional nystagmus (opposite direction) in the nose-down position, which are caused by the affected canal becoming gravity sensitive. OBJECTIVE: To investigate the clinical features of posterior cupulolithiasis. MATERIALS AND METHODS: We interviewed 30 consecutive patients with cupulolithiasis of the posterior canal and categorized them by onset time into the following four groups: (1) during sleep; (2) at the time of awakening; (3) morning; and (4) afternoon. We defined disease duration as the period from onset to the day when we detected remission of positional nystagmus. RESULTS: Time of awakening was the most common onset time. The mean disease duration was 18.2 days, and 90% of patients achieved cure within 1 month. CONCLUSIONS: Physicians should take into account the duration of nystagmus, because cupulolithiasis of posterior canal exists. The etiology of posterior cupulolithiasis is closely related to sleep, because time of awakening is the most common onset time of vertigo. Most patients with posterior cupulolithiasis cure within 1 month. %@ 1434-4726 %L 10.1007/s00405-022-07508-2 %W HZBOOK

%0 Journal Article %T Posterior canal benign paroxysmal positional vertigo with long duration: Heavy or light cupula? %A Chang-Hee · Kim/Kim CH %A Jung Eun · Shin/Shin JE %A Hansol · Kim/Kim H %A Joon Yong · Park/Park JY %+ [Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science Konkuk University School of Medicine Seoul Republic of Korea., Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science Konkuk University School of Medicine Seoul Republic of Korea., Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science Konkuk University School of Medicine Seoul Republic of Korea., Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science Konkuk University School of Medicine Seoul Republic of Korea.] %J Laryngoscope investigative otolaryngology. %D 2023 8 %N 4 %P 1108-1113 %K [Canalolithiasis, Cupulolithiasis, benign paroxysmal positional vertigo, light cupula, posterior semicircular canal] %X OBJECTIVE: To investigate the characteristics of positional nystagmus in posterior semicircular canal (PSCC) benign paroxysmal positional vertigo (BPPV) patients with longer durations, and to discuss the possible underlying mechanism of this nystagmus. METHODS: We conducted a retrospective review, and enrolled 118 consecutive patients with unilateral PSCC BPPV. The duration of nystagmus during a Dix-Hallpike test was classified into short (<1 min) and long (≥1 min) durations. For the identification of a neutral point in PSCC BPPV patients with long durations, the patient's head was turned 45° to the lesioned side to set the affected PSCC on the sagittal plane, and the disappearance of positional nystagmus was investigated in a pitch plane. RESULTS: Among 118 patients with PSCC BPPV, positional nystagmus during a Dix-Hallpike test showed short durations (<1 min) in 112 patients and long durations (≥1 min) in 6 patients. Of 6 PSCC BPPV patients with a long duration, a neutral point was identified in 5 patients whose nystagmus lasted for longer than 2 min; interestingly, a neutral point was observed when the patient's head was slightly tilted backward in all 5 patients. CONCLUSION: Considering that a neutral position was identified when the patient's head was slightly tilted backward while keeping the head turned 45° to the right or left, we assume that the light cupula condition of the ipsilateral PSCC or the contralateral anterior semicircular canal, and not PSCC BPPV cupulolithiasis, could be responsible for the occurrence of persistent torsional-upbeating nystagmus in a Dix-Hallpike test. LEVEL OF EVIDENCE: 4. %@ 2378-8038 %L 10.1002/lio2.1113 %W HZBOOK

%0 Journal Article %T Atypical Benign Paroxysmal Positional Vertigo: Concomitant Cupulolithiasis and Short-Arm Canalolithiasis Involving the Posterior Canal? %A Hyun-Jae · Kim/Kim HJ %A Namyoung · Kim/Kim N %A Young-Eun · Gil/Gil YE %A Ji-Soo · Kim/Kim JS %+ [Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea., Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea., Department of Neurology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea., Department of Neurology, Dizziness Center, and Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea., Department of Neurology, Seoul National University College of Medicine, Seoul, Korea. jisookim@snu.ac.kr.] %J Journal of clinical neurology. %D 2024 20 %N 3 %P 336-338 %@ 1738-6586 %L 10.3988/jcn.2023.0445 %W HZBOOK

%0 Journal Article %T Vestibular function in cases of posterior semicircular canal canalolithiasis and cupulolithiasis. %A Xu · Wenyan/Wenyan X %A Yue · Lifeng/Lifeng Y %A Wu · Jing/Jing W %A Jiang · Hui/Hui J %+ [Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China., Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China., Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China., Department of Otolaryngology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China.] %J Frontiers in neurology %D 2024 15 %P 1369193 %K [benign paroxysmal positional vertigo, cupulolithiasis, vestibular evoked myogenic potentials, vestibular function, video head impulse test] %X OBJECTIVE: To analyze and compare the vestibular function of posterior canal cupulolithiasis and canalolithiasis. METHODS: The results of posterior cupulolithiasis in 45 cases, posterior canalolithiasis in 122 cases and 19 healthy controls were analyzed retrospectively. RESULTS: The abnormal rates of vHIT in the canalolithiasis group and the cupulolithiasis group were 42.6 and 37.8%, respectively, both higher than those in the control group (both p < 0.05); there was no statistically significant difference between two BPPV groups (p = 0.573). The abnormal vHIT in 76.9% of the canalolithiasis cases and 82.4% of the cupulolithiasis cases showed normal gain with saccades, with no difference between the groups (p = 0.859). The lesion location of vHIT in the two groups did not show a correlation with the affected side of BPPV (both p > 0.05). 84.4% of canalolithiasis and 65.0% of cupulolithiasis had abnormal VEMP results, with no significant differences in abnormality rates or sides (both p > 0.05). Abnormal results of VEMPs did not show any correlation with side (p > 0.05). The results of pc-ca and pc-cu were both abnormal in 14 cases and 7 cases, and there was no correlation between the site and side of the injury (all p > 0.05). CONCLUSION: The results of vHIT and VEMP in pc-cu and pc-ca were partially abnormal, but they did not show any correlation with side of BPPV. It can be considered that there are scattered vestibular peripheral organ damage in both groups. %@ 1664-2295 %L 10.3389/fneur.2024.1369193 %W HZBOOK

%0 Journal Article %T Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion. %A L S · Parnes/Parnes LS %A J A · McClure/McClure JA %+ [Department of Otolaryngology, University of Western Ontario, London, Canada.] %J The Laryngoscope. %D 1992 102 %N 9 %P 988-92 %X Most clinicians accept cupulolithiasis as the pathophysiological mechanism underlying benign paroxysmal positional vertigo (BPPV.) According to this theory, a cupular deposit induces a gravitational effect on the posterior canal crista. Posterior semicircular canal occlusion is a new operative procedure for treating incapacitating BPPV. It is postulated that canal occlusion abolishes endolymph movement within the canal, effectively fixing the cupula and rendering it unresponsive to both angular and linear acceleration (gravity). During two recent canal occlusions, abundant “free-floating particles“ were identified within the posterior canal endolymph. When changing the position of the canal in the earth vertical plane, these free-floating particles would move under the influence of gravity. The hydrodynamic drag of the particles would induce endolymph movement with cupular displacement leading to the typical response. This finding supports an alternate explanation to cupulolithiasis as the pathophysiological mechanism underlying BPPV. %@ 0023-852X %L 10.1288/00005537-199209000-00006 %W HZBOOK

%0 Journal Article %T Treatment Efficacy of Various Maneuvers for Lateral Canal Benign Paroxysmal Positional Vertigo With Apogeotropic Nystagmus: A Randomized Controlled Trial. %A Hyun Jin · Lee/Lee HJ %A Eun-Ju · Jeon/Jeon EJ %A Sungil · Nam/Nam S %A Seog-Kyun · Mun/Mun SK %A Shin-Young · Yoo/Yoo SY %A Seong Hyun · Bu/Bu SH %A Jin Woong · Choi/Choi JW %A Jae Ho · Chung/Chung JH %A Seok Min · Hong/Hong SM %A Seung-Hwan · Lee/Lee SH %A Min-Beom · Kim/Kim MB %A Ja-Won · Koo/Koo JW %A Hyun Ji · Kim/Kim HJ %A Jae-Hyun · Seo/Seo JH %A Seong-Ki · Ahn/Ahn SK %A Shi Nae · Park/Park SN %A Minbum · Kim/Kim M %A Won-Ho · Chung/Chung WH %+ [Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea., Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea., Department of Otorhinolaryngology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea., Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea., Myoung-dong Yonsei Ear Clinic, Seoul, Korea., Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea., Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Korea., Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea., Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea., Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea., Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea., Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea., Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, Korea., Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea., Department of Otorhinolaryngology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea., Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea., Department of Otorhinolaryngology-Head and Neck Surgery, Catholic Kwandong University College of Medicine, Gangneung, Korea., Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea.] %J Clinical and experimental otorhinolaryngology. %D 2023 16 %N 3 %P 251-258 %K [Cupulolith Repositioning Maneuver, Gufoni-Appiani Maneuver, Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo, Therapeutic Head-Shaking] %X OBJECTIVES: The aim of this study was to determine the most effective treatment approach by comparing the impacts of various otolith reduction techniques in patients with apogeotropic lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV). METHODS: We performed a multicenter randomized prospective study from January to December 2015, involving 72 consecutive patients with apogeotropic LC-BPPV. The patients were divided into three treatment groups: therapeutic head-shaking (group A), the Gufoni-Appiani maneuver (group B), and the cupulolith repositioning maneuver (CuRM; group C). Each group underwent evaluation and treatment up to the fourth week. Treatment success was defined as the disappearance of positional vertigo and nystagmus. RESULTS: This study included 72 patients (49 male and 23 female), with a mean (±standard deviation) age of 55.4±13.5 years. The mean duration of vertigo experienced prior to treatment was 3.9±4.4 days. The mean latency and duration of nystagmus were 2.7±3.0 seconds and 47.9±15.8 seconds, respectively. The overall treatment frequency was 2.0±0.9. The number of treatments differed significantly among the three groups (P<0.05). After 4 weeks, the success rates for groups A, B, and C were 90.5%, 92.3%, and 100%, respectively. No significant difference was observed in the success rate across treatment. METHODS: and periods (P>0.05). However, CuRM was the only method with a 100% treatment success rate. CONCLUSION: While no clear difference was observed among the three treatments for LC-BPPV, CuRM was found to be superior to the other approaches in the long term. %@ 1976-8710 %L 10.21053/ceo.2023.00619 %W HZBOOK

%0 Journal Article %T Less talked variants of benign paroxysmal positional vertigo. %A Jae-Myung · Kim/Kim JM %A Seung-Han · Lee/Lee SH %A Hyo-Jung · Kim/Kim HJ %A Ji-Soo · Kim/Kim JS %+ [Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea., Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea., Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Republic of Korea., Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: jisookim@snu.ac.kr.] %J Journal of the neurological sciences. %D 2022 442 %P 120440 %K [Benign paroxysmal positional vertigo, Nystagmus, Semicircular canal] %X The diagnostic criteria were established for benign paroxysmal positional vertigo (BPPV), the most common vestibular disorder worldwide, by the Barany Society in 2015. This marked an important milestone in the diagnosis and treatment of BPPV. However, there still remain uncertainties and ambiguities regarding the clinical features and pathophysiology of BPPV, and its clinical variants. In this manuscript, we will discuss 1) the emerging and controversial syndromes of BPPV (i.e., canalolithiasis of the anterior canal, cupulolthiasis of the posterior canal, and lithiasis of multiple canals) with updates, 2) atypical nystagmus according to the canal involved (e.g., nystagmus induced by head position changes in the pitch plane in horizontal canal BPPV, and positional downbeat nystagmus in posterior canal BPPV), 3) persistent geotropic positional nystagmus. Consideration of these uncommon types and manifestations of BPPV would broaden our understanding of BPPV pathomechanisms and allow differentiation from central vertigo and nystagmus. %@ 1878-5883 %L 10.1016/j.jns.2022.120440 %W HZBOOK

%0 Journal Article %T Treatment Maneuvers in Cupulolithiasis of the Posterior Canal Benign Paroxysmal Positional Vertigo: A Randomized Clinical Trial. %A Eun Hye · Oh/Oh EH %A Jae-Hwan · Choi/Choi JH %A Hyun Sung · Kim/Kim HS %A Seo Young · Choi/Choi SY %A Hyun Ah · Kim/Kim HA %A Hyung · Lee/Lee H %A In Soo · Moon/Moon IS %A Ji-Yun · Park/Park JY %A Byeol-A · Yoon/Yoon BA %A Sang Ho · Kim/Kim SH %A Jeong-Yeon · Kim/Kim JY %A Hyo Jung · Kim/Kim HJ %A Kwang-Dong · Choi/Choi KD %+ [Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea., Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea., Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, South Korea., Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea., Department of Neurology, Keimyung University Dongsan Hospital, Daegu, South Korea., Department of Neurology, Keimyung University Dongsan Hospital, Daegu, South Korea., Department of Neurology, Daedong Hospital, Busan, South Korea., Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Seoul, South Korea., Department of Neurology, Dong-A University Hospital, Busan, South Korea., Kim's Neurology Clinic, Busan, South Korea., Kim's Neurology Clinic, Busan, South Korea., Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea., Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea.] %J JAMA network open. %D 2025 8 %N 3 %P e250972 %X IMPORTANCE: Head-shaking and mastoid oscillation maneuvers effectively treat cupulolithiasis of horizontal canal benign paroxysmal positional vertigo. However, to date there are no validated treatments for cupulolithiasis of posterior canal benign paroxysmal positional vertigo (PC-BPPV-cu). OBJECTIVE: To determine the immediate and short-term therapeutic efficacy of head-shaking and mastoid oscillation maneuvers in PC-BPPV-cu. DESIGN, SETTING, AND PARTICIPANTS: This double-blind randomized clinical trial was conducted at 6 referral-based university hospitals in South Korea between November 1, 2019, and April 30, 2023. The inclusion criteria consisted of (1) repetitive episodes of positional vertigo or dizziness; (2) positional nystagmus beating torsionally with the upper pole of the eye to the lower ear and vertically upward (to the forehead) and lasting longer than 1 minute, which was evoked by Dix-Hallpike or half Dix-Hallpike maneuver; and (3) absence of accompanying neurologic symptoms or signs suggesting central nervous system disorders. Patients were excluded who declined to participate or had cervical spine problems, multicanal BPPV, or cognitive dysfunction. INTERVENTIONS: Patients were randomly assigned to the head-shaking, mastoid oscillation, or sham maneuver groups. After a maximum of 2 trials of each maneuver, therapeutic response was assessed within 30 minutes and the following day. MAIN OUTCOMES AND MEASURES: The primary outcome was the short-term resolution rate of positional vertigo and nystagmus the following day. The secondary outcome was the immediate efficacy of 2 trials of each maneuver within 30 minutes. RESULTS: A total of 159 patients were included in the analysis (108 [67.9%] women; mean [SD] age, 65.4 [10.5] years). Fifty-three participants were randomized to the head-shaking group (mean [SD] age, 64.0 [11.2] years; 33 [62.3%] women), 53 to the mastoid oscillation group (mean [SD], age, 66.5 [11.1] years; 41 [77.4%] women), and 53 to the control group (mean [SD] age, 65.6 [9.2] years; 34 [64.2%] women). A total of 142 patients (89.3%) completed the assessment the following day. In the intention-to-treat analysis, 20 patients in the head-shaking group (37.7%), 14 in the mastoid oscillation group (26.4%), and 7 in the control group (13.2%) showed the resolution of vertigo and nystagmus the following day (χ2 = 8.40; odds ratio, 2.86; 95% CI, 1.32-6.18; P = .004; α = .0167). For the secondary outcome (the immediate effectiveness of 2 trials of each maneuver compared with sham within 30 minutes), no significant difference was detected (6 of 53 [11.3%] vs 4 of 53 [7.5%] vs 2 of 53 [3.8%]; P = .34; α = .05). CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, the head-shaking maneuver was effective in the treatment of PC-BPPV-cu. TRIAL REGISTRATION: CRIS clinical trial registration: KCT0004756. %@ 2574-3805 %L 10.1001/jamanetworkopen.2025.0972 %W HZBOOK