Research in Vestibular Science

Case Reports

Conservative Management of Horizontal Canal Benign Paroxysmal Positional Vertigo Resistant to Treatment: Hye Ran Son, Chung Ku Rhee, Myung Whan Suh, Jae Yun Jung; Res Vestib Sci. 2011;10(4):141-144.

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Abstract PDF: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Although it is easily cured by repositioning maneuvers for the majority of patients, it can be resistant to treatment in rare cases. Surgery can be considered for such patients with intractable BPPV. But surgery may be followed by some side effects such as hearing loss and persistent disequilibrium. We report a 77-year-old-female patients who had positional vertigo for 5 years in despite of repositioning maneuver at several hospitals. We performed repeated repositioning maneuvers twice a day for 1 month. Her symptom and nystagmus finally subsided after 2 months. Repeated aggressive repositioning maneuver may be an alternative for surgery for patients with intractable BPPV.

Multicanal Benign Paroxysmal Positional Vertigo: Concurrent Bilateral Posterior Canalolithiasis and Unilateral Lateral Cupulolithiasis: Seung Won Chung, Chang Hyun Cho, Gyu Cheol Han; Res Vestib Sci. 2009;8(2):142-146.

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Abstract PDF: Multicanal BPPV (benign paroxysmal positional vertigo), especially BPPV affecting both labyrinths, is uncommon. A review of the literature revealed that the majority of reported cases of multiple BPPV either involved a combination of two different canals limited to one labyrinth or two different canals in both labyrinths, although one case of multicanal BPPV was reported to involve three canals bilaterally. Here, the authors report a case of bilateral posterior canalolithiasis and unilateral horizontal canal cupulolithiasis in a 54-year-old man, and include a review of the literature.

Bilateral Multiple Benign Paroxysmal Positional Vertigo Combined with Vestibular Neuritis: Seong Jun Choi, You Lee Shin, Yun Tae Kim, Nam Soo Han, Yun Hoon Choung; J Korean Bal Soc. 2006;5(1):81-85.

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Abstract PDF: Although classical benign paroxysmal positional vertigo (BPPV) has generally been resolvable by routine manual repositioning maneuvers, nevertheless resistant cases and variant remain a significant problem. Recently, we experienced a case of posterior semicircular canal BPPV combined with changes to various types of BPPV during manual reposition maneuver and vestibular neuritis. We examined her brain MRI due to low response of routine manual reposition maneuvers and frequently recurrence of BPPV. In brain MRI, we found 1.3cm sized mass in hypoglossal canal. It seemed to be neuroma on hypoglossal nerve. A refractory BPPV poses problems of pathophysiogenetic interpretation, differential diagnosis with a CNS lesion and therapeutic strategy. We thought that refractory BPPV should be treated with more frequently examination and manual repositional maneuver and distinguished from CNS lesion. Key Words : Canalolithiasis, Cupulolithiasis, Vestibular neuritis

Original Articles

The Effectiveness of Physical Therapy for the Horizontal Canal Cupulolithiasis: Byung Kun Kim, Hee Jun Bae, Ja Seong Koo, Oh Hyun Kwon, Jong Moo Park; J Korean Bal Soc. 2005;4(2):219-224.

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Abstract PDF: Background
and Objectives: Recently many reports suggest the horizontal canal benign paroxysmal positional vertigo (h-BPPV) is not rare. However there have been few reports on physical therapy for horizontal canal cupulolithiasis, while horizontal canal canalithiasis has a relatively well defined and effective therapy. To evaluate the efficacy of different methods of treating horizontal canal cupulolithiasis, we conducted prospective study. Materials and Method: We enrolled 104 consecutive patients who were diagnosed with h-BPPV. During that period, patients with posterior canal BPPV numbered 112. Patients with h-BPPV were diagnosed when lateral head rotation in the supine position resulted in geotropic or apogeotropic bilateral horizontal nystagmus. In patients presenting with apogeotropic variant (n=40), following maneuvers was performed sequentially. First of all, we performed head shaking and applied vibrator to the mastoid bone to detach otolith from cupula. If they failed to detach otolith from cupula, we performed barbecue rotation and forced prolonged position (FPP). The treatment outcome was considered as responsive when, immediately after each physical therapy, nystagmus shifted from apogeotropic to geotropic or no nystagmus was elicited by provocation test and symptoms of positional vertigo abated.
Results
There were 27 women and 13 men from ages 30 to 80 (mean 55) years. The average duration of symptoms before intervention was 0 to 12 (mean 0.6) days. In 4 cases, symptoms resolved spontaneously after provocation test. Of the 36 patients treated with headshaking, 6 were responsive. Of the 30 patients treated with vibrator after failure of head shaking, only 1 were responsive. In the barbecue rotation, none obtained relief after barbecue rotation. Of the 9 patients treated with FPP after failure of the barbecue rotation, 4 were symptom free after FPP. Twenty five patients, including 5 non-responders with FPP, underwent no more rehabilitation maneuver. In most of cases (n=24), horizontal canal cupulolithiasis resolved spontaneously within a week.
Conclusion
The direct effectiveness of physical therapy for horizontal canal cupulolithiasis is largely unsatisfactory. However, in many cases, horizontal canal cupulolithiasis resolved spontaneously in a few days.

A New Treatment Strategy of Ageotrophic Horizontal Canal Benign Paroxysmal Positional Vertigo: Gyu Cheol Han, Hyung Gyu Jeon, Jin Myung Huh; J Korean Bal Soc. 2002;1(1):113-117.

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Abstract PDF: Background
and Objectives : Ageotrophic nystagmus in the horizontal canal BPPV has been explained as a result of cupulolithiasis theory, and has been reported to have the less therapeutic response to conservative rehabilitations than the other type BPPV . Though methods to detach the debris with vibrator have been introduced, the effect has been questioned and it’s not physiologic. Materials and Method : We introduce a new head shaking-forced prolonged position method as a more convenient method, and report typical 2 cases of ageotrophic horizontal canal BPPV managed with it and analyzed results of 25 cases all told.
Results
and conclusion : The average number of rehabilitation was less than two, and loss of direction changing positional nystagmus could be observed immediately after rehabilitation.

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