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J Korean Bal Soc > Volume 4(2); 2005 > Article
Journal of the Korean Balance Society 2005;4(2): 219-224.
가쪽반고리관 팽대부릉결석에 대한 재활치료의 효과
김병건, 배희준, 구자성, 권오현, 박종무
을지의과대학 을지병원 신경과학교실
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
Department of Neurology, Eulji University, Eulji Hospital, Seoul, Korea. kbk1403@eulji.or.kr
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.
Keywords: Physical therapy; Cupulolithiasis; Benign paroxysmal positional vertigo
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The Effectiveness of Physical Therapy for The Horizontal Canal Cupulolithiasis  2005 December;4(2)
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