D'Albora Rivas Ricardo, Teixido Michael, Casserly Ryan M, Mónaco María Julia
Department of ENT, Hospital de Clínicas, University of the Republic, Montevideo, Uruguay.
Christiana Care Health Systems, Newark, DE, United States.
Front Neurol. 2020 Aug 13;11:857. doi: 10.3389/fneur.2020.00857. eCollection 2020.
Anterior canalithiasis is an uncommon and challenging diagnosis. This is due in part to the difficulty of defining the affected side, the extreme positioning required to carry out described therapeutic maneuvers, and the infrequent use of specific maneuvers. Our objective is to present a new treatment alternative for anterior canalithiasis which is based on the well-known canalith repositioning procedure (CRP) described by Epley and which is used routinely in the treatment of both posterior and anterior canalithiasis. Analysis of the standard CRP for anterior canalithiasis with a biomechanical model validates that this new maneuver is an enhanced treatment option for anterior canalithiasis. We call the new maneuver the "short CRP." A previously published 3D biomechanical model of the human labyrinths for the study of BPPV was used to analyze the conventional CRP in the treatment of anterior canalithiasis. The expected position of free otoliths near the anterior ampulla of the anterior semicircular duct was followed while recreating the sequential positions of the CRP. Although the standard CRP was possibly effective, certain enhancements were evident that could increase successful repositioning. These enhancements were incorporated into the modification of the CRP presented here as the "short CRP" for anterior canalithiasis. The traditional CRP used for posterior canalithiasis can also be used for anterior canalithiasis. Although in the traditional CRP the head hangs 30° below horizontal, our simulation shows that a 40° head-hang below horizontal is an enhancement and may ensure progression of anterior otolith debris. Elimination of Position 4 of the classic CRP, in which the face is turned 45° toward the floor, was also seen as an enhancement as this position is predicted to cause retrograde movement of otoliths back into the anterior canal if the patient tucks the chin in position 4 or when sitting up. A modification of the CRP called the "short CRP" can be used to treat anterior canalithiasis. Model analysis predicts possible increased efficacy over the standard CRP. Model analysis of existing BPPV treatments is a valuable exercise for examination and can lead to realistic enhancements in patient care.
后半规管耳石症是一种罕见且具有挑战性的诊断。部分原因在于确定患侧存在困难、实施所述治疗手法需要极端的体位，以及特定手法的使用频率较低。我们的目的是提出一种针对后半规管耳石症的新治疗方法，该方法基于Epley描述的著名的耳石复位程序（CRP），并且在治疗后半规管和水平半规管耳石症中常规使用。使用生物力学模型对后半规管耳石症的标准CRP进行分析，证实这种新手法是治疗后半规管耳石症的一种改进治疗选择。我们将这种新手法称为“短CRP”。先前发表的用于研究良性阵发性位置性眩晕（BPPV）的人体迷路三维生物力学模型被用于分析治疗后半规管耳石症时的传统CRP。在重现CRP的连续体位时，追踪自由耳石在前半规管壶腹附近的预期位置。尽管标准CRP可能有效，但明显存在某些可以提高复位成功率的改进之处。这些改进之处被纳入此处提出的CRP改良方法，即后半规管耳石症的“短CRP”中。用于后半规管耳石症的传统CRP也可用于水平半规管耳石症。尽管在传统CRP中头部悬挂在水平以下30°，但我们的模拟显示，头部悬挂在水平以下40°是一种改进，可能确保水平半规管耳石碎片的移动。经典CRP的第4步（面部转向地面45°）被取消，这一步也被视为一种改进，因为如果患者在第4步时收下巴或坐起，预计该体位会导致耳石逆行回到水平半规管。一种名为“短CRP” 的CRP改良方法可用于治疗水平半规管耳石症。模型分析预测其疗效可能优于标准CRP。对现有BPPV治疗方法进行模型分析是一项有价值的检查工作，可切实改善患者护理。
