University of Navarra, Clinica Universitaria de Navarra, Department of Otorhinolaryngology, Pamplona, Spain.
University of Navarra, Clinica Universitaria de Navarra, Department of Otorhinolaryngology, Pamplona, Spain.
Braz J Otorhinolaryngol. 2022 Sep-Oct;88(5):708-716. doi: 10.1016/j.bjorl.2020.09.009. Epub 2020 Oct 28.
In patients with benign paroxysmal positional vertigo, BPPV; a torsional-vertical down beating positioning nystagmus can be elicited in the supine straight head-hanging position test or in the Dix-Hallpike test to either side. This type of nystagmus can be explained by either an anterior canal BPPV or by an apogeotropic variant of the contralateral posterior canal BPPV Until now all the therapeutic maneuvers that have been proposed address only one possibility, and without first performing a clear differential diagnosis between them.
To propose a new maneuver for torsional-vertical down beating positioning nystagmus with a clear lateralization that takes into account both possible diagnoses (anterior canal-BPPV and posterior canal-BPPV).
A prospective cohort study was conducted on 157 consecutive patients with BPPV. The new maneuver was performed only in those with torsional-vertical down beating positioning nystagmus with clear lateralization.
Twenty patients (12.7%) were diagnosed with a torsional-vertical down beating positioning nystagmus. The maneuver was performed in 10 (6.35%) patients, in whom the affected side was clearly determined. Seven (4.45%) patients were diagnosed with an anterior canal-BPPV and successfully treated. Two (1.25%) patients were diagnosed with a posterior canal-BPPV and successfully treated with an Epley maneuver after its conversion into a geotropic posterior BPPV.
This new maneuver was found to be effective in resolving all the cases of torsional-vertical down beating positioning nystagmus-BPPV caused by an anterior canal-BPPV, and in shifting in a controlled way the posterior canal-BPPV cases of the contralateral side into a geotropic-posterior-BPPV successfully treated during the followup visit. Moreover, this new maneuver helped in the differential diagnosis between anterior canal-BPPV and a contralateral posterior canal-BPPV.
在良性阵发性位置性眩晕（BPPV）患者中，在仰卧位直头悬垂试验或 Dix-Hallpike 试验中，任何一侧均可引出扭转性垂直下跳性位置性眼球震颤。这种类型的眼球震颤可以用前管 BPPV 或对侧后管 BPPV 的向地性变异来解释。到目前为止，所有提出的治疗手法都只针对一种可能性，而且在没有对它们进行明确的鉴别诊断之前。
提出一种新的扭转性垂直下跳性位置性眼球震颤的手法，明确偏向，同时考虑到两种可能的诊断（前管 BPPV 和后管 BPPV）。
对 157 例连续 BPPV 患者进行前瞻性队列研究。仅对那些扭转性垂直下跳性位置性眼球震颤且偏向明确的患者进行新的手法。
20 例（12.7%）被诊断为扭转性垂直下跳性位置性眼球震颤。该手法在 10 例（6.35%）患者中进行，明确确定了受累侧。7 例（4.45%）患者被诊断为前管 BPPV，并成功治疗。2 例（1.25%）患者被诊断为后管 BPPV，并在转为向地性后管 BPPV 后成功进行 Epley 手法治疗。
新手法对所有由前管 BPPV 引起的扭转性垂直下跳性位置性眼球震颤-BPPV 病例均有效，并能以可控的方式将对侧后管 BPPV 病例成功转为向地性后管 BPPV，在随访期间成功治疗。此外，这种新的手法有助于在前管 BPPV 和对侧后管 BPPV 之间进行鉴别诊断。
