Li Yanjun, Yang Xiaokai
Department of Research Center, Third Affiliated Hospital of Shanghai University, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, China.
Front Neurol. 2023 Feb 17;14:1132343. doi: 10.3389/fneur.2023.1132343. eCollection 2023.
The preferred supine roll test for the diagnosis of horizontal semicircular canal BPPV has several disadvantages, including difficulty in locating the affected ear, inconsistent nystagmus performance on repeated testing, and lack of a typical latency period, resulting in insensitive diagnosis.
To investigate novel diagnostic techniques with more scientific design, more accessible application, and better diagnostic sensitivity and specificity.
Based on clinical microscopic CT data, we created a virtual simulation model of BPPV using Unity software. The physical simulation of the traditional supine roll test was performed to observe and analyse the movement of the otoliths, whose initial position was the typical stable position. In addition, the normal vectors of the plane and crista ampullaris of the horizontal semicircular canal were measured using 3D Slicer software. Based on this, we analyzed the critical steps for designing diagnostic maneuvers for BPPV in the horizontal semicircular canal. For a more accurate diagnosis of horizontal semicircular canal BPPV, it is critical to rotate the horizontal semicircular canal to be parallel to gravity. It is also necessary to move the otolith by swinging the head. As a result, we developed two diagnostic maneuvers: the 60° roll test and the prone roll test. We also performed simulations to observe otolith movement and predict nystagmus performance.
The 60° roll test and the prone roll test can complement the supine roll test. Compared to the supine roll test, they not only effectively differentiate canalolithiasis from cupulolithiasis, but also make it easier to determine the position of the otoliths, and the characteristics of the nystagmus are more pronounced. Significant diagnostic features have significant potential benefits for home and telemedicine.
用于诊断水平半规管良性阵发性位置性眩晕（BPPV）的传统仰卧翻滚试验存在若干缺点，包括难以确定患耳、重复测试时眼震表现不一致以及缺乏典型的潜伏期，导致诊断不敏感。
研究设计更科学、应用更便捷且诊断敏感性和特异性更高的新型诊断技术。
基于临床显微CT数据，我们使用Unity软件创建了BPPV的虚拟模拟模型。对传统仰卧翻滚试验进行物理模拟，以观察和分析耳石的运动，其初始位置为典型的稳定位置。此外，使用3D Slicer软件测量水平半规管平面和壶腹嵴的法向量。基于此，我们分析了设计水平半规管BPPV诊断手法的关键步骤。为更准确地诊断水平半规管BPPV，将水平半规管旋转至与重力平行至关重要。通过摇头移动耳石也很有必要。结果，我们开发了两种诊断手法：60°翻滚试验和俯卧翻滚试验。我们还进行了模拟以观察耳石运动并预测眼震表现。
60°翻滚试验和俯卧翻滚试验可补充仰卧翻滚试验。与仰卧翻滚试验相比，它们不仅能有效区分管结石症和嵴顶结石症，还更容易确定耳石位置，且眼震特征更明显。显著的诊断特征对家庭医疗和远程医疗具有显著的潜在益处。
