Audiology and Phoniatrics Department, San Pio Hospital, Benevento.
ENT Department, Santa Maria Goretti Hospital, Azienda USL Latina, Italy.
Otol Neurotol. 2024 Sep 1;45(8):e607-e613. doi: 10.1097/MAO.0000000000004256. Epub 2024 Jul 25.
Lateral semicircular canal BPPV (LSC-BPPV) is diagnosed with the Head Yaw Test (HYT) by observing nystagmus direction and comparing the nystagmus intensity on both sides according to Ewald's laws. Head Pitching Test (HPT) is a diagnostic maneuver performed in the upright position by bending the patient's head forward (bowing) and backward (leaning) and observing the evoked nystagmus. We aimed to assess the sensitivity of HPT in correctly diagnosing LSC-BPPV through the quantitative measurement of Bowing and Leaning nystagmus slow-phase velocity (SPV).
One hundred cases of LSC-BPPV were prospectively enrolled. HPT was performed, looking for pseudospontaneous, bowing, and leaning nystagmus. HYT was considered for the "final diagnosis." HPT was defined as "diagnostic" if the nystagmus was present in at least one position, "undiagnostic" if no nystagmus was detectable. The direction and the SPV of nystagmus in all positions were analyzed and compared to determine the degree of agreement between HPT and HYT.
Sixty-four geotropic and 36 apogeotropic forms were diagnosed. HPT was diagnostic in 80 cases, with no difference between the two forms. According to Ewald's laws, the direction of stronger nystagmus evoked by HPT agreed with the HYT results in 39/52 (75%) cases in geotropic forms and 21/28 (75%) cases in apogeotropic forms. The agreement between HPT and HYT was "substantial" considering all the cases and "almost complete" considering only the patients with diagnostic HPT.
Quantitative HPT is a valid test in diagnosing the affected side and form of LSC-BPPV, even if less reliable than HYT.
通过观察眼震方向并根据 Ewald 定律比较两侧眼震强度，利用头位偏斜试验（HYT）诊断水平半规管良性阵发性位置性眩晕（LSC-BPPV）。头位俯仰试验（HPT）是一种在直立位下进行的诊断性操作，通过使患者头部前倾（弯腰）和后倾（倾斜）并观察诱发的眼震来进行。我们旨在通过定量测量弯腰和倾斜眼震慢相速度（SPV）来评估 HPT 在正确诊断 LSC-BPPV 中的敏感性。
前瞻性纳入 100 例 LSC-BPPV 患者。行 HPT 检查，寻找假性自发性、弯腰和倾斜眼震。HYT 被认为是“最终诊断”。如果至少在一个位置出现眼震，则认为 HPT 为“诊断性”，如果未检测到眼震，则认为 HPT 为“非诊断性”。分析并比较所有位置眼震的方向和 SPV，以确定 HPT 与 HYT 之间的一致性程度。
诊断为 64 例向地性和 36 例离地性。80 例 HPT 为诊断性，两种形式之间无差异。根据 Ewald 定律，HPT 诱发的较强眼震的方向与向地性形式中的 39/52（75%）例和离地性形式中的 21/28（75%）例的 HYT 结果一致。考虑所有病例，HPT 与 HYT 的一致性为“高度一致”，仅考虑诊断性 HPT 的患者，则为“几乎完全一致”。
定量 HPT 是诊断 LSC-BPPV 受累侧和形式的有效检查方法，尽管其可靠性不如 HYT。
