Barin Kamran, Petrak Michelle R, Cassidy Amy R, Whitney Susan L
Department of Otolaryngology Head and Neck Surgery, The Ohio State University, Columbus, OH, United States.
Northwest Speech and Hearing, Arlington Heights, IL, United States.
Front Neurol. 2025 Mar 31;16:1549407. doi: 10.3389/fneur.2025.1549407. eCollection 2025.
Patients with posterior canal benign paroxysmal positional vertigo (BPPV) have a characteristic response of torsional-vertical nystagmus after a Dix-Hallpike maneuver. The nystagmus usually has a delayed onset with the intensity increasing rapidly and then subsiding over a relatively short duration of less than 1 min. We recorded horizontal, vertical, and torsional eye movements with a VNG system in 15 patients with case histories consistent with BPPV. The nystagmus response patterns were quantified by the latency, peak nystagmus intensity, duration, rise time, and fall time parameters. The results showed a high degree of variability in the response parameters, which signifies that a typical response pattern is not universal in patients with BPPV. In addition to the torsional-vertical nystagmus response, all patients exhibited different levels of horizontal nystagmus. However, the direction and the timing of the responses were not consistent. Some patients showed nystagmus patterns that lasted much longer than 1 min. Other patients had lower levels of nystagmus in response to the Dix-Hallpike contralateral to the affected side. The differences in response patterns may signify differences in the composition or the placement of otoconia within the canal, which may affect the patient symptoms and the outcome of the repositioning maneuvers. However, some of the variability may reflect how the test is performed and how the eye movements are recorded. The purpose of this study was to demonstrate the need for standardization of nystagmus recording protocols because responses to the Dix-Hallpike maneuver are influenced by many factors such as the gaze direction and whether the measurements are made from the ipsilateral or contralateral eye.
后半规管良性阵发性位置性眩晕（BPPV）患者在进行Dix-Hallpike试验后会出现扭转性垂直眼震的特征性反应。眼震通常起病延迟，强度迅速增加，然后在不到1分钟的相对短时间内减弱。我们使用视频眼震图（VNG）系统记录了15例病史符合BPPV的患者的水平、垂直和扭转眼球运动。通过潜伏期、眼震峰值强度、持续时间、上升时间和下降时间参数对眼震反应模式进行量化。结果显示反应参数存在高度变异性，这表明典型的反应模式在BPPV患者中并非普遍存在。除了扭转性垂直眼震反应外，所有患者均表现出不同程度的水平眼震。然而，反应的方向和时间并不一致。一些患者的眼震模式持续时间远超过1分钟。其他患者对患侧对侧的Dix-Hallpike试验的眼震程度较低。反应模式的差异可能表明半规管内耳石的组成或位置存在差异，这可能会影响患者症状和复位手法的效果。然而，部分变异性可能反映了测试的执行方式以及眼球运动的记录方式。本研究的目的是证明眼震记录方案标准化的必要性，因为对Dix-Hallpike试验的反应受许多因素影响，如注视方向以及测量是从同侧眼还是对侧眼进行。
