Journal of Audiology & Otology

The Korean Audiology Society (대한청각학회)
권호 표지
DOI QR코드

DOI QR Code

Spontaneous Direction-Changing or Reversing Positional Nystagmus without Changing Head Position during Head-Roll/Head-Hanging Maneuvers: Biphasic Positional Nystagmus

  • Yetiser, Sertac (Department of Otorhinolaryngology, Head and Neck Surgery, Anadolu Medical Center)
  • Received : 2020.06.24
  • Accepted : 2020.09.16
  • Published : 2021.01.20
⟨ Previous Next ⟩

Abstract

Background and Objectives: Conflicting mechanisms have been reported about spontaneous reversal of positional nystagmus during head-roll maneuver in patients with benign paroxysmal positional vertigo (BPPV). The objective of this study is to review the reports about the characteristics and possible mechanisms of reversing positional nystagmus and to present seven new cases. Subjects and Methods: Seven cases (5 males, 2 females; 4 left-sided, 3 right-sided) were recruited among 732 patients with BPPV seen outpatient clinic between 2009 and 2019. Diagnosis of lateral canal canalolithiasis was confirmed when transient geotropic nystagmus was documented during head-roll test. Reversing positional nystagmus was analyzed in each case and clinical characteristics of the patients were documented. Results: The age of patients was ranging between 30 to 64 years (46.44±10.91). Duration of symptoms was short (21.34±19.74). Six of them had a story of head trauma. Initial latency was short. First, intense geotropic nystagmus was observed following provocative head-roll position on the affected side. There was short "silent phase". Then, a longer second-phase of reversed nystagmus was noted. Total duration of nystagmus was 78.40±6.82 seconds. Maximal slow phase velocity was 24.05±6.34 deg/sec. All patients were cured with barbeque maneuver. Conclusions: Ipsilateral reversing positional nystagmus during head-roll maneuver is due to lateral canal canalolithiasis. Mechanism is likely to be due to endolymphatic double flow. Bilateral cases may be due to simultaneous co-existence of canalolithiasis and cupulolithiasis. Longer recording of nystagmus is recommended not to miss the cases with spontaneous direction-changing positional nystagmus.

Keywords

References

  1. Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. Clinical practice guideline: benign paroxysmal positional vertigo (Update) executive summary. Otolaryngol Head Neck Surg 2017;156:403-16. https://doi.org/10.1177/0194599816689660
  2. Sakata E, Ohtsu K, Itoh Y. Positional nystagmus of benign paroxysmal type (BPPN) due to cerebellar vermis lesions. Pseudo-BPPN. Acta Otolaryngol Suppl 1991;481:254-7. https://doi.org/10.3109/00016489109131394
  3. Dunniway HM, Welling DB. Intracranial tumors mimicking benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1998;118:429-36. https://doi.org/10.1016/S0194-5998(98)70197-4
  4. De la Meilleure G, Dehaene I, Depondt M, Damman W, Crevits L, Vanhooren G. Benign paroxysmal positional vertigo of the horizontal canal. J Neurol Neurosurg Psychiatry 1996;60:68-71. https://doi.org/10.1136/jnnp.60.1.68
  5. Stahle J, Terins J. Paroxysmal positional nystagmus: an electronystagmographic and clinical study. Ann Otol Rhinol Laryngol 1965;74:69-83. https://doi.org/10.1177/000348946507400107
  6. Pagnini P, Nuti D, Vannucchi P. Benign paroxysmal vertigo of the horizontal canal. ORL J Otorhinolaryngol Relat Spec 1989;51:161-70. https://doi.org/10.1159/000276052
  7. Baloh RW, Jacobson K, Honrubia V. Horizontal semicircular canal variant of benign positional vertigo. Neurology 1993;43:2542-9. https://doi.org/10.1212/WNL.43.12.2542
  8. Nuti D, Vannucchi P, Pagnini P. Benign paroxysmal positional vertigo of the horizontal canal: a form of canalolithiasis with variable clinical features. J Vestib Res 1996;6:173-84.
  9. Lee SH, Kim MK, Cho KH, Kim JS. Reversal of initial positioning nystagmus in benign paroxysmal positional vertigo involving the horizontal canal. Ann N Y Acad Sci 2009;1164:406-8. https://doi.org/10.1111/j.1749-6632.2008.03739.x
  10. Jeong KH, Shin JE, Shin DH, Kim CH. Direction-reversing nystagmus in horizontal and posterior semicircular canal canalolithiasis. Otol Neurotol 2016;37:767-71. https://doi.org/10.1097/mao.0000000000001052
  11. Ogawa Y, Ichimura A, Otsuka K, Hagiwara A, Inagaki T, Shimizu S, et al. Spontaneous inversion of nystagmus without a positional change in the horizontal canal variant of benign paroxysmal positional vertigo. J Vestib Res 2015;25:169-75. https://doi.org/10.3233/ves-150552
  12. Yetiser S. A new variant of posterior canal benign paroxysmal positional vertigo: a nonampullary or common crus canalolithiasis. Case Rep Otolaryngol 2015;2015:816081.
  13. Barany E. [Diagnosis of symptoms in the area of the otolith enapparates]. Acta Otolaryngol 1920;2:434-7. https://doi.org/10.3109/00016482009123103
  14. Yetiser S. Simultaneous and spontaneous reversal of positional nystagmus; an unusual peripheral sign of benign paroxysmal positional vertigo. Otolaryngology Case Reports 2017;3:4-6. https://doi.org/10.1016/j.xocr.2017.04.001
  15. Kim CH, Shin JE, Yoo MH, Park HJ. Direction-changing and direction-fixed positional nystagmus in patients with vestibular neuritis and meniere disease. Clin Exp Otorhinolaryngol 2019;12:255-60. https://doi.org/10.21053/ceo.2018.00038