Highlights
The maiden HPE report of HSC pathology improves the understanding of etiology of BPPV.
The quick head rotational test using gravity complements Dix-Hallpike test and is more effective in locating cupular and anterior arm pathology of HSC.
Modified II stage of Semont’s maneuvere using utmost gravity force clears the cupolar deposits more efficiently than concurrent therapies.
The proposed protocol in managing HSC BPPV of complex presentation is found to be extremely useful in clinical practice in a busy vertigo clinic.
Abstract
Objective:
Horizontal semicircular canal site pathology of benign paroxysmal positional vertigo demonstrating three types of nystagmi on positional test were studied. We have attempted to design a protocol for its diagnosis and treatment.
Methods:
320 patients of HSC-BPPV were subjected to two types of positional tests. Of these, patients with bilateral steady apogeotropic nysatgmus were treated with VAV modification of Semont’s maneuver. Patients with unsteady or changing apo/geotropic signs were converted into steady geotropic ones by repetitive positional tests; followed by barbecue maneuver with forced prolong positioning.
Results:
Overall 88% of patients had a total recovery. 92% of patients with geotropic nystagmus showed no symptoms after second maneuveral sitting. 85% of patients with apogeotropic nystagmus recovered fully after third maneuveral sitting.
Conclusion:
Correct identification of subtypes of HSC-BPPV is based on provoked nystagmus by positional tests. After locating the site and side on the basis of nystagmic pattern, physician can apply the appropriate PRM.
Level of evidence: II a.
Keywords
Benign paroxysmal positional vertigo; Horizontal semicircular canal; Particle repositioning maneuver; Geotropic nystagmus; Apogeotropic nystagmus
Thumbnail
Thumbnail
Thumbnail
Thumbnail
Thumbnail
