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Ichijo H, Ichijo H. A new roll test to diagnose posterior semicircular canal benign paroxysmal positional vertigo. Am J Otolaryngol 2024; 45:104309. [PMID: 38657533 DOI: 10.1016/j.amjoto.2024.104309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The Dix-Hallpike (DH) test is a gold standard for diagnosing benign paroxysmal positional vertigo (BPPV). However, lateral semicircular canal BPPV is not rare. We have been performing the new roll test that begins from the sitting position and contains a head-hanging position, in order not to overlook lateral canal BPPV. We noticed that transient vertical/torsional nystagmus sometimes occurs during the new roll test. OBJECTIVE To clarify the value of the new roll test in diagnosing posterior canal BPPV and elucidate the position that elicits nystagmus. MATERIALS AND METHODS The subjects were 100 consecutive patients (79 were female, 21 were male) with posterior canal BPPV. We classified the patients into four types based on a position that induced nystagmus. RESULTS The patient's position that elicited nystagmus varied. The supine type accounted for 24 %, the lateral type accounted for 62 %, the head-hanging type accounted for 9 %, and the DH type accounted for 5 %. CONCLUSION The new roll test is valuable for diagnosing posterior canalolithiasis cases. Most patients reveal vertical/torsional nystagmus in the supine or lateral position. Therefore, performing the new roll test first is efficient at the initial visit.
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Affiliation(s)
- Hiroaki Ichijo
- Ichijo Ear, Nose and Throat Clinic, 3-2-1, Ekimae, Hirosaki 036-8002, Japan.
| | - Hisako Ichijo
- Ichijo Ear, Nose and Throat Clinic, 3-2-1, Ekimae, Hirosaki 036-8002, Japan
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Han JS, Lee DH, Park SN, Park KH, Kim TH, Han JH, Kang MJ, Kim SH, Seo JH. Evaluation of the reliability and validity of the upright head roll test for lateral semicircular canal benign paroxysmal positional vertigo. J Vestib Res 2024; 34:103-112. [PMID: 38457163 DOI: 10.3233/ves-230127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND The upright head roll test (UHRT) is a recently introduced diagnostic maneuver for lateral semicircular canal benign paroxysmal positional vertigo (LSC-BPPV). OBJECTIVE This study aimed to evaluate the reliability and validity of the UHRT. METHODS Two separate studies were conducted. Study 1 analyzed 827 results of videonystagmography (VNG) to assess UHRT reliability, and Study 2 analyzed 130 LSC-BPPV cases to evaluate UHRT validity. RESULTS The inter-test reliability between UHRT and the supine head roll test (SHRT) showed substantial agreement (Cohen's kappa = 0.753) in direction-changing positional nystagmus (DCPN) and almost perfect agreement (Cohen's kappa = 0.836) in distinguishing the direction of DCPN. The validity assessment of UHRT showed high accuracy in diagnosing LSC-BPPV (80.0%) and in differentiating the variant types (74.6%). UHRT was highly accurate in diagnosing the canalolithiasis type in LSC-BPPV patients (Cohen's kappa = 0.835); however, it showed only moderate accuracy in diagnosing the cupulolithiasis type (Cohen's kappa = 0.415). The intensity of nystagmus in UHRT was relatively weaker than that in SHRT (P < 0.05). CONCLUSION UHRT is a reliable test for diagnosing LSC-BPPV and distinguishing subtypes. However, UHRT has a limitation in discriminating the affected side owing to a weaker intensity of nystagmus than SHRT.
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Affiliation(s)
- Jae Sang Han
- Department of Otolaryngology, Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Hee Lee
- Department of Otolaryngology, Head and Neck Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shi Nae Park
- Department of Otolaryngology, Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Ho Park
- Department of Otolaryngology, Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Ho Kim
- Department of Otolaryngology, Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hong Han
- Department of Otolaryngology, Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Ju Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So-Hyun Kim
- Department of Otolaryngology, Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Hyun Seo
- Department of Otolaryngology, Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kim MJ, Rhim G. Blood Pressure Response to the Head-Up Tilt Test in Benign Paroxysmal Positional Vertigo. J Clin Med 2023; 12:7725. [PMID: 38137794 PMCID: PMC10744299 DOI: 10.3390/jcm12247725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
The vestibular organ is involved in controlling blood pressure through vestibulosympathetic reflexes of the autonomic nervous system. This study aimed to investigate the effect of benign paroxysmal positional vertigo (BPPV) on blood pressure control by the autonomic nervous system by observing changes in blood pressure before and after BPPV treatment using the head-up tilt test (HUTT). A total of 278 patients who underwent the HUTT before and after treatment were included. The HUTT measured blood pressure repeatedly on the day of diagnosis and the day of complete recovery, and the results were analyzed using repeated measures analysis of variance. Regarding the difference in the systolic blood pressure of patients with BPPV, the blood pressure at 1, 2, and 3 min in the upright position after complete recovery was significantly lower than before treatment (p = 0.001, p = 0.001, and p = 0.012, respectively). Blood pressure at 1 and 2 min in the diastolic blood pressure of patients with BPPV in the upright position after complete recovery was significantly lower than before treatment (p = 0.001 and p = 0.034, respectively). This study shows that BPPV increases blood pressure during the initial response to standing in the HUTT.
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Affiliation(s)
- Moon-Jung Kim
- Department of Laboratory Medicine, Myongji Hospital, Hanyang University Medical Center, Goyang 10475, Republic of Korea;
| | - Guil Rhim
- Department of Otorhinolaryngology, One Otorhinolaryngology Clinic, Paju 10924, Republic of Korea
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Tian E, Li F, Liu D, Wang J, Guo Z, Chen J, Guo J, Zhang S. Dispelling Mist That Obscures Positional Vertigo in Vestibular Migraine. Brain Sci 2023; 13:1487. [PMID: 37891854 PMCID: PMC10605638 DOI: 10.3390/brainsci13101487] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Patients with vestibular migraine (VM) often present with positional vertigo. A portion of these patients have features of benign paroxysmal positional vertigo (BPPV). It is a challenge to rapidly identify the BPPV component of VM associated with positional vertigo. (2) Methods: Retrospective data collected from 60 VM and 47 VM + BPPV patients were used to build a diagnostic model, and then prospective data from 47 patients were used for the external validation. All patients had VM manifesting as positional vertigo, with or without accompanying BPPV. The clinical manifestations and the results of vestibular function tests were comprehensively analyzed using logistic regression. (3) Results: The univariate and multivariate analyses showed that the age, symptom duration, tinnitus, ear fullness, nausea, head shaking nystagmus, the direction of the Dix-Hallpike and roll tests, and horizontal gain could help differentiate between the two groups. A nomogram and an online calculator were generated. The C-index was 0.870. The diagnostic model showed good discriminative power and calibration performance during internal and external validation. (4) Conclusions: This study provided a new perspective for diagnosing VM with positional vertigo by identifying the BPPV component and, for the first time, offers a prediction model integrating multiple predictors.
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Affiliation(s)
- E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Fei Li
- Department of Neurology, Changzheng Hospital, Naval Medical University, Shanghai 200003, China;
| | - Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhaoqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jingyu Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jiaqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (E.T.); (D.L.); (J.W.); (Z.G.); (J.C.); (J.G.)
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Rosa MS, Campagnoli M, Masnaghetti D, Taranto F, Pisani G, Garzaro M, Aluffi Valletti P. Clinical and Prognostic Implications of Cervical and Ocular Vestibular Evoked Myogenic Potentials (cVEMP and oVEMP) in Benign Paroxysmal Positional Vertigo (BPPV): A Prospective Study. Audiol Res 2023; 13:700-709. [PMID: 37736942 PMCID: PMC10514798 DOI: 10.3390/audiolres13050061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Several studies have investigated the efficacy of VEMP (vestibular evoked myogenic potential) in patients with vestibular disorders and BPPV (benign paroxysmal positional vertigo). However, previous data were inconclusive. The aim of this study was to investigate the difference in latency, amplitude P1-N1, asymmetry ratio (AR), and cervical/ocular-VEMP values between BPPV patients and healthy controls. METHODS 125 healthy subjects and 42 BPPV patients were prospectively enrolled in the study. In both groups, c/oVEMP tests with 500 Hz tone-burst stimuli were performed. Latencies P1, N1 peaks, and corrected amplitudes (CA) were measured, and AR was calculated. RESULTS in the BPPV group, 14.29% of patients lacked oVEMPs that recovered after therapy. N1 latencies were significantly elongated, and 50% of patients had pathological AR; this value normalized at follow-up sessions. In addition, there was a reduction in CA in the pathologic ear compared to healthy ears (p = 0.04) and compared to healthy controls (p = 0.01). For cVEMP, a significant reduction in latency-P1 was observed in BPPV patients compared to controls; no significant differences were observed for P1, N1, and CA values between the two ears. The cVEMPs were absent in 14.29% of BPPV patients (AR > 35) that recovered after therapy. CONCLUSION We identified several abnormal c/oVemp values in BPPV patients compared with healthy controls, with most changes in values occurring in oVEMPs, suggesting that utricular dysfunction may be more common than saccular. In addition, patients with oVEMP alteration showed later clinical recovery, suggesting a possible prognostic role of the test.
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刘 宇, 张 嫄, 陶 方, 兰 莉, 杨 可. [Investigation of sleep position and triggered movement in patients with benign paroxysmal positional vertigo]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:515-519. [PMID: 35822378 PMCID: PMC10128382 DOI: 10.13201/j.issn.2096-7993.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Indexed: 06/15/2023]
Abstract
Objective:To investigate the characteristics of habitual sleeping position and triggered movement in patients with benign paroxysmal positional vertigo(BPPV). Methods:The patients with idiopathic tubulitic BPPV who the symptoms were relieved after repositioning were enrolled in this study. The relationship between the side, the tube of otolith detachment and habitual sleeping position and triggered movement was analyzed. Results:①Among the 446 patients, female gender predominated(319 cases, 71.5%), 41-60 years old group accounted for the highest proportion(192 cases, 43.0%), and posterior semicircular canal patients accounted for the highest proportion(289 cases, 64.8%); ②The affected side was associated with habitual sleep postion(P<0.05, ES=0.392), ipsilateral ear was more common in left or right decubitus; ③There were statistically significant differences in the triggered movement in different types of BPPV(P<0.05, ES=0.380), BPPV of multiple semicircular canals. Horizontal semicircular canals and posterior semicircular canals were more likely to induce vertigo and nystagmus. Conclusion:Habitual sleeping position and triggered movement could be collected during the diagnosis of BPPV, to predict the affected side and tube. The combination of Roll test and Dix-Hallpike test is more conducive to accurately distinguish the location of otolith shedding.
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Affiliation(s)
- 宇清 刘
- 贵州省人民医院听力科 贵州省听力康复研究中心 贵州省新生儿听力筛查诊断中心(贵阳,550000)Department of Audiology, Guizhou Provincial People's Hospital, Guizhou Hearing Rehabilitation Research Center, Guizhou Newborn Hearing Screening and Diagnosis Center, Guiyang, 550000, China
| | - 嫄 张
- 贵州省人民医院听力科 贵州省听力康复研究中心 贵州省新生儿听力筛查诊断中心(贵阳,550000)Department of Audiology, Guizhou Provincial People's Hospital, Guizhou Hearing Rehabilitation Research Center, Guizhou Newborn Hearing Screening and Diagnosis Center, Guiyang, 550000, China
| | - 方英 陶
- 贵州省人民医院听力科 贵州省听力康复研究中心 贵州省新生儿听力筛查诊断中心(贵阳,550000)Department of Audiology, Guizhou Provincial People's Hospital, Guizhou Hearing Rehabilitation Research Center, Guizhou Newborn Hearing Screening and Diagnosis Center, Guiyang, 550000, China
| | - 莉 兰
- 贵州省人民医院听力科 贵州省听力康复研究中心 贵州省新生儿听力筛查诊断中心(贵阳,550000)Department of Audiology, Guizhou Provincial People's Hospital, Guizhou Hearing Rehabilitation Research Center, Guizhou Newborn Hearing Screening and Diagnosis Center, Guiyang, 550000, China
| | - 可婕 杨
- 贵州省人民医院听力科 贵州省听力康复研究中心 贵州省新生儿听力筛查诊断中心(贵阳,550000)Department of Audiology, Guizhou Provincial People's Hospital, Guizhou Hearing Rehabilitation Research Center, Guizhou Newborn Hearing Screening and Diagnosis Center, Guiyang, 550000, China
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