Zuma Modified Maneuver as a Treatment to Geotropic Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo
Bernardo Faria RamosRenato Valério Rodrigues CalCamila Martins BrockPedro Luiz Mangabeira AlbernazFrancisco Zuma e Maia
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Abstract Introduction Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular disorder, resulting from detached otoliths that migrate to one of the semicircular canals – canalolithiasis – or one of the cupulas – cupulolithiasis. The present study is related to lateral canal BPPVs, which may be either geotropic or apogeotropic. The geotropic variant of lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV) is attributed to free floating particles in the posterior arm of the lateral semicircular canal. Objectives To verify the possibility of employing the Zuma repositioning maneuver, with a brief modification, as an alternative treatment for geotropic LC-BPPV. Methods Seven patients with geotropic LC-BPPV were enrolled and treated with the Zuma modified maneuver. Patients were reevaluated 1 hour after a single maneuver, to confirm the resolution of vertigo and positional nystagmus. Results All seven patients achieved immediate resolution of vertigo and positional nystagmus as measured 1 hour after the application of the maneuver. Conclusion The Zuma modified maneuver was effective for geotropic LC-BPPV after a single application. The use of the Zuma maneuver for both apogeotropic and geotropic LC-BPPV may simplify the treatment of these patients.Keywords:
Posterior Semicircular Canal
Vestibular disorders
Objective To analyze clinical characteristics and therapy of benign paroxysmal positional vertigo.Methods Histories of 131 cases of BPPV were inquired and their clinical data retrospectively analyzed.All the patients were followed up for 3 months.Results Of the 131 patients,51 were male and 80 were female,with a mean age of 47.7 years (20 to 82 years).Lesion was located in the posterior semicircular canal in 75 patients,horizontal semicircular canal in 39 patients,horizontal semicircular cup in 4 patients,superior semicircular canal in 1 patient,and combined multiple semicircular canals in 8 patients.Symptoms were subjective in 3 patients.Idiopathic BPPV was diagnosed in 103 patients,and secondary BPPV in the rest patients.Conclusion Patients with BPPV have various clinical characteristics.Understanding of such characteristics is necessary to apply appropriate repositioning maneuvers.
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To investigate the characteristics of canal conversion between the anterior and posterior semicircular canals in benign paroxysmal positional vertigo (BPPV).Retrospective chart review.Secondary referral center.A total of 709 patients who were treated with the Epley maneuver for BPPV of the anterior or posterior semicircular canal.Vestibular examinations with videonystagmography and the canalith repositioning procedure (CRP) to treat BPPV.Canal conversion between the anterior and posterior semicircular canals was observed in 18 (2.9%) patients who underwent CRP. In 13 (2.3%) of 564 patients initially diagnosed with posterior canal BPPV (PC-BPPV), switch to anterior canal BPPV (AC-BPPV) was observed at a follow-up visit. In 5 (12.1%) of 41 patients who presented with AC-BPPV, canal switch to PC-BPPV occurred more frequently (p = 0.005). The average number of CRPs before nystagmus resolution was 3.6 in conversion cases versus 1.6 in the nonconversion group (p < 0.001).Canal conversion between the anterior and posterior semicircular canals can occur during treatment. The possibility of canal conversions should be considered for appropriate management of BPPV of the vertical semicircular canals.
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Objective To investigate the diagnosis and treatment of secondary benign paroxysmal positional vertigo(BPPV).Method We reported six cases of secondary posterior semicircular canal benign paroxysmal positional vertigo.The diagnosis w as based on history and nystagmus induced by Dix-Hallpike test.Results Six cases of inner ear disease associated w ith the posterior semicircular canal benign paroxysmal positional vertigo w as diagnosed by DixHallpike test.There w ere three cases of sudden deafness,tw o cases of Meniere's disease and one case of vestibular neuronitis,respectively.Vertical torsional nystagmuses w ere induced in all the patients.Conclusions Secondary benign paroxysmal positional vertigo is rare in clinic,and posterior semicircular canal w as involved mostly.It can be diagnosed and cured by the Dix-Hallpike test and Epley manipulative method.
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Conclusion. Video-oculography demonstrates a higher occurrence of atypical positional nystagmus in patients with benign paroxysmal positional vertigo (BPPV). This includes anterior and horizontal canal variants and multiple positional nystagmus, suggesting combined lesions affecting several canals. Objective. To analyse the video-oculographic findings of positional tests in patients with BPPV. Material and methods. Seventy individuals with symptoms of BPPV and positional nystagmus were included in this study. The diagnosis was based on a history of brief episodes of vertigo and the presence of positional nystagmus as confirmed by video-oculographic examination during the Dix–Hallpike test, the McClure test or the head-hanging manoeuvre. Patients were treated by means of different particle repositioning manoeuvres according to the affected canal (Epley's manoeuvre for the posterior or anterior canals and Lempert's manoeuvre for the lateral canal) and the effectiveness was evaluated at 7 and 30 days. Results. Twenty-nine individuals (41.43%) presented an affected unilateral posterior canal. Fifteen patients (21.43%) presented a pure horizontal direction-changing positional nystagmus consistent with a diagnosis of horizontal canal BPPV. Twelve individuals (17.14%) presented a unilateral down-beating nystagmus, suggesting possible anterior canal BPPV. In addition, 14 patients (20%) showed multiple positional nystagmus during the examination corresponding to simultaneous multi-canal BPPV, 5 had bilateral posterior canal BPPV and 2 presented a positional down-beating nystagmus in both left and right Dix–Hallpike manoeuvres and the head-hanging manoeuvre, which is highly suggestive of anterior canal BPPV. However, seven individuals showed positional horizontal and vertical side-changing nystagmus that could not be explained by single-canal BPPV. These patients with multiple positional nystagmus showed changing patterns of positional nystagmus at follow-up.
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Background and Objectives Benign paroxysmal positional vertigo (BPPV) generally involves a single semicircular canal (single canal BPPV) but it has been reported that more than one semicircular canal on either the same or the opposite side can be involved in 6.8-20% of the cases (multiple canal BPPV). In this study, the clinical characteristics of multiple canal BPPV were analyzed and compared to those of single canal BPPV. Materials and Methods Retrospective analysis was performed on 1054 consecutive patients diagnosed with BPPV. Multiple canal BPPV was diagnosed when the combination of typical nystagmus was provoked by the Dix-Hallpike and supine head roll tests. Canalith repositioning maneuver was performed sequentially starting with the semicircular canal causing more severe nystagmus or symptoms. Clinical characteristics and the treatment course were statistically compared between single canal BPPV and multiple canal BPPV. Results Among the 1054 patients, single canal BPPV was diagnosed in 1005 patients (95.4%) while multiple canal BPPV was diagnosed in 49 patients (4.6%). BPPV involving semicircular canals on the same side was more common (79.6%) than BPPV with bilateral involvement. The most common combination of the involved canals was ipsilateral posterior and horizontal semicircular canals (63.3%). Multiple canal BPPV was significantly more associated with underlying otologic diseases, especially labyrinthitis. Multiple canal BPPV required more treatment sessions and longer duration of treatment to achieve resolution of nystagmus and symptoms. Conclusions As all cases of multiple canal BPPV were treated successfully although a longer duration of treatment and more treatment sessions were required compared to single canal BPPV, the results of our study could aid in making an accurate diagnosis and providing appropriate treatment of multiple canal BPPV. Keywords: Benign paroxysmal positional vertigo · Multiple · Labyrinthitis · Semicircular canal.
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Objective To study whether there will be a reduction on the falls of elderly patients with BPPV after the particle repositioning maneuver( PRM). Methods The elderly above 60 with BPPV who had falls during the past 5 year was studied retrospectively. All patients accepted the PRM according to the affected semicircular canal. After positioning vertigo and nystagmus subsidised,the patients accepted a 12 month follow-up and were investigated about the number of falls. Wilcoxon's test was performed to compare the number of falls before and after 12 months of the PRM. Results One hundred and forty seven patients were included in the study. One hundred and twenty one patients involved the posterior semicircular canal,18 of the lateral and 8 of the anterior. The Epley maneuver was used for posterior semicircular canal and superior semicircular canal BPPV,and the Lempert maneuver was used for lateral semicircular canal BPPV. We noticed a reduction on the number of falls,with statistically significant difference when all the patients were analyzed together( P 0. 01),the posterior canal BPPV patients( P 0. 01),the lateral canal BPPV patients( P = 0. 001) and the anterior canal BPPV patients( P = 0. 016). Conclusion The PRM could reduce the number of falls of elderly patients with BPPV.
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Benign paroxysmal positional vertigo of the superior semicircular canal is a rare form of BPPV. It accounts for 1% to 3% of cases. The characteristic nystagmus is positional, down-beating, with a torsional component elicited by the Dix-Hallpike maneuver. Symptoms of superior semicircular canal BPPV often resolve spontaneously; however, it can be refractory to repositioning maneuvers. Surgical management is described for posterior semicircular canal BPPV. To date, however, there is only one reported case of surgical management for superior semicircular canal BPPV. Here we show video documentation of positional, down-beating nystagmus and describe a case of superior semicircular canal BPPV requiring canal occlusion with successful resolution of symptoms.
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Conclusion: To make a comprehensive analysis with a variety of diagnostic maneuvers is conducive to the correct diagnosis and classification of BPPV.Objective: Based on the standard spatial coordinate-based semicircular canal model for theoretical observation on diagnostic maneuvers for benign paroxysmal positional vertigo (BPPV) to analyze the meaning and key point of each step of the maneuver.Materials and methods: This study started by building a standard model of semicircular canal with space orientation by segmentation of the inner ear done with the 3D Slicer software based on MRI scans, then gives a demonstration and observation of BPPV diagnostic maneuvers by using the model.Results: The supine roll maneuver is mainly for diagnosis of lateral semicircular canal BPPV. The Modified Dix-Hallpike maneuver is more specific for the diagnosis of posterior semicircular canal BPPV. The side-lying bow maneuver designed here is theoretically suitable for diagnosis of anterior semicircular canal BPPV.
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Posterior Semicircular Canal
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Objective:To explore treatment and therapeutic effectiveness of patients with Meniere' s disease and benign paroxysmal positional vertigo.Method: A series of BPPV 60 cases was retrospective analyzed. The patients were divided into three groups: Meniere' s disease with multiple semicircular canal BPPV(n=6), with single semicircular canal BPPV (n=11) and BPPV without Meniere' s disease group(Control,n=43). All patients were diagnosed by the Dix-Hallpike test or roll test and treated with the canalith repositioning procedure. The outcomes were compared among the three groups. Result: Unilateral semicircular canal BPPV was more than bilateral BPPV, the posterior semicircular canal was the most common canal involved, and multiple semicircular canal BPPV with Meniere' s disease patients needed repeated canalith repositioning procedure and had a higher recurrence rate.Conclusion:A lower success rate of treatment and a higher recurrence rate was found in BPPV patients with Meniere' s disease compared with those without Meniere' s disease . The recurrence rate is highest in multiple semicircular canal BPPV with Meniere' s disease.
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