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CC BY-NC-ND 4.0 · Annals of Otology and Neurotology 2019; 2(02): 85-88
DOI: 10.1055/s-0039-1695678
Case Report

Unveiling Positioning Nystagmus in Patients of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo by Diagnostic Head-Shaking in the Yaw Plane

Ajay Kumar Vats
1   Chaudhary Hospital and Medical Research Centre Private Limited, Udaipur, Rajasthan, India
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Abstract

Introduction The diagnosis of benign paroxysmal positional vertigo (BPPV) is largely dependent on elicitation of positioning nystagmus on the diagnostic positional tests, namely Dix-Hallpike and supine roll tests (DHT and SRT, respectively), in patients complaining of vertigo, which occurs when patient’s head moves relative to the gravity. The pattern of elicited positioning nystagmus localizes as well as lateralizes the diseased canal, and the therapeutic positioning maneuver is accordingly undertaken.

Objective The diagnostic positional tests, at times fail to elicit positional nystagmus, leaving clinician in a state of dilemma, when examining a patient who is currently experiencing paroxysms of vertigo triggered by positional change. In two patients with history consistent with BPPV but with negative positional tests initially, head shaking for 10 seconds in the yaw axis was done, and Dix-Hallpike and supine roll tests were repeated. The aim of head shaking for 10 seconds was to unveil positional nystagmus, to precisely localize and lateralize the diseased semicircular canal.

Results and Discussion In the two cases of horizontal semicircular canal BPPV (HSC-BPPV) reported here, the DHT and/or SRT initially failed to elicit positional nystagmus but head shaking for 10 seconds in the left Dix–Hallpike position in case one and with the head anteflexed 30-degrees in the sitting position in the case two, unveiled horizontal positional nystagmus on ensuing SRT. The use of head-shaking in the yaw plane to unveil a horizontal positioning nystagmus in cases where a conventional positional test (DHT and SRT) has failed to elicit the PN, has not been reported in the literature hitherto.

Conclusion After precise localization and lateralization of the diseased canal, both patients successfully underwent successful treatment with Gufoni maneuver. A verifying SRT done at 1 hour and/or at 24 hours follow-up was negative. In patients, who are currently experiencing paroxysms of vertigo triggered by the change of position of head relative to the gravity; head-shaking for few seconds just prior to the positioning test, can unveil positional nystagmus not elucidated with the conventionally performed positional tests.

Keywords

benign paroxysmal positional vertigo - Dix-Hallpike test - Gufoni maneuver - positional nystagmus - supine roll test

Supplementary Material



Publication History

Article published online:
30 December 2019

© 2019. Indian Society of Otology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Dix MR, Hallpike CS. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Ann Otol Rhinol Laryngol 1952; 61 (04) 987-1016
    CrossrefPubMedGoogle Scholar
  • 2 von Brevern M, Bertholon P, Brandt T. et al. Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res 2015; 25 (3–4) 105-117
    CrossrefPubMedGoogle Scholar
  • 3 Tirelli G, D’Orlando E, Giacomarra V, Russolo M. Benign positional vertigo without detectable nystagmus. Laryngoscope 2001; 111 (06) 1053-1056
    CrossrefPubMedGoogle Scholar
  • 4 Haynes DS, Resser JR, Labadie RF. et al. Treatment of benign positional vertigo using the semont maneuver: efficacy in patients presenting without nystagmus. Laryngoscope 2002; 112 (05) 796-801
    CrossrefPubMedGoogle Scholar
  • 5 Anagnostou E, Mandellos D, Patelarou A, Anastasopoulos D. [Benign paroxysmal positional vertigo with and without manifest positional nystagmus: an 18-month follow-up study of 70 patients]. HNO 2007; 55 (03) 190-194
    CrossrefPubMedGoogle Scholar
  • 6 Zhang JH, Huang J, Zhao ZX. et al. [Clinical features and therapy of subjective benign paroxysmal positional vertigo]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2007; 42 (03) 177-180
    PubMedGoogle Scholar
  • 7 Johkura K, Momoo T, Kuroiwa Y. Positional nystagmus in patients with chronic dizziness. J Neurol Neurosurg Psychiatry 2008; 79 (12) 1324-1326
    CrossrefPubMedGoogle Scholar
  • 8 Caldas MA, Ganança CF, Ganança FF, Ganança MM, Caovilla HH. Clinical features of benign paroxysmal positional vertigo. Rev Bras Otorrinolaringol (Engl Ed) 2009; 75 (04) 502-506
    Google Scholar
  • 9 House MG, Honrubia V. Theoretical models for the mechanisms of benign paroxysmal positional vertigo. Audiol Neurotol 2003; 8 (02) 91-99
    CrossrefPubMedGoogle Scholar
  • 10 Kaplan DM, Slovik Y, Joshua BZ, Puterman M, Kraus M. Head shaking during Dix-Hallpike exam increases the diagnostic yield of posterior semicircular canal BPPV. Otol Neurotol 2013; 34 (08) 1444-1447
    CrossrefPubMedGoogle Scholar