Can the bending forward test be used to detect a diseased anterior semi-circular canal in patients with chronic vestibular multi-canalicular canalithiasis (BPPV)?

Abstract

Introduction: Patients with chronic vestibular multi-canalicular canalithiasis (CVMCC) can have serious morbidities, for example, musculoskeletal pain, dizziness, fatigue, and cognitive difficulties. Involvement of the anterior semi-circular canal (SCC) is common in CVMCC. A mono-canalicular diseased anterior SCC is rare.

Aim: To examine if the Bending forward test can be used to detect a diseased anterior semi-circular canal in patients with CVMCC.

Material and Methods: Prospective consecutive observational cohort study in patients with relapse of an earlier successfully treated chronic CVMCC, where 16 patients have a diseased anterior SCC, 11 without any involvement of the anterior SCC, and 15 healthy controls. Patients are tested in sitting and in bending forward position. The difference in downwards directed nystagmus count and slow phase velocity in the two test positions AND reported movement illusion are the main outcome.

Results: The sensitivity of the Bending forward-test is 81%; the specificity 91%. Five of the healthy controls have positional nystagmus without movement illusion. This is interpreted as cupulolithiasis. Positional nystagmus with movement illusion is interpreted as canalithiasis.

Conclusions: Bending forward-test is a valuable test. Only positional nystagmus accompanied by a movement illusion, that is canalithiasis, is of clinical relevance.

Significance: These findings may assist in diagnosing compound musculoskeletal disorders.

简介：患有慢性前庭多管小管白斑病（CVMCC）的患者可能具有严重的症状, 例如, 肌肉骨骼疼痛、头晕、疲劳和认知困难。涉及到半圆形管（SCC）前部在CVMCC中很常见。单小管病变的SCC前部是罕见的。

目的：检查弯曲正向试验是否可用于检测CVMCC患者的病变前半圆形管。

资料和方法：对曾经成功治疗的慢性CVMCC后来复发的患者进行前瞻性连续观察性群体研究, 其中16例SCC前部病变, 11例不涉及SCC前部和15例健康对照。患者以坐的和向前弯曲的姿势接受测试。两种姿势下测试的向下定向的眼球震颤计数和慢相速度的差异以及所报告的运动错觉是其主要结果。

结果：对前弯检验的敏感性为81％；特异性为91％。五名健康​​对照者的没有运动错觉的位置性眼球震颤, 被认为是杯石症。具有运动错觉的位置性眼球震颤被称为小管白斑病。

结论：前弯测试是一项有价值的测试。只有位置性眼球震颤伴有运动错觉, 即小管白斑病, 才具有临床意义。

意义：这些发现可能有助于诊断复合性肌肉骨骼疾病。

Keywords:

• Chronic BPPV
• anterior semi-circular canal
• headache
• temporomandibular joint pain
• fatigue
• head and neck trauma

Disclosure statement

No potential conflict of interest was reported by the authors.