A new treatment (the affected-ear-up 90° maneuver) for benign paroxysmal positional vertigo of the lateral semicircular canal

Abstract

Background: Although several researchers have tried various kinds of canalith repositioning procedures for lateral canalolithiasis, a standard treatment has not been established. We have adopted 90° rotation, which is anatomically appropriate.

Objective: To clarify the efficacy of the affected-ear-up 90° maneuver.

Materials and methods: The subjects were 23 consecutive patients (15 females, 8 males) who revealed transient direction-changing geotropic positional nystagmus. After determining the affected side, we immediately performed the canalith repositioning procedure. To perform this maneuver: (1) Place the patient in the supine position. (2) Rotate the head toward the healthy side until 90° from the supine. (3) Sit up. (4) Ask the patient to remain upright with the chin down until going to bed.

Results: Nineteen patients (83%) became symptom-free by only one maneuver. However, three patients converted to ipsilateral cupulolithiasis of the lateral canal, and one patient required a second maneuver.

Conclusion: The affected-ear-up 90° maneuver is effective against lateral canalolithiasis.

Chinese abstract

背景：尽管若干研究人员尝试过各种耳石再定位术治疗侧管结石, 但标准治疗方法尚未建立起来。我们采用了90°旋转, 这在解剖学上是合适的。

目的：阐明病耳向上90°操作的效果。

材料和方法：受试者为23名连续患者（15名女性, 8名男性）, 他们诉说短暂的变向性地向位置性眼球震颤。在受影响的一侧被确认后, 我们立即进行了耳石再定位手术。进行下列操作：（1）将患者置于仰卧位。 （2）将头部朝向健康侧转90度。 （3）坐起来。 （4）让患者保持直立, 下巴低垂直至睡觉。

结果：19名患者（83％）仅通过一次操作就已无症状。然而, 三名患者转为侧管同侧椎管结石；一名患者需要进行第二次手术。

结论：病耳向上90°操作对治疗侧管结石有效。

Keywords:

• Canalolithiasis
• cupulolithiasis
• lying-down nystagmus
• Ewald’s second law
• positional nystagmus

Acknowledgements

We thank Dr. Kazunori Futai for preparing some of the figures. The author alone is responsible for the content and writing of the paper.

Disclosure statement

No potential conflict of interest was reported by the author.