Diagnostic and treatment strategy of lateral semicircular canal canalolithiasis - PubMed (original) (raw)

Comparative Study

Diagnostic and treatment strategy of lateral semicircular canal canalolithiasis

G Asprella Libonati. Acta Otorhinolaryngol Ital. 2005 Oct.

Abstract

in English, Italian

A new strategy for the diagnosis and treatment both of geotropic and apogeotropic Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo is proposed. To this end, a new strategy of approach to Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo is described in order to rapidly highlight both the side and the affected canal. Thus, in the first treatment session, using the so-called "strategy of the minimum stimulus", a large percentage of cases are successfully treated, with the lowest number of vertigos for the patient. Following a review of the literature, 269 case studies, personally observed over a 4-year period, are described. The diagnostic strategy is performed by a single manoeuvre to determine whether the posterior semicircular canal or the lateral canal is affected. In the latter case, it is possible to highlight the affected sides both of the geotropic and apogeotropic forms. The therapeutic strategy comprises several liberatory manoeuvres, barbecue rotation techniques (Vannucchi-Asprella, Lempert), and Gufoni manoeuvre by continuously monitoring the ampullofugal movement of the otoliths. Almost 98% of cases are successfully treated at the first treatment diagnostic-therapeutic session. This approach to Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo allows a two-fold goal to be achieved, i.e., to effect both diagnosis and treatment at the first examination. Furthermore, thanks to the philosophy of the approach to Benign Paroxysmal Positional Vertigo, called the "Strategy of the minimum stimulus", patient compliance is very good since a very small number of vertigos are produced, and few neuro-vegetative disorders.

Lo scopo del lavoro è quello di illustrare una nuova strategia per la diagnosi e la terapia della vertigine parossistica posizionale benigna (VPPB) del canale semicircolare laterale (CSL), sia nella forma geotropa che in quella apogeotropa. Viene descritta una metodologia di approccio alla VPPB del CSL che consente di individuare rapidamente il lato ed il canale affetto, portando già nel corso della prima seduta ad immediata risoluzione una elevata percentuale di casi, con il minimo disagio per il paziente. Infatti con la metodica illustrata si consegue il risultato terapeutico sottoponendo il paziente al minor numero di vertigini indispensabili: “strategia del minimo stimolo”. Dopo una disamina della letteratura viene riportata la propria esperienza relativa a 269 casi osservati in 4 anni. La strategia diagnostica utilizza una manovra unica, finalizzata a distinguere l’interessamento del canale semicircolare posteriore dal laterale, consentendo, in quest’ultimo caso, di individuare il lato affetto sia nelle forme geotrope che apogeotrope. La strategia terapeutica utilizza la combinazione di diverse manovre liberatorie, tecniche di barbecue rotation (Vannucchi-Asprella, Lempert), e la manovra di Gufoni, monitorizzando sempre l’effettiva progressione in senso ampullifugo dell’ammasso otolitico. Il controllo videonistagmoscopico step by step del nistagmo evocato nell’esecuzione delle varie fasi della terapia, consente, infatti, di rilevarne l’efficacia, testimoniata dalla comparsa di un nistagmo diretto verso l’orecchio sano, da deflessione ampullifuga della cupula ampollare dell’orecchio coinvolto, quindi inibitorio. La percentuale di risoluzioni della patologia nel corso della prima seduta diagnostico/terapeutica è elevata, raggiungendo il 98%. Con tale strategia di approccio alla VPPB del CSL si consegue dunque l’obiettivo di effettuare sia la diagnosi che la terapia già alla prima osservazione. Inoltre la compliance da parte del paziente è elevata essendo limitata al minimo indispensabile la stimolazione di vertigini e del corredo neurovegetativo associato, con una filosofia di approccio alla VPPB definita come “Strategia del minimo stimolo”.

PubMed Disclaimer

Figures

Fig. 1

Fig. 1

Patient lies on side of healthy ear: in geotropic forms, otoliths found in posterior arm of LSC settle along canal, towards utricle, generating an ampullofugal, inhibitory current and, therefore, geotropic nystagmus beating to healthy ear. In apogeotropic forms, otoliths found in anterior arm settle along canal, towards ampulla, causing an excitatory, ampullopetal endolymphatic current and consequent apogeotropic nystagmus beating to impaired side.

Fig. 2

Fig. 2

Patient lies on impaired side: in geotropic forms, otoliths found in posterior arm of LSC settle along canal, towards ampulla, generating an excitatory, ampullopetal endolymphatic current and, consequently, geotropic nystagmus beating to affected side. In apogeotropic forms, otoliths found in anterior arm move away from ampulla, generating an inhibitory ampullofugal endolymphatic current and, consequently, apogeotropic nystagmus.

Fig. 3

Fig. 3

Asprella Single Manoeuvre performed to diagnose both LSC and PSC BPPV: a brisk change from seated to supine position, under videonystagmoscopic control.

Fig. 4

Fig. 4

Asprella Single Manoeuvre: when patient lies supine, LSC is on vertical plane; therefore, due to brisk deceleration caused by manoeuvre, otoliths are pushed downwards: if they are in posterior arm, they float towards utricle, if they are in anterior arm, they float towards ampulla.

Fig. 5

Fig. 5

Vannucchi-Asprella manoeuvre for right LSC-BPPV: 1. patient lies in supine position, 2. his/her head is briskly turned 90° towards healthy side, 3. while keeping head turned, he/she is returned to seated upright position, 4. his/her head is slowly brought back in axis with body; 1. he/she is returned to supine position.

Fig. 6

Fig. 6

Lempert barbecue rotation technique for right LSC-BPPV. Head is rotated 90° three times towards healthy side, thus applying an overall 270° rotation.

Fig. 7

Fig. 7

Gufoni manoeuvre for right geotropic/left apogeotropic LSC-BPPV: 1. patient sits upright on examination table with his/her legs downwards; 2. he/she is then tilted rapidly on one side on the healthy side, in geotropic form, on the impaired side, in apogeotropic form; 3. head is then turned 45° downwards after which examin-er waits 2-3 minutes; 4. patient is returned to original position.

Similar articles

Cited by

References

    1. Cipparrone L, Corridi G, Pagnini P. Cupulolitiasi. In: V Giornata Italiana di Nistagmografia Clinica. Nistagmografia e patologia vestibolare periferica. Milano: CSS Boots-Formenti; 1985. p. 36-53.
    1. McClure A. Lateral canal BPV. Am J Otolaryngol 1985;14:30-5. - PubMed
    1. Pagnini P, Nuti D, Vannucchi P. Benign paroxysmal vertigo of the horizontal canal. ORL J Otorhinolaryngol Relat Spec 1989;51:161-70. - PubMed
    1. Ewald R. Physiologische Untersuchungen über das Endorgan des Nervous Octavus. Weisbaden: Bergmann; 1892.
    1. Pagnini P, Vannucchi P, Nuti D. Le nystagmus apogéotropique dans la vertige paroxystique positionelle bénin du canal sémicirculaire horizontal. La Revue d’Otoneurologie Française 1994;12:304-7.

Publication types

MeSH terms

LinkOut - more resources