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European Archives of Oto-Rhino-Laryngology

, Volume 273, Issue 2, pp 311–316 | Cite as

Neutral position of persistent direction-changing positional nystagmus

  • Hiroaki IchijoEmail author
Otology

Abstract

The aim of this study was to measure the neutral position of direction-changing apogeotropic positional nystagmus (heavy cupula of the horizontal semicircular canal) and persistent direction-changing geotropic positional nystagmus (light cupula of the horizontal semicircular canal). We conducted a prospective case series study on 31 patients with heavy cupula (12 males, 19 females; mean age, 64.3 years) and 33 patients with light cupula (10 males, 23 females; mean age, 60.9 years). We measured the angle of the neutral position in patients with heavy cupula (θ 1) and that in patients with light cupula (θ 2) using a large protractor. The mean value and standard deviation of θ 1 was 31.6 ± 22.4°, minimum value was 5°, and maximum value was 89°. The mean value and standard deviation of θ 2 was 44.4 ± 20.5°, minimum value was 5°, and maximum value was 85°. θ 2 was significantly greater than θ 1 (p < 0.05). The neutral position varies widely. Some patients exhibit a great angle (more than 40°); therefore, examiners should make patients adopt a completely lateral position in the supine head roll test and should confirm the direction of nystagmus in order to avoid mistaking positional nystagmus for spontaneous nystagmus.

Keywords

Horizontal semicircular canal Supine head roll test Heavy cupula Light cupula Buoyancy 

References

  1. 1.
    Imai T, Ito M, Takeda N, et al (2005) Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology 64:920–921Google Scholar
  2. 2.
    Baloh RW, Yue Q, Jacobson KM, Honrubia V (1995) Persistent direction-changing positional nystagmus: another variant of benign positional nystagmus? Neurology 45:1297–1301PubMedCrossRefGoogle Scholar
  3. 3.
    Bisdorff AR, Debatisse D (2001) Localizing signs in positional vertigo due to lateral canal cupulolithiasis. Neurology 57:1085–1088PubMedCrossRefGoogle Scholar
  4. 4.
    Baloh RW, Jacobson K, Honrubia V (1993) Horizontal semicircular canal variant of benign positional vertigo. Neurology 43:2542–2549PubMedCrossRefGoogle Scholar
  5. 5.
    Ichijo H (2011) Positional nystagmus of horizontal canalolithiasis. Acta Otolaryngol 131:46–51PubMedCrossRefGoogle Scholar
  6. 6.
    Hiruma K, Numata T (2004) Positional nystagmus showing neutral points. ORL J 66:46–50CrossRefGoogle Scholar
  7. 7.
    Bergenius J, Tomanovic T (2006) Persistent geotropic nystagmus–a different kind of cupular pathology and its localizing signs. Acta Otolaryngol 126:698–704PubMedCrossRefGoogle Scholar
  8. 8.
    Ichijo H (2012) Persistent direction-changing geotropic positional nystagmus. Eur Arch Otorhinolaryngol 269:747–751PubMedCrossRefGoogle Scholar
  9. 9.
    Kim CH, Kim MB, Ban JH (2014) Persistent geotropic direction-changing positional nystagmus with a null plane: the light cupula. Laryngoscope 124:15–19CrossRefGoogle Scholar
  10. 10.
    Hiruma K, Numata T, Mitsuhashi T et al (2011) Two types of direction-changing positional nystagmus with neutral points. Auris Nasus Larynx 38:46–51PubMedCrossRefGoogle Scholar
  11. 11.
    Igarashi M (1967) Dimensional study of the vestibular apparatus. Laryngoscope 77:1806–1817PubMedCrossRefGoogle Scholar
  12. 12.
    Bradshaw AP, Curthoys IS, Todd MJ et al (2010) A mathematical model of human semicircular canal geometry: a new basis for interpreting vestibular physiology. J Assoc Res Otolaryngol 11:145–159PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Ichijo H (2002) Angles between left and right vertical semicircular canals. Nihon JibiinkokaGakkaiKaiho 105:1138–1142Google Scholar
  14. 14.
    Della Santina CC, Potyagaylo V, Migliaccio AA et al (2005) Orientation of human semicircular canals measured by three-dimensional multiplanar CT reconstruction. J Assoc Res Otolaryngol 6:191–206PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Yamane H, Igarashi M (1984) Free-floating cells in the endolymphatic sac after surgical utricular nerve section. ORL J 46:289–293CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Ichijo Ear, Nose and Throat ClinicHirosakiJapan

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