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Recovery of positional nystagmus after benign paroxysmal positional vertigo fatigue

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

In benign paroxysmal positional vertigo (BPPV), positional nystagmus is generally weaker when the Dix–Hallpike test is repeated. This phenomenon is known as BPPV fatigue. The positional nystagmus induced by the Dix–Hallpike test can be observed again when time has passed. There has been no study regarding the length of time required to recover the positional nystagmus. The purpose of this study was to examine whether positional nystagmus recovers within 30 min after the disappearance of the nystagmus by BPPV fatigue.

Methods

This was a prospective observational study. Twenty patients with posterior canal type of BPPV (canalolithiasis of the posterior canal) were included. Dix–Hallpike tests were performed three times for each patient. A second Dix–Hallpike test was performed immediately after the first Dix–Hallpike test. A third Dix–Hallpike test was performed 30 min after the second Dix–Hallpike test. We recorded positional nystagmus induced by the Dix–Hallpike tests and analyzed maximum slow-phase eye velocity (SPEV) of the positional nystagmus.

Results

The average maximum SPEV of positional nystagmus induced by the second Dix–Hallpike test (4.8°/s) was statistically lower than that induced by the first Dix–Hallpike test (48.0°/s); this decrease was caused by BPPV fatigue. There was no statistical difference between average maximum SPEV of positional nystagmus induced by the first Dix–Hallpike test and that induced by the third Dix–Hallpike test (41.6°/s); this indicates that the effect of BPPV fatigue disappeared. The effect of BPPV fatigue disappears within 30 min.

Conclusions

A second Dix–Hallpike test should be performed at least 30 min after the first.

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Acknowledgements

Approval for the study was obtained from the ethics committees of Osaka Rosai Hospital and Osaka University Hospital (No. 16165), and the study was included in the University Hospital Medical Information Network (UMIN) (UMIN000025291). We thank Ryan Chastain-Gross, Ph.D., from Edanz Group (http://www.edanzediting.com/ac) for editing a draft of this manuscript.

Funding

This work was supported by JSPS KAKENHI Grant (no. 17K11327) and a Grant-in-Aid from the Japan Agency for Medical Research and Development.

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan

    Takao Imai, Tomoko Okumura, Yumi Ohta, Takashi Sato & Hidenori Inohara

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan

    Suetaka Nishiike

  3. Department of Otorhinolaryngology-Head and Neck Surgery, Tokushima University Graduate School of Medicine, Tokushima, Japan

    Noriaki Takeda

  4. Department of Otolaryngology, Kinki University Faculty of Medicine, Osaka, Japan

    Yasuhiro Osaki

Authors
  1. Takao Imai
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  2. Tomoko Okumura
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  3. Suetaka Nishiike
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  4. Noriaki Takeda
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  5. Yumi Ohta
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  6. Yasuhiro Osaki
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  7. Takashi Sato
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  8. Hidenori Inohara
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Contributions

TI substantial contributions to conception, acquisition of data, analysis and interpretation of data, and drafting of the article. TO substantial contributions to analysis of data. SN substantial contributions to acquisition of data. NT substantial contributions to interpretation of data. YO substantial contributions to acquisition of data. YO substantial contributions to acquisition of data. TS substantial contributions to acquisition of data. HI substantial contributions to study supervision.

Corresponding author

Correspondence to Takao Imai.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Imai, T., Okumura, T., Nishiike, S. et al. Recovery of positional nystagmus after benign paroxysmal positional vertigo fatigue. Eur Arch Otorhinolaryngol 275, 2967–2973 (2018). https://doi.org/10.1007/s00405-018-5165-3

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  • DOI: https://doi.org/10.1007/s00405-018-5165-3

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