360-Degree Canalith Repositioning Procedure for the Horizontal Canal

Abstract

OBJECTIVES: To evaluate the efficacy of modifications to the standard canalith repositioning procedure (CRP) in the treatment of benign positional vertigo (BPV) of the horizontal semicircular canal (HSC).

STUDY DESIGN AND SETTING: Prospective trial of 72 patients with BPV of the HSC treated with a modified 360-degree CRP.

RESULTS: 51 of the 62 patients treated for canalolithiasis made a complete recovery (82.2%) after a single 360-degree CRP.

CONCLUSIONS AND SIGNIFICANCE: It is proposed a full 360-degree rotation of the HSC involved. It is essential to begin rotation of the patient departing from the affected side towards the healthy side, especially for canal side cupulolithiasis and for canalithiasis of the ampullar branch of the HSC. The head resting on the chest at angle of 30-degree during rotating encourages free-floating debris in the HSC to move into the utricle. Instead of using an oscillator for oscillation of the mastoid bone the head is shaken manually.

Get full access to this article

View all access options for this article.

References

Parnes

Free-floating endolymph particles: A new operative finding during posterior semicircular canal occlusion. Laryngoscope 1992; 102: 988–92.

Baloh

Benign positional vertigo. In: Baloh

Halmagy

, editors. Disorders of the vestibular system. New York: Oxford University Press; 1996. pp. 328–339.

Parnes

Mc Clure

. Free-floating endolynph particles: A new operative finding during posterior semicircular canal occlusion. Laryngoscope 1992; 102: 988–92.

Parnes

Price-Jones

Particle repositioning manoeuvre for benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 1993; 102: 325–31.

Baloh

Yue

Jacobson

, et al. Persistent direction-changing positional nystagmus: Another variant of benign positional nystagmus? Neurology 1995; 45: 1297–301.

Nuti

Agus

Barbieri

The management of horizontal-canal paroxysmal positional vertigo. Acta Otolaryngol (Stock) 1998; 118: 455–60.

Baloh

Jacobson

Honrubia

Horizontal semicircular canal variant of benign positional vertigo. Neurology 1993; 43: 2543–44.

Lempert

Tiel-Wilck

A positional manoeuvre for treatment of horizontal canal benign positional vertigo. Laryngoscope 1996; 106: 476–8.

Vannucchi

Giannoni

Pagnini

Treatment of horizontal semicircular canal benign paroxysmal positional vertigo. J Vestib Res 1997; 7: 1–6.

10.

Lempert

Lateral benign positional vertigo. Neurology 1994; 44: 2213–4.

11.

Baloh

Reply to the letter by Lempert: Lateral benign positional vertigo. Neurology 1994; 44: 2214.

12.

Tirelli

D'Orlando

Zarcone

, et al. Modified particle repositioning procedure. Laryngoscope 2000; 100: 462–8.

13.

Jacobson

Newman

The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990; 116: 424–7.

14.

Brandt

Vertigo: its multisensory syndromes. London: Sprinter; 1999.

15.

Epley

Particle repositioning for benign paroxysmal positional vertigo. Otolaryngol Clin North Am 1996; 29: 323–31.

16.

Harvey

Hain

Adamiec

Modified liberatory manoeuvre: Effective treatment for benign paroxysmal positional vertigo. Laryngoscope 1994; 104: 1206–12.

17.

Mastoid oscillation: A critical factor for success in the canalith repositioning procedure. Otolaryngol Head Neck Surg 1995; 112: 670–5.

18.

Lempert

Davies

Gresty

, et al. Three hundred sixty-degree rotation of the posterior semicircular canal for treatment of benign positional vertigo: A placebo-controlled trial. Neurology 1997; 49: 729–33.

19.

Tirelli

D'Orlando

Giacomarra

, et al. Benign positional vertigo without detectable nystagmus. Laryngoscope 2001; 111: 1053–6.

20.

Casani

Vannucci

Fattori

The treatment of horizontal canal positional vertigo: Our experience in 66 cases. Laryngoscope 2002; 112: 172–8.