Abstract
To investigate the pathophysiology of benign paroxysmal positional vertigo (BPPV), we observed positional nystagmus and assessed the efficacy of the canalith repositioning procedure (CRP). Nystagmus was recorded using an infrared CCD camera. Subjects were 36 patients who exhibited typical rotatory nystagmus of BPPV with Hallpike maneuvers. The therapy given to the control group (Group A, n=18) was medication only, while Group B (n=18) was treated by both CRP and medication. In almost all patients, rotatory nystagmus was provoked by slow position change from the healthy ear down (head hanging position with a 45-degree tilt to the healthy side) to the affected ear down (head hanging position with a 45-degree tilt to the affected side). This phenomenon indicates that rapid movement is not necessary for provocation, and a 45-degree off sagittal tilt indicates that the lesion is in the posterior semicircular canal. The period of disease in Group B was significantly shorter than that in Group A. In Group B, CRP was effective in 16 patients (89%). We conclude that free-moving particles in the posterior semicircular canal is the cause of BPPV. We suggest that rotatory positional nystagmus is a result of ampullofugal flow of sinking particles in the posterior semicircular canal and secondary ampullof ugal flow in the anterior semicircular canal.
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