Treatment of Benign Positional Vertigo Using Heels-Over-Head Rotation

Abstract

Particle repositioning, using either bedside techniques or whole-body manipulation devices, has been used effectively to treat benign positional vertigo (BPV). We assessed the efficacy of particle repositioning using a device designed and built specifically to treat BPV that rotated patients 360° heels-over-head in their sagittal body plane while their heads were turned to align the posterior semicircular canal with the plane of rotation. Eye movements were monitored during the maneuver by an infrared video recording system that allowed subsequent review of the induced nystagmus. Our results indicate that 1) heels-over-head rotation is an extremely efficacious procedure for treating patients with BPV and 2) the pattern of nystagmus during repositioning is consistent with the theory that free-floating debris is highly likely to account for BPV.

Keywords

nystagmus otoliths vestibulo-ocular reflex

Get full access to this article

View all access options for this article.

References

Parnes

McClure

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

Hall

Ruby

RRF

McClure

. The mechanics of benign paroxysmal vertigo. J Otolaryngol 1979;8: 151–8.

Epley

. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992;107: 399–404.

Parnes

Price-Jones

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

Mira

Valli

Zucca

Valli

. Why do episodes of benign paroxysmal positioning vertigo recover spontaneously [Abstract]?. J Vestib Res Suppl 1996;6(Suppl):S49.

Brey

Lynn

Trine

. Diagnosis and remediation of benign paroxysmal positioning vertigo. Proceedings from the XXI Congress of the Neurotological and Equilibriometric Society, Bad Kissingen, Germany, March 1994.

Lempert

Wolsley

Davies

Gresty

Bronstein

. Curing benign positional vertigo in a 3D flight simulator [Letter]. Lancet 1996;347: 1192.

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

Baloh

Honrubia

Jacobson

. Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology 1987;37: 371–8.

10.

Dix

Hallpike

. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med 1952;45: 341–54.

11.

Baloh

. Benign positional vertigo. In: Baloh

Halmagyi

, eds. Disorders of the vestibular system. New York, NY: Oxford University Press, 1996: 328–49.

12.

Leigh

Maas

Grossman

Robinson

. Visual cancellation of the torsional vestibulo-ocular reflex in humans. Exp Brain Res 1989;75: 221–6.

13.

Katsarkas

. Nystagmus of paroxysmal positional vertigo: some new insights. Ann Otol Rhinol Laryngol 1987;96: 305–8.

14.

Raphan

Cohen

Matsuo

. A velocity storage mechanism responsible for optokinetic nystagmus (OKN), optokinetic after-nystagmus (OKAN) and vestibular nystagmus. In: Baker

Berthoz

, eds. Control of gaze by brain stem neurons. New York, NY: Elsevier North-Holland Biomedical Press, 1977: 37–48.

15.

Robinson

. Vestibular and optokinetic symbiosis: an example of explaining by modelling. In: Baker

Berthoz

, eds. Control of gaze by brain stem neurons. New York, NY: Elsevier North-Holland Biomedical Press, 1977: 49–58.

16.

Seidman

Leigh

. The human torsional vestibulo-ocular reflex during rotation about an earth-vertical axis. Brain Res 1989;504: 264–8.

17.

Bohmer

Baloh

. Vertical optokinetic nystagmus and optokinetic afternystagmus in humans. J Vestib Res 1991;1: 309–15.

18.

Sills

Honrubia

Baloh

. Is the adaptation model a valid description of the vestibulo-ocular reflex?. Biol Cybern 1978;30: 209–20.

19.

Herdman

Tusa

Zee

Proctor

Mattox

. Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 1993;119: 450–4.

20.

Parnes

Rochaud

. Further observations during the particle repositioning maneuver for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1997;116: 238–43.