Diagnosis and treatment of the short-arm type posterior semicircular canal BPPV

Abstract

Introduction: The Epley maneuver is useful for the otoconia to return from the long arm of the posterior semicircular canal into the utricle. To move otoconia out of the posterior semicircular canal short arm and into the utricle, we need different maneuvers.

Objective: To diagnose the short-arm type BPPV of the posterior semicircular canal and treat them with bow-and-yaw maneuver.

Methods: 171 cases were diagnosed as BPPV of the posterior semicircular canal based on a positive Dix-Hallpike maneuver. We first attempted to treat patients with the bow-and-yaw maneuver and then performed the Dix-Hallpike maneuver again. If the repeated Dix-Hallpike maneuver gave negative results, we diagnosed the patient with the short-arm type of BPPV of the posterior semicircular canal and considered the patient to have been cured by the bow-and-yaw maneuver; otherwise, probably the long-arm type BPPV of the posterior semicircular canal existed and we treated the patient with the Epley maneuver.

Results: Approximately 40% of the cases were cured by the bow-and-yaw maneuver, giving negative results on repeated Dix-Hallpike maneuvers, and were diagnosed with short-arm lithiasis.

Conclusion: The short-arm type posterior semicircular canal BPPV can be diagnosed and treated in a convenient and comfortable manner.

Keywords: Benign paroxysmal positional vertigo; Lithiasis; Posterior; Semicircular canal; Therapy.

Figure 1

Bow-and-yaw maneuver. (A) Sit/kneel upright, posterior view. The membranous semicircular canals of the left and right ears, including cupula, are shown. (B) Holds and bows the patient’s head 135°. (C) Rotate the patient’s head 45° to the right. (D) Rotate the patient’s head 45° to the left. Shaking the head helps to shed the otolith before repeating C, D steps.

Figure 2

Otolith movement observation of Dix–Hallpike maneuver. (A) Sit upright, posterior view. The otoliths in different positions of the membranous labyrinth were set up. (B) Rotate the patient’s head 45° to the right. (C) Moving the patient to supine lying with the neck extended 30° (side view). (D) Moving the patient to supine lying with the neck extended 30° (posterior view).

Figure 3

Supine Dix–Hallpike maneuver. (A), Sit upright, posterior view. The bony and membranous semicircular canals of the left and right ears, including cupula, are shown. (B) Bows the patient’s head 60°. (C) Rotate the patient’s head 45° to the right. (D) Moving the patient to supine lying without the neck extended.

Figure 4

Otolith movement observation of Bow-and-yaw maneuver. Bows head 135°. The blue arrow refers to the otolith on the long arm side of PSC, the orange arrow refers to the otolith on the short arm side of PSC. Based on the physical engine, the otolith on the short arm side can be reduced to the utricle directly through the short arm and the otolith on the long arm side cannot be reduced to the utricle.

Figure 5

Diagnosis and treatment strategy for the short-arm type PSC-BPPV. Try reduction otolith in the short arm of the PSC with bow-and-yaw maneuver, if failed, reduction otolith in the long arm of the PSC with Epley maneuver.