Research in Vestibular Science

Symposium

Vol. 9, Suppl. 1, June 2010

pIS S N 2092-8882, eIS S N 2093-5501

Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo

Jae Yong Byun, MD, Eun Woong Ryu, MD
Department of Otolaryngology, KyungHee University School of Medicine, Seoul, Korea

(cupulolithiasis) .
Dix-Hallpike

(Benign Paroxysmal Positional

Vertigo)

1979 Hall 4 BPPV

(gravity)

(angular acceleration)

(canalolithiasis) .

. 1921 Robert Barany

Schuknecht

. BPPV

BPPV

, 1952 Dix-Hallpike (Benign

BPPV

Paroxysmal Positional Vertigo, BPPV) ,

. BPPV 6

, . Schuknecht

(cupulolithiasis),

1969 (otoconia)

(canalolithiasis), Epley5

(canalith jam) 3

18 .

(Utriculofugal)

BPPV
,

Corresponding Author: Jae Yong Byun, M D

Departm ent of Otolaryngology, KyungHee University School of
Medicine, Esat-W est neo m edical Center, Sangil-dong,
Gangdong-gu, Seoul 134-727, Korea
Tel: +82-2-440-7321 Fax: +82-2-440-7336
E-m ail: otorhino512@naver.com

. BPPV

.

Copyright 2010 by The Korean Balance Society.

All rights reserved.

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Res Vestibul Sci Vol. 9, Suppl. 1, Jun. 2010

.
45

1.

, 20
,

. Dix-Hallpike

2~20

, ,

, , .

(crescendo-

30 1 .

decrescendo) .

, . 50%

BPPV

(Figure 1).

. 30%

. Dix-Hallpike

Dix-Hallpike

. Dix-Hallpike

2.

BPPV (cervical stenosis),

, , , Paget
BPPV
Dix-Hallpike
2

.6

. Dix-Hallpike

Side-lying

BPPV

. Side-lying

45

, Dix-Hallpike

frontal plane

. Dix-Hallpike

. Side-lying

Figure 1. Dix-Hallpike maneuver (right ear). The patient is seated and positioned so that the patients head will extend over the top edge
of the table when supine. The head is turned 45 toward the ear being tested (position A). The patient is quickly lowered into the supine
position with the head extending about 30 below the horizontal (position B). The patient head is held in this position and the examiner
observes the patient eyes for nystagmus (from Furman JM, et al. The New England Journal of Medicine. 1999 341(21), 1590-6).

S56

 1. BPPV

. ,

.
, ,
Brandt Daroff BPPV

,

11

Semont

.12 1992 Epley

BPPV
5

, ,

.13 Semont Epley 1
50~80%
90% .

Figure 2. Side-lying test (right ear). The subject head is turned

with the nose pointing 45away from the side to be tested (The
head is turned left). Then, the subject is briskly laid on the side
being tested. The examiner is not shown, but supports the subject
head. Arms are crossed to prevent the patient from inadvertently
stopping the motion (from Cohen S, Otol Neurotol 25:130-134, 2004).

1) Brandt-Daroff (Brandt-Daroff
habituation exercise)

, 30
. 30
(Figure 3).

(Figure 2).

Dix-Hallpike

.
Dix-Hallpike
, , ,

BPPV (subjective BPPV) .
,
.8-10
,
,
Dix-Hallpike
.8
3.

Figure 3. Brandt-Daroff exercises. Start sitting upright. Then move

into the Side-lying position, with the head angled upward about
half-way. Stay in the Side-lying position for 30 seconds, or until the
dizziness subsides, then go back to the sitting position. Stay there
for 30 seconds and then go to the opposite side and follow the
same routine (from Helminski, JO, et al. Arch Otolaryngol Head
Neck Surg 2005;131:344-348.).

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Res Vestibul Sci Vol. 9, Suppl. 1, Jun. 2010

(vibrator)

Parnes 13 3

Epley

, Clinic Epley

11

.
Epley Dix-Hallpike

2) Semont (Semont liberatory maneuver)

90 , .

, 5

90 ,

. Dix-Hallpike

5~10 .

80~90% ,

48 ,

(Figure 4).

. Brandt-Daroff

14

. .
3) (Modified Epley Maneuver)
BPPV
5

1~2 ,
. 5

, Epley

, Semont

24~48 ,

. BPPV

. Epley

(Figure 5).15
Epley
96~100% ,16,17
. Epley

90% 27.3% .
, 1



.
.13 ,

Figure 4. Semont liberatory maneuver (right ear). (A) The patient

is sitting with the head turned horizontally 45 to the healthy (left) ear.
(B) Moving to right Side-lying position. (C) Moving to left Side-lying
position (from Semont A, et al. Adv Otorhinolaryngol 1988;42:290-3).

S58

.18

 1. BPPV

1.
BPPV

.
2.
BPPV Dix-Hallpike

BPPV , (Head
roll test) .
Dix-Hallpike Gold-standard

.6
90 ,

. 1
(geotropic) ,
(Figure 6).
Ewald's 2
. Rahko Kotti20
walk-rotate-walk test
. 180
,

Figure 5. Modified Epley maneuver (right ear). The patient is seated on a table as viewed from the right side. (A) Patient in normal
Dix-Hallpike head-hanging position. The patient head is then rotated
toward the opposite side with the neck in full extension through
position (B) and into position (C) in a steady motion by rolling
the patient onto the opposite lateral side and then the patient sits back
up to position (D) (Furman JM, et al. The New England Journal of
Medicine. 1999 341(21), 1590-6).

.

.

21

Brandt-Daroff Epley , Semont

7
24%, 71%, 74% 3 Brandt-Daroff
60%
.
.19

Figure 6. Mechanism of nystagmus of right lateral semicircular canal

canalithiasis in head roll test (from Lee SC, J Clinical Otolaryngol
2006 17:182-188).

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Res Vestibul Sci Vol. 9, Suppl. 1, Jun. 2010

Figure 7. Mechanism of nystagmus of right lateral semicircular canal

cupulolithiasis in head roll test (from Lee SC, J Clinical Otolaryngol
2006 17:182-188).

(ageotropic) ,
.

(Figure 7).
,
, null point

Figure 8. Lempert positional maneuver for treatment of right lateral

semicircular canal canalithiasis. This figure shows the barbecue rotation
for right-sided HBPPV. Each 90-degree head rotation is performed
rapidly within a half second. Head positions are maintained for
between 30 and 60 seconds until all nystagmus has subsided. (A)
Starting position: supine, (B) head rotation toward the unaffected
side, (C) body turn from supine to prone while head position is
maintained, (D) head rotation to nose-down position, (E) final head
turn affected side to down position, (F) sitting up position (X: affected
side, RS: right shoulder, from Lee SC, J Clinical Otolaryngol
2006 17:182-188).

. ,

. BPPV
,
Dix-Hallpike ,
,
.
3. (canalithiasis)
1) Forced prolonged position (Vannucchi)
90
12

3 90% .
Epley
.22
2) Lempert Barbecue rotation (Casani)

Figure 9. Barbecue maneuver in patient with right lateral semicircular

canal canalithiasis. (from Lee SC, J Clinical Otolaryngol 2006 17:182-188).

(0.5 ) 90
30~60 90 270

Lempert 360

30~60 .

23

(Figure 8).

S60

1 75%

 1. BPPV

, 52%

4. (cupulolithiais)

24

1~5 (Figure 9).

1) Appiani
3) Appiani

. 45

, 45 2

2 .

26

2) Casini

1 ,

45 2

, 45 2~3

(Figure 10).

25

.24

BPPV BPPV
.
,

3) Brandt-Daroff
30

(Habituation) .

Brandt-Daroff .

4)

.

.

BPPV BPPV
.
.
BPPV Dix-Hallpike
.

BPPV .
BPPV
.
(sagittal plane) 41
,
23
Figure 10. Four positions of Appiani liberatory maneuver for treatment of left lateral semicircular canal canalithiasis. HC, horizontal
canal (from Lee SC, J Clinical Otolaryngol 2006 17:182-188).

. Dix-Hallpike
,

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Res Vestibul Sci Vol. 9, Suppl. 1, Jun. 2010

. BPPV

, Dix-Hallpike

Dix-Hallpike

8th , , Arnold

27

Chiary malformation, .

Rahko BPPV

. ,

, 60

, ,

.28
,

.
1.
1.
,
BPPV reverse Epley

.29

BPPV Epley .

. Rahko

1) (Singular neurectomy)

1970

45)

31

45 30
. Rahko 53
BPPV .

28

2) (Posterior semicircular canal

occlusion)

30

1990 Parnes 32

60

BPPV

(Bone dust) fibrogen glue

.30

.32-34

, 1

MRI

CT .

2.

.
,
.

BPPV BPPV

S62

 1. BPPV

3) Gentamycin(Intratympanic injection
of gentamicin)
,

17.

gentamycin
, .35

18.

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