Journal Reading

Tutor : dr. Tris Sudyartono, Sp.THT-KL dr. Agus Sudarwi, Sp.THT-KL dr. Afif Zjauhari, Sp.THT-KL Presented By : Dimar Kumala Puspaningrum Dyah Carano Fitri

Sultan Agung Islamic University Faculty of Medicine

Effect of the canalith repositioning procedure on subjective visual horizontal

in patients with posterior canal benign paroxysmal positional vertigo

SHINICHI IWASAKI, YASUHIRO CHIHARA, MUNETAKA USHIO, ATSUSHI OCHI, TOSHIHISA MUROFUSHI & TATSUYA YAMASOBA Department of Otolaryngology, Faculty of Medicine, University of Tokyo, and Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital, Kawasaki, Japan

ABSTRACT
OBJECTIVE METHOD

To evaluate the changes of subjective visual horizontal (SVH) in patients with p-BPPV before and after treatment with the canalith repositioning procedure.

26 patients with p-BPPV were treated with Epleys maneuver. Baseline SVH measurements were taken before performing the maneuver, just after maneuver, and 2 weeks after maneuver.

RESULT

CONCLUSION

26 patients with p-BPPV, 11 showed abnormal deviation of SVH. Just after and 2weeks performing Epleys maneuver, the patients who showed an abnormal deviation decreased.

patients with posterior canal have signs of utricular dysfunction at baseline improves after performing the canalith repositioning procedure.

INTRODUCTION
The canalith repositioning maneuver relocates the freefloating particles from the affected semicircular canal back into the utricle

BPPV is considered to be caused by small particles trapped in the semicircular canals

the results of SVH/V in patients with BPPV have been controversial.

Several studies have reported that there were no significant

that half of the patients with BPPV showed an abnormal deviation of SVH/V

the timing of the measurement of SVH/V

Measurement
Before the Dix-Hallpike After maneuver performing the canalith and the canalith repositioning repositioning procedure procedure

2 weeks after treatment

Material and methods

INCLUSION
unilateral p-BPPV

EXCLUSION
Bilateral BPPV, previously received Epleys maneuver

ages ranged from 19 to 76 years

Menieres disease, other vestibular diseases ,other ear diseases.

PostEpley

Baseline

Baseline

2 weeks post Epley

Post Epley

SUBJECTIVE VISUAL HORIZONTAL (SUBJECT)

SUBJECTIVE VISUAL HORIZONTAL (CONTROL)

P > 0,01

P < 0,01

Ratio of subjective visual horizontal (SVH) in patients with BPPV.

DISCUSSION
Epleys Manouver 40 % abnormal deviation of SVH (baseline)

Previous Results studies

8 of 16 patients with BPPV

normal or slightly abnormal SVH in

patients with BPPV

showed an abnormal deviation of SVV before performing the canalith repositioning procedure

dislodgement of otoconia

head movements

activities of the utricular nerve

free-floating otoconia posterior semicircular canal.

Excitation inhibition

ABNORMAL DEVIATION OF SVH/V

Successive changes of the mean value of SVH

(A) and 15 patients who showed normal SVH at the baseline condition (B). Dotted lines show the upper and lower limits of normal SVH (+ 2.18 and 2.18). Positive values indicate affected side down and negative values indicate unaffected side down.

THE RESULT of CANALITH REPOSITIONING PROCEDURE

20 %
NORMAL ABNORMAL

ABNORMAL NORMAL

73 %

CONCLUSION
40% of patients with pBPPV show an abnormal deviation of SVH, which significantly improved after performing Epleys maneuver.