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Is the modified cupulolith repositioning maneuver effective for treatment of persistent geotropic direction-changing positional nystagmus?

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objective

Clinicians sometimes see patients with relatively persistent geotropic direction-changing positional nystagmus (DCPN) as a variant of lateral semicircular canal-benign paroxysmal positional vertigo (LSCC-BPPV). Recently, the concept of a “light cupula” in the lateral semicircular canal, exhibiting persistent geotropic DCPN, has been introduced. However, the underlying pathogenesis of light cupula is not known. We investigated the efficacy of a modified cupulopathy repositioning maneuver (mCuRM), designed to reduce light debris attached to the cupula in patients with persistent geotropic DCPN.

Study design

Retrospective cohort study.

Methods

Participants included 65 patients with a persistent geotropic DCPN: 35 underwent treatment (mCuRM group), and 30 were followed-up but received no treatment (No CuRM group). We compared the therapeutic and survival rate of persistent geotropic DCPN between two groups.

Results

On Day 1, the persistent geotropic DCPN did not resolve in either group. On the first and second follow-up days, persistent geotropic DCPN was observed in 28 (80%) and 21 (60%) of patients, respectively, in the mCuRM group, and in 28 (93.3%) and 24 (80%) patients, respectively, in the no mCuRM group. The differences between groups were not statistically significant. Furthermore, no between-group differences were found in the time from diagnosis to resolution of nystagmus, or the time from symptom onset to resolution of nystagmus. Kaplan–Meier analysis of the time course of persistent geotropic DCPN resolution from the day of diagnosis and day of symptom onset revealed no significant differences between the groups.

Conclusion

Our findings indicate that mCuRM had no therapeutic benefit for a persistent geotropic DCPN and suggest that the pathophysiology of persistent geotropic DCPN is less likely to be a light debris attached to the cupula.

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References

  1. Hiruma K, Numata T (2004) Positional nystagmus showing neutral points. ORL J Otorhinolaryngol Relat Spec 66:46–50

    Article  PubMed  Google Scholar 

  2. Bergenius J, Tomanovic T (2006) Persistent geotropic nystagmus—a different kind of cupular pathology and its localizing signs. Acta Otolaryngol 126:698–704

    Article  PubMed  Google Scholar 

  3. Imai T, Matsuda K, Takeda N, Uno A, Kitahara T, Horii A, Nishiike S, Inohara H (2015) Light cupula: the pathophysiological basis of persistent geotropic positional nystagmus. BMJ Open 5:e006607

    Article  PubMed  PubMed Central  Google Scholar 

  4. Schubert MC, Dunlap PM, Whitney SL (2017) A case study of high-velocity, persistent geotropic nystagmus: is this BPPV? J Neurol Phys Ther 41:182–186

    Article  PubMed  Google Scholar 

  5. von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D (2015) Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res 25:105–117

    Article  Google Scholar 

  6. Kim CH, Kim MB, Ban JH (2014) Persistent geotropic direction-changing positional nystagmus with a null plane: the light cupula. Laryngoscope 124:E15–E19

    Google Scholar 

  7. Hiruma K, Numata T, Mitsuhashi T, Tomemori T, Watanabe R, Okamoto Y (2011) Two types of direction changing positional nystagmus with neutral points. Auris Nasus Larynx 38:46–51

    Article  PubMed  Google Scholar 

  8. Ichijo H (2012) Persistent direction-changing geotropic positional nystagmus. Eur Arch Otorhinolaryngol 269:747–751

    Article  PubMed  Google Scholar 

  9. Ichijo H (2016) Neutral position of persistent direction-changing positional nystagmus. Eur Arch Otorhinolaryngol 273:311–316

    Article  PubMed  Google Scholar 

  10. Kim SH, Jo SW, Chung WK, Byeon HK, Lee WS (2012) A cupulolith repositioning maneuver in the treatment of horizontal canal cupulolithiasis. Auris Nasus Larynx 39:163–168

    Article  PubMed  Google Scholar 

  11. Ban JH, Kim MB, Hong SM (2016) Immediate and short-term therapeutic results between direction-changing positional nystagmus with short- and long-duration groups. Ear Hear 37:243–246

    Article  PubMed  Google Scholar 

  12. Kim CH, Shin JE, Kim YW (2015) A new method for evaluating lateral semicircular canal cupulopathy. Laryngoscope 125:1921–1925

    Article  PubMed  Google Scholar 

  13. Aschan G, Bergstedt M, Goldberg L, Laurell L (1956) Positional nystagmus in man during and after alcohol intoxication. Q J Stud Alcohol 17:381–405

    PubMed  CAS  Google Scholar 

  14. Shigeno K, Egami T, Sasano T (1989) Experimental study of nystagmus induced by injecting various solutions into the middle ear cavity. Acta Otolaryngol 108:31–37

    Article  PubMed  CAS  Google Scholar 

  15. Kim CH, Choi JM, Jung HV, Park HJ, Shin JE (2014) Sudden sensorineural hearing loss with simultaneous positional vertigo showing persistent geotropic direction-changing positional nystagmus. Otol Neurotol 35:1626–1632

    Article  PubMed  Google Scholar 

  16. Kim CH, Shin JE, Yang YS, Im D (2016) Sudden sensorineural hearing loss with positional vertigo: initial findings of positional nystagmus and hearing outcomes. Int J Audiol 55:541–546

    Article  PubMed  Google Scholar 

  17. Kim YW, Shin JE, Lee YS, Kim CH (2015) Persistent positional vertigo in a patient with sudden sensorineural hearing loss: a case report. J Audiol Otol 19:104–107

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kim CH, Shin JE, Shin DH, Kim YW, Ban JH (2014) “Light cupula” involving all three semicircular canals: a frequently misdiagnosed disorder. Med Hypotheses 83:541–544

    Article  PubMed  Google Scholar 

  19. Shin JE, Jeong KH, Ahn SH, Kim CH (2015) Conversion between geotropic and apogeotropic persistent direction-changing positional nystagmus. Acta Otolaryngol 135:1238–1244

    Article  PubMed  Google Scholar 

  20. Ichijo H (2006) Persistent type of geotropic direction-changing positional nystagmus. Equilib Res 65:422–428

    Article  Google Scholar 

  21. Kim JS, Oh SY, Lee SH, Kang JH, Kim DU, Jeong SH, Choi KD, Moon IS, Kim BK, Oh HJ, Kim HJ (2012) Randomized clinical trial for apogeotropic horizontal canal benign paroxysmal positional vertigo. Neurol 78:159–166

    Article  Google Scholar 

  22. Kim HA, Park SW, Kim J, Kang BG, Lee J, Han BI, Seok JI, Chung EJ, Kim J, Lee H (2017) Efficacy of mastoid oscillation and the Gufoni maneuver for treating apogeotropic horizontal benign positional vertigo: a randomized controlled study. J Neurol 264:848–855

    Article  PubMed  Google Scholar 

  23. Shim DB, Ko KM, Lee JH, Park HJ, Song MH (2015) Natural history of horizontal canal benign paroxysmal positional vertigo is truly short. J Neurol 262:74–80

    Article  PubMed  Google Scholar 

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Funding

This study was funded by National Research Foundation of Korea (NRF) Grant funded by the Korea government (MSIP) (2015R1C1A1A01055849).

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Correspondence to Seok Min Hong.

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The authors declare that they have no conflict of interest.

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Kim, CH., Hong, S.M. Is the modified cupulolith repositioning maneuver effective for treatment of persistent geotropic direction-changing positional nystagmus?. Eur Arch Otorhinolaryngol 275, 1731–1736 (2018). https://doi.org/10.1007/s00405-018-5006-4

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  • DOI: https://doi.org/10.1007/s00405-018-5006-4

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