Value of lying-down nystagmus in the lateralization of horizontal semicircular canal benign paroxysmal positional vertigo.
BACKGROUND
Horizontal canal benign paroxysmal positional vertigo is characterized by horizontal direction-changing nystagmus induced by lateral head turning in supine position. According to Ewald's second law, the direction of head turning that creates a stronger response represents the affected side in geotropic nystagmus and the healthy side in apogeotropic nystagmus. However, it may not always be possible to lateralize the involved ear only by comparing the intensity of the nystagmus. We studied the values of nystagmus induced by position change from sitting to supine in the lateralization of horizontal canal benign paroxysmal positional vertigo.


METHODS
A retrospective study of 54 patients who had been diagnosed as having horizontal canal benign paroxysmal positional vertigo at the Dizziness Clinic of Seoul National University Bundang Hospital from May 2003 to February 2004 was performed. The directions of the nystagmus induced by lying down were compared with those determined by Ewald's second law.


RESULTS
Of the 54 patients, 32 (20 apogeotropic and 12 geotropic) showed horizontal nystagmus induced by lying down. The nystagmus tended to be ipsilesional in apogeotropic patients (80%) and contralesional in their geotropic counterparts (75%).


CONCLUSIONS
In horizontal canal benign paroxysmal positional vertigo, lying-down nystagmus mostly beats toward the involved ear in the apogeotropic type and directs to the healthy ear in the geotropic type. The direction of lying-down nystagmus may help lateralizing the involved ear in horizontal canal benign paroxysmal positional vertigo.
Koo
Ja-Won
JW
Department of Otolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Moon
Il Joon
IJ
Shim
Woo Sub
WS
Moon
So Young
SY
Kim
Ji Soo
JS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004584:Electronystagmography; D005260:Female; D006801:Humans; D007759:Labyrinth Diseases / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000503:physiopathology*; D011187:Posture; D012189:Retrospective Studies; D012665:Semicircular Canals / Q000473:pathology / Q000503:physiopathology*; D016683:Supine Position; D014717:Vertigo / Q000175:diagnosis / Q000503:physiopathology*