Vestibular paroxysmia is the name given to the syndrome caused by vascular compression of the vestibulocochlear nerve. The main symptoms of vestibular paroxysmia are recurrent, spontaneous, brief attacks of spinning, non-spinning vertigo or positional vertigo that generally last less than one minute, with or without ear symptoms (tinnitus and hypoacusis). Prior to attributing a patient's symptoms to vestibular paroxysmia, however, clinicians must exclude common conditions like benign paroxysmal positional vertigo, Menière's disease, vestibular neuritis and vestibular migraine. This is usually possible with a thorough history and bedside vestibular/ocular motor examination. Herein, we describe a patient with vestibular paroxysmia that mimicked resolved BPPV with a literature review.
Benign Paroxysmal Positional Vertigo ; Carbamazepine ; Ear ; Humans ; Migraine Disorders ; Neuritis ; Vertigo ; Vestibular Diseases ; Vestibulocochlear Nerve

Humans ; Cochlear Implants ; Cochlear Implantation ; Vestibule, Labyrinth ; Vestibular Function Tests ; Vestibular Diseases

Case history of a 67-year-old man diagnosed with posterior benign paroxysmal positional vertigo (BPPV) with extremely long latencies after holding the Dix-Hallpike position for five minutes. Additional vestibular assessment indicated partial unilateral hypofunction. The patient had a history compatible with classic BPPV. This patient, however, did not have any positional nystagmus after doing standard positional testing. With extremely prolonged Dix-Hallpike testing (five minutes), the patient experienced nausea and vertigo. Concomitantly classic peripheral nystagmus was observed. After a total of seventeen treatments in a reposition chair a total relief of symptoms was obtained. The extremely long latencies observed in this patient were ascribed to otoconial adherence and/or otoconial size. This type of BPPV has not previously been described.
Aged ; Benign Paroxysmal Positional Vertigo ; Humans ; Nausea ; Nystagmus, Physiologic ; Semicircular Canals ; Vertigo ; Vestibular Diseases ; Vestibular Function Tests

BACKGROUND AND OBJECTIVE: The purpose of this study was to identify clinical characteristics of secondary form of BPPV. MATERIALS AND METHODS:Of 384 patients with BPPV, 82 patients have a ipsilateral inner ear disease to the BPPV. We reviewed the site of lesion, duration of treatment in secondary BPPV and compared with idiopathic BPPV. RESULTS: The site of canal affected by idiopathic BPPV (M=119, F=183) showed that 138 (Lt=62, Rt=76) had a lateral canal, 157 (Lt=63, Rt=94) had a posterior canal, 7 had a multicanal. The involved canal by secondary BPPV (M=45, F=37) showed that 34 had a lateral canal, 43 in posterior canal, 1 in anterior canal and 4 in multicanal. 28 patients with idiopathic sudden sensory hearing loss developed BPPV within a few days (posterior=17, lateral=7, multicanal=4). 12 patients had a unilateral peripheral vestibulopathy and ipsilateral BPPV (posterior=11, lateral=1, anterior canal=1). 14 patients with meniere's disease developed ipsilateral BPPV (Lateral=9, posterior=5). 28 patients with BPPV had a history of headtrauma which is considered to be cause of BPPV. The mean duration of treatment is 2.68 on idiopathic BPPV, 6.27 on BPPV with ISSHL, 6.75 on BPPV with unilateral vestibulopathy, 2.28 on BPPV with meniere's disease and 2.4 on posttraumatic BPPV. There was no significant difference of recurrence among groups. CONCLUSION: Secondary BPPV showed different prevalence of involved canal from idiopathic BPPV. The duration of treatment for BPPV with ISSHL or unilateral vestibulopathy take longer time than for other groups.
Hearing Loss ; Humans ; Labyrinth Diseases ; Meniere Disease ; Prevalence ; Recurrence ; Vertigo

OBJECTIVES: The purpose of this study was to examine the clinical manifestations and significance of pseudo-spontaneous nystagmus (PSN) and head-shaking nystagmus (HSN) in horizontal canal benign paroxysmal positional vertigo (HC-BPPV). METHODS: Two hundred fifty-two patients diagnosed as HC-BPPV were reviewed retrospectively. After excluding 55 patients with ipsilateral vestibular diseases, multiple canal BPPV, or those who were lost to follow-up, we analyzed the direction of PSN and HSN in patients with HC-BPPV. We also compared the clinical characteristics and treatment outcome between PSN-positive and PSN-negative groups. RESULTS: Our study included 197 patients composed of 80 patients with geotropic HC-BPPV and 117 patients with apogeotropic HC-BPPV. PSN was observed in 13.7% patients and HSN was observed in 45.2%. The incidence of HSN was higher in apogeotropic HC-BPPV, while the proportion of PSN was not statistically significant between the two subtypes. There was no directional preponderance in geotropic HC-BPPV, while ipsilesional PSN and contralesional HSN showed higher incidence in apogeotropic HC-BPPV. The dizziness handicap inventory score in the PSN-positive group was higher than that in the PSN-negative group (p<0.001), and the duration of symptom onset in the PSN-positive group was shorter than that in the PSN-negative group (p=0.047). However, there was no significant difference in the treatment outcome between the two groups. CONCLUSIONS: The incidence of HSN was higher than that of PSN in patients with apogeotropic HC-BPPV. Patients with HC-BPPV showing PSN demonstrated more severe initial symptoms and visited the hospital in a shorter period of time after the onset of symptoms.
Benign Paroxysmal Positional Vertigo ; Dizziness ; Humans ; Incidence ; Lost to Follow-Up ; Retrospective Studies ; Treatment Outcome ; Vestibular Diseases

Vertigo/dizziness is a common complaint in patients who are seeking a primary health clinic. Vertigo is traditionally attributed to damage of the vestibular system. Many peripheral and central vestibular disorders are usually presented with vertigo. However, patients with benign paroxysmal positional vertigo (BPPV), a leading cause of vertigo, may present with postural lightheadedness, near faint, imbalance rather than true vertigo. On the contrary, patients with orthostatic hypotension may present with true spinning vertigo, not dizziness. Persistent postural perceptual dizziness, a second most common cause of dizziness (after BPPV), is mainly occurred after organic vestibular disorders such as BPPV or vestibular neuritis, and classified as a chronic functional vestibular disorder. This article describes non-vestibular disorders presenting dizziness and/or vertigos, which conditions may be misdiagnosed as structural vestibular disorders.
Benign Paroxysmal Positional Vertigo ; Diagnosis ; Dizziness ; Humans ; Hypotension, Orthostatic ; Orthostatic Intolerance ; Vertigo ; Vestibular Neuronitis ; Vestibulocochlear Nerve Diseases

Delayed endolymphatic hydrops （DEH） is a rare disease that causes vertigo and is often misdiagnosed as other vertigo diseases. This article reports on a patient with vertigo who was easily misdiagnosed. The patient was a middle ear cholesteatoma complicated by labyrinthine fistula （LF）; however, his vertigo was episodic vertigo, which could not be explained solely by LF causing labyrinthitis. The possibility of endolymphatic hydrops was suspected, which was confirmed by inner ear magnetic resonance gadolinium imaging. This is the first reported case of middle ear cholesteatoma complicated by LF and DEH. The patient underwent surgical resection of the cholesteatoma and three semicircular canal obstructions at the same time. During two years postoperative follow-up, the patient did not experience a recurrence of vertigo. When diagnosing vertigo diseases, a careful history of vertigo is of utmost importance.
Humans ; Endolymphatic Hydrops/diagnosis* ; Cholesteatoma, Middle Ear/complications* ; Vertigo/complications* ; Labyrinth Diseases/complications* ; Magnetic Resonance Imaging/adverse effects* ; Semicircular Canals

There are a number of reports on the pathologies of vestibular disorders. However, these studies included only a few examples, which were not quantitative but merely anecdotal or descriptive. However, a single tissue section may be relevant to a specific disease in multiple ways. The histopathological characteristics of common peripheral vestibulopathies, including benign paroxysmal positional vertigo, Ménière's syndrome, labyrinthitis, vestibular neuritis, and ototoxicity, have been described. A recent study validated a new quantitative method for determining vestibular otopathology. Detailed quantitative analyses of vestibular pathology are required to obtain a deeper understanding of the vestibular system. Such studies will likely reveal the pathophysiological causes of specific diseases by elucidating the correlations between structural and functional features. Therefore, histopathological studies of vestibular disorders should be performed.
Benign Paroxysmal Positional Vertigo ; Ear, Inner ; Labyrinthitis ; Methods ; Pathology ; Temporal Bone ; Vestibular Neuronitis

Benign Paroxysmal Positional Vertigo ; diagnosis ; therapy ; Humans

Isolated otolith dysfunction(iOD) involves a group of unexplained vestibular syndromes that manifest clinically as a sense of translation, tilting or floating, and blurred vision with head movement, with normal semicircular canal function but abnormal otolith function on laboratory vestibular testing. As vestibular medicine has gained widespread popularity in recent years, increasing attention has also been paid to iOD and case reports, clinical studies and diagnostic criteria have been published. However, there is no consensus document to guide the diagnosis of this disease in China. In this context, the Special Committee on Vertigo of China Medical Education Association organized a group of domestic experts in vestibular medicine and formulated this diagnostic consensus after thorough discussion based on the latest evidence in China and abroad, in order to promote the best clinical practice for iOD.
Humans ; Otolithic Membrane ; Vestibular Diseases/diagnosis* ; Vertigo/diagnosis* ; Vestibule, Labyrinth ; Semicircular Canals