Objective:To evaluate the utility of the Rapid Axial Roll Test （RART）, Supine Roll Test （SRT）, and Lying-Down Test （LDT） in determining the affected semicircular canal in cases of horizontal semicircular canal benign paroxysmal positional vertigo （HSC-BPPV）. Methods:A total of 330 patients diagnosed with HSCBPPV from September 2022 to September 2023 were collected and divided into three groups based on the different positional tests received: ①SRT Group, ②LDT+SRT Group, ③RART+SRT Group. The trial was divided into two stages: LDT/RART for patients in the first stage, and SRT for patients in the second stage. The elicitation rate of nystagmus among the three groups was compared to evaluate the accuracy in determining the affected semicircular canal in HSCBPPV. Results:Nystagmus was elicited in 84.55% （279/330） of the patients by positional tests. The elicitation rate of nystagmus in the RART+SRT/LDT group was 94.55% （104/110）, in the LDT+SRT group it was 84.11% （90/107）, and in the SRT group it was 69.91% （79/113）. The differences among the three groups were statistically significant （χ²= 23.88, P<0.001）. In the ② and ③ groups, there was a statistically significant difference in the elicitation rate of nystagmus between stage Ⅰ （patients with LDT or RART） （χ²=43.842, P<0.001）. SRT was performed in the stage Ⅱ, and there was a statistically significant difference in nystagmus extraction rate between the two groups （χ² =4.690, P=0.030）. The difference in the proportion of agreement between stage Ⅰ（LDT or RART） and stageⅡ （SRT） in determining the affected side of the semicircular canal was also statistically significant （χ² =40.502, P<0.001）. For patients with a consistent diagnosis of the affected semicircular canal, the difference in cure rate was not significant （P=0.149）. The Kappa statistic indicated substantial agreement between RART and SRT in terms of eliciting nystagmus （agreement 96.36%, Kappa = 0.730, P<0.001）. Conclusion:RART and SRT show a high degree of agreement regarding the elicitation rate of nystagmus. RART is simple and safe, and it can effectively induce the characteristic nystagmus of HSC-BPPV, accurately identify the responsible semicircular canal and provide a more optimized examination protocol for clinical practice in HSCBPPV.
Humans ; Semicircular Canals/physiopathology* ; Benign Paroxysmal Positional Vertigo/diagnosis* ; Female ; Male ; Middle Aged ; Nystagmus, Pathologic/diagnosis* ; Vestibular Function Tests/methods* ; Aged ; Vertigo/diagnosis* ; Adult

Objective:To investigate the effects of the Epley and Semont procedures with varying lateral angles of the head on posterior semicircular canal benign paroxysmal positional vertigo （PC-BPPV）. Methods:A total of 115 patients with unilateral PC-BPPV were randomly divided into five groups: Epley group, Semont group, Semont+10° group, Semont+20° group, and Semont+30° group, with 23 patients in each group. Corresponding reduction treatments were performed. Results:The total effective rates for the Epley group, Semont group, Semont+10° group, Semont+20° group, and Semont+30° group were 95.7% （22/23）, 4.3% （1/23）, 30.4% （7/23）, 52.2% （12/23）, and 87.0% （20/23） respectively. The inefficiencies were 4.3% （1/23）, 95.7% （22/23）, 69.6% （16/23）, 47.8% （11/23）, and 13.0% （3/23）. Statistically significant differences were observed in the total effective rates among the five groups （χ²=54.11, P<0.01）. The total effective rates in the Semont group, Semont+10° group, and Semont+20° group were significantly different from that of the Epley group （P<0.01）, while no statistically significant difference was found between the Semont+30° group and the Epley group （P= 0.608>0.012 5）. Conclusion:Among the four Semont methods with different lateral lying angles, the total effective rate of reduction treatment increased with the elevation of the lateral lying angle on the affected side. The efficacy of the Semont+30° group in treating PC-BPPV was not significantly different from the Epley group's reduction effect, which was markedly superior to that of the other four Semont methods at different angles. Therefore, the Semont+30° reduction technique is recommended for the treatment of PC-BPPV.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Benign Paroxysmal Positional Vertigo/therapy* ; Head ; Posture ; Semicircular Canals/physiopathology* ; Treatment Outcome

Objective:This study aimed to analyze the results of auditory and vestibular function tests in patients with unilateral vestibular schwannoma and explore their association with tumor size. Methods:Clinical data from 81 patients diagnosed with unilateral vestibular schwannoma who underwent pure-tone audiometry（PTA）, cervical and ocular vestibular evoked myogenic potentials（c/oVEMP）, as well as video head impulse test（vHIT）, and subsequently underwent surgical treatment, were retrospectively analyzed. Patients were categorized into groups based on tumor size: small （≤ 15 mm）, medium（16-30 mm）, and large （>30 mm）, determined by the maximum tumor diameter on contrast-enhanced MRI scans. Results:PTA results indicated hearing loss in 73 cases（90.1%）; vestibular function tests revealed abnormal rates for the anterior semicircular canal, horizontal semicircular canal, posterior semicircular canal, utricle, and saccule at 29.6%, 77.8%, 54.3%, 90.1%, and 92.6%, respectively. Statistically, no significant differences were found in preoperative hearing test results among patients in different groups（F=0.393, P=0.676）. However, significant differences were observed in horizontal semicircular canal gain（r=-0.248, P=0.025）, abnormal rates of horizontal semicircular canal catch-up saccades（r=0.507, P<0.001）, as well as cVEMP（χ²=15.111, P=0.004） and oVEMP thresholds（χ²=18.948, P<0.001） across varying tumor size groups. Conclusion:The extent of hearing loss in patients with vestibular schwannoma is not correlated with tumor size, whereas the degree of vestibular dysfunction demonstrates a correlation with tumor size.
Humans ; Neuroma, Acoustic/physiopathology* ; Retrospective Studies ; Audiometry, Pure-Tone ; Vestibular Function Tests ; Vestibular Evoked Myogenic Potentials ; Female ; Male ; Head Impulse Test ; Middle Aged ; Adult ; Semicircular Canals/physiopathology* ; Aged ; Hearing Loss/physiopathology*

To analyze the functional change of horizontal semicircular canals after cochlear implantation.Eighteen patients were enrolled in this study.Their vestibular function was evaluated by using the caloric test and video head impulse test before and one week,one month after CI surgery,respectively.The unilateral weakness(UW),slow phase velocity(SPV)in caloric test and gain in video head impulse test(vHIT-G)were observed.Caloric test was abnormal when UW>25% or SPV mean<6°/s,while vHIT was abnormal when vHIT-G<0.8.The SPV of the implanted ear were[(10.36±8.01)°/s;(14.77±14.24)°/s]pre-operatively,[(6.45±7.52)°/s;(5.14±4.67)°/s]1 week post-operatively and[(6.05±3.86)°/s;(6.27±4.17)°/s]1 month post-operatively.Statistically significant difference(<0.05)was found between pre-and post-operative period.The vHIT-G of the implanted ear were(0.73±0.33)pre-operatively,(0.65±0.32)1 week post-operatively and(0.71±0.36)1 month post-operatively.There was no statistically significant difference of vHIT-G between preand post-operative period((pre-operative/1 week post-operative)=0.084,(pre-operative/1 month post-operative)=0.679).Four patients presented with vertigo and one of them manifested slight unsteadiness post-operatively.All symptoms resolved within 7 days.These symptoms had no correlate with age,gender,implantedear and results of vestibular test.Cochlear implantation can affect the horizontal semicircular canal function,and the video head impulse test and caloric test should be used in a complementary fashion.
Caloric Tests ; Cochlear Implantation ; adverse effects ; methods ; Head Impulse Test ; Humans ; Semicircular Canals ; physiopathology ; Vertigo

To assess the clinical application of video head impulse test (vHIT) for vestibular function in vestibular neuritis (VN) and benign paroxysmal positional vertigo (BPPV) patients.Thirty-three patients with VN and 43 patients with BPPV were enrolled from Sir Run Run Shaw Hospital and Ningbo Second Hospital from March 15 to September 10, 2015; and 50 healthy controls were also enrolled in the study. vHIT was used to quantitatively test the vestibulo-ocular reflex (VOR) gains of a pair of horizontal semicircular canals. VOR gains two pairs of vertical semicircular canals, and the corresponding asymmetrical value of three VOR gains. The saccades information was also recorded.Compared with the healthy control group and BPPV patients, the affected horizontal and vertical VOR gains were declined and the corresponding asymmetries were increased in VN patients (all<0.01). BPPV group also showed higher vertical VOR gain asymmetries compared with the healthy control group (all<0.01), but no significant difference was observed in VOR gains and horizontal VOR gain asymmetry (all>0.05). The sensibility of vHIT in diagnosis of VN was 87.9%. Among 33 VN patients, 22 were diagnosed with superior vestibular nerve dysfunction, 7 were found with inferior vestibular nerve dysfunction and 3 were with both dysfunction; and 1 case was not distinguished.Video head impulse test can quantitatively evaluate the vestibular dysfunction of VN and can help early diagnosis of VN, which may be widely used in clinic.
Benign Paroxysmal Positional Vertigo ; diagnosis ; Head Impulse Test ; Humans ; Reflex, Vestibulo-Ocular ; physiology ; Saccades ; physiology ; Semicircular Canals ; innervation ; physiopathology ; Sensitivity and Specificity ; Vestibular Diseases ; classification ; diagnosis ; Vestibular Nerve ; pathology ; Vestibular Neuronitis ; classification ; diagnosis

OBJECTIVE: To compare the effectiveness of sequential treatment for subjective and objective benign paroxysmal positional vertigo(BPPV). METHOD: The efficacy of sequential treatment for nineteen vertical semicircular canal S-BPPV patients(Group A) and forty-five vertical semicircular canal O-BPPV patients(Group B) who were admitted to our hospital between January 2014 and July 2015 was retrospectively analyzed and compared, treatment of five cases with horizontal semicircular canal S-BPPV was reported here as well. RESULT: The number of repositioning maneuver for Group A was 2 - 6 times (average: 4. 21±1. 18) while 2 - 3 times (average: 2. 29 ± 0. 46) for Group B. There was significant difference between the two groups(P<0. 01). The effective rate of initial treatment for Group A was 78. 9%(15/19) while 82. 2%(37/45)for Group B. After one weeks treatment, the effective rate for Group A changed to be 89. 5% (17/19)while 88. 9% (40/45) for Group B. Non-significant difference was found in the two groups neither in the initial nor one weeks treatment. On three months' follow-up, one in Group A and two in Group B relapsed, and they were cured after treated in the initial treatment. The recurrence for Group A was 5. 3%(1/19) while 4. 4%(2/45) for Group B and there was non-significant difference. The five cases with horizontal semicircular canal S-BPPV were completely free of disease after undergoing treatment. CONCLUSION The sequential treatment is effective for both vertical semicircular canal S-BPPV and vertical semicircular canal O-BPPV, but the former needs more repositioning maneuver times. The repositioning maneuver, combined with drug therapy and head-shake-in-supine-position method is recommended for horizontal semicircular canal S-BPPV.
Benign Paroxysmal Positional Vertigo ; therapy ; Humans ; Patient Positioning ; Recurrence ; Retrospective Studies ; Semicircular Canals ; physiopathology ; Treatment Outcome

OBJECTIVE: To observe the short and long-term efficacy of quick repositioning maneuver for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) in different age groups. METHOD: The clinical data of 113 adult patients with single PC-BPPV who underwent quick repositioning maneuver from July 2009 to February 2015 were retrospectively analyzed. The quick repositioning maneuver was to roll the patient from involved side to healthy side in the coronal plane for 180° as quickly as possible. The patients were divided into 3 groups according to different ages: young group (< 45 years), middle-age group (45 ≤ age < 60 years) and old group (≥ 60 years). The short and long term outcomes of the three groups were observed. RESULT: The left ear was involved in 58 cases (51.3%) and the right ear in 55 cases (48.7%). The short term improvement rates of the young, middle-age and the old groups were 92.5%, 93.6% and 92.3% respectively, and the long term improvement rate was 90.0%, 85.1% and 73.1% respectively. There was no significant difference among the three groups in short and long term outcomes (P > 0.05). The recurrence rate of the three groups was 5.0%, 6.4% and 15.4% respectively, also no significant difference (P > 0.05). CONCLUSION The quick repositioning maneuver along the coronal plane for PC-BPPV has a definite effect for every age groups. The method is simple, rapid and easy to master, and the patients are tolerated the maneuver well without evident side effect.
Adult ; Benign Paroxysmal Positional Vertigo ; therapy ; Humans ; Middle Aged ; Patient Positioning ; Retrospective Studies ; Semicircular Canals ; physiopathology

OBJECTIVE: To analyze the feature of horizontal semicircular canal function at high and low-frequencies in Meniere's disease. METHOD: Thirty patients suffering from unilateral Meniere's disease were included in the research from 2013 June to 2014 June. Caloric test and video head impulse test were performed to evaluate the high low-frequency function of horizontal semicircular canal. RESULT: these patients were devided by the severity of unilateral weakness in caloric test. The gain value in video head impulse test, which reflects the high-frequency function of semicircular canal, were not different between the normal and mild abnormal group (P > 0.05), but were obviously different between the normal and mild-severe abnormal group, slight abnormal and mild-severe abnormal group (P < 0.05). Gain asymmetry, which reflects the high-frequency function of both side, has no difference between three groups (P > 0.05). CONCLUSION A part of Meniere's disease may have normal high, low-frequency function of horizontal semicircular canal. As patient suffering slight injury of low-frequency function, the high-frequency function keeps normal. As the injury of low-frequency function become mildly to severely, the damage of high-frequency function appears, but the symmetry still keeps balance.
Caloric Tests ; Head Impulse Test ; Humans ; Meniere Disease ; physiopathology ; Semicircular Canals ; physiopathology

OBJECTIVE: The purpose of the study was to investigate the balance function of the patients with benign paroxysmal positional vertigo (BPPV) during standing. METHOD: In this study 41 patients with posterior semicircular canal BPPV (PC BPPV) and 11 patients with horizontal semicircular canal BPPV (HC BPPV) were recruited. Dynamic balance during standing was measured in Sensory Organization Test (SOT). Static balance during standing was measured in modified Clinical Test of Sensory Interaction and Balance (mCTSIB). Data of BPPV patients were compared to that from 44 normal controls. RESULT: Scores of the patients with PC BPPV were lower than that of the normal controls in the last three test conditions of SOT. Patients with PC BPPV demonstrated greater sway velocity in stance on foam with eyes open and eyes closed in mCTSIB. No postural deficit was observed in neither SOT nor mCTSIB when the patients with HC BPPV were compared to the normal controls. CONCLUSION Disorders of the horizontal semicircular canal do not influence postural control. Both dynamic and static posturography can detect the postural imbalance caused by posterior semicircular canal dysfunction.
Benign Paroxysmal Positional Vertigo ; physiopathology ; Case-Control Studies ; Humans ; Postural Balance ; Semicircular Canals ; physiopathology

OBJECTIVE: To explore the clinical characteristics and prognosis of patients with idiopathic sudden sensorineural hearing loss (ISSHL) with vertigo. METHOD: By analyzing the clinical data of 271 ISSHL patients, they were divided into without vertigo group (n = 169) and vertigo group (n = 102). In vertigo group, 34 cases were patients with benign paroxysmal positional vertigo (BPPV) secondary to the ISSHL. All patients received conventional treatment. According to the types of BPPV, patients with secondary BPPV received Epley maneuver or Barbecue roll maneuver. By analyzing the results of the pure tone audiometry test and treatment outcomes of the patients, we summarized the clinical characteristics of ISSHL patients with vertigo. RESULT: The audiometric curves of ISSHL with vertigo group were mainly at high frequency. The degrees of hearing loss of these patients were severe and profound. After treatment, the improvement of hearing threshold for ISSHL with vertigo group was lower than that for ISSHL without vertigo group. What's more, the rate of recovery, success and total effective of audition for ISSHL with vertigo group was also obviously lower than that for ISSHL without vertigo group. Of all the patients with BPPV, 27 cases of posterior semicircular canal and 7 cases of lateral semicircular canal were identified. All patients with BPPV were diagnosed as the same ears as the ISSHL. CONCLUSION ISSHL with vertigo group lost hearing more severely than ISSHL without vertigo group. Also, the improvement of hearing and the effective after treatment were really poor. The symptoms of ISSHL with BPPV group improved and eased significantly than that of ISSHL without BPPV group. The major of BPPV secondary to the ISSHL occurs in the posterior semicircular canal. The canalith repositioning is an effective therapy to the secondary BPPV.
Audiometry, Pure-Tone ; Auditory Perception ; Benign Paroxysmal Positional Vertigo ; complications ; therapy ; Hearing Loss, Sensorineural ; complications ; therapy ; Hearing Loss, Sudden ; complications ; therapy ; Humans ; Patient Positioning ; Prognosis ; Semicircular Canals ; physiopathology ; Treatment Outcome