Office-based differential diagnosis of transient and persistent geotropic positional nystagmus in patients with horizontal canal type of benign paroxysmal positional vertigo

Suzuyo Okazaki; Takao Imai; Kayoko Higashi-Shingai; Kazunori Matsuda; Noriaki Takeda; Tadashi Kitahara; Atsuhiko Uno; Arata Horii; Yumi Ohta; Tetsuo Morihana; Chisako Masumura; Suetaka Nishiike; Hidenori Inohara

doi:10.1080/00016489.2016.1227478

Office-based differential diagnosis of transient and persistent geotropic positional nystagmus in patients with horizontal canal type of benign paroxysmal positional vertigo

Acta Otolaryngol. 2017 Mar;137(3):265-269. doi: 10.1080/00016489.2016.1227478. Epub 2016 Sep 20.

Authors

Affiliations

¹ a Department of Otorhinolaryngology - Head and Neck Surgery , Osaka University Graduate School of Medicine , Osaka , Japan.
² b Department of Otolaryngology , Suita Municipal Hospital , Osaka , Japan.
³ c Department of Otorhinolaryngology - Head and Neck Surgery , Tokushima University Graduate School of Medicine , Tokushima , Japan.
⁴ d Department of Otolaryngology - Head and Neck Surgery , Nara Medical University , Nara , Japan.
⁵ e Department of Otorhinolaryngology - Head and Neck Surgery , Osaka General Medical Center , Osaka , Japan.
⁶ f Department of Otolaryngology - Head and Neck Surgery , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan.
⁷ g Department of Otorhinolaryngology , National Hospital Organization Osaka National Hospital , Osaka , Japan.
⁸ h Department Otorhinolaryngology - Head and Neck Surgery , Osaka Rosai Hospital , Osaka , Japan.

PMID: 27644766
DOI: 10.1080/00016489.2016.1227478

Abstract

Conclusion: A 30 s observation of geotropic positional nystagmus is sufficient to distinguish persistent geotropic positional nystagmus (PGPN) from transient geotropic positional nystagmus (TGPN) in patients with horizontal canal type of benign paroxysmal positional vertigo (H-BPPV) in ENT office.

Objective: As a canalith repositioning procedure effectively treats H-BPPV with TGPN, but not PGPN, the differentiation between patients with PGPN and with TGPN is essential. The purpose of this study is to determine the observation period enough to distinguish TGPN from PGPN.

Methods: This study first analyzed positional nystagmus images recorded with an infrared CCD camera three-dimensionally in 47 patients with H-BPPV. PGPN is distinguished from TGPN in patients with H-BPPV precisely by means of time constant calculated form analysis of positional nystagmus. Ten-second and 30-s movies were made of positional nystagmus of the all 47 patients. Ten independent otolaryngologists were then asked to distinguish TGPN from PGPN after a 10 s or 30 s observation of the geotropic positional nystagmus images in 47 patients with H-BPPV.

Results: The sensitivity and specificity to distinguish TGPN from PGPN was 100% and 97% after 30 s observation, but 100% and 40% after 10 s observation, respectively.

Keywords: Geotropic positional nystagmus; benign paroxysmal positional vertigo; three-dimensional; time constant.

MeSH terms

Aged
Aged, 80 and over
Benign Paroxysmal Positional Vertigo / classification
Benign Paroxysmal Positional Vertigo / diagnosis*
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Nystagmus, Physiologic