Benign Paroxysmal Positional Vertigo with Simultaneous Involvement of Multiple Semicircular Canals

Abstract

Background and ObjectivesBenign paroxysmal positional vertigo (BPPV) generally involves a single semicircular canal (single canal BPPV) but it has been reported that more than one semicircular canal on either the same or the opposite side can be involved in 6.8-20% of the cases (multiple canal BPPV). In this study, the clinical characteristics of multiple canal BPPV were analyzed and compared to those of single canal BPPV.Materials and MethodsRetrospective analysis was performed on 1054 consecutive patients diagnosed with BPPV. Multiple canal BPPV was diagnosed when the combination of typical nystagmus was provoked by the Dix-Hallpike and supine head roll tests. Canalith repositioning maneuver was performed sequentially starting with the semicircular canal causing more severe nystagmus or symptoms. Clinical characteristics and the treatment course were statistically compared between single canal BPPV and multiple canal BPPV.ResultsAmong the 1054 patients, single canal BPPV was diagnosed in 1005 patients (95.4%) while multiple canal BPPV was diagnosed in 49 patients (4.6%). BPPV involving semicircular canals on the same side was more common (79.6%) than BPPV with bilateral involvement. The most common combination of the involved canals was ipsilateral posterior and horizontal semicircular canals (63.3%). Multiple canal BPPV was significantly more associated with underlying otologic diseases, especially labyrinthitis. Multiple canal BPPV required more treatment sessions and longer duration of treatment to achieve resolution of nystagmus and symptoms.ConclusionsAs all cases of multiple canal BPPV were treated successfully although a longer duration of treatment and more treatment sessions were required compared to single canal BPPV, the results of our study could aid in making an accurate diagnosis and providing appropriate treatment of multiple canal BPPV.

Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome

“…On the contrary, our population was characterised by considerably more horizontal BPPV and multi-canal BPPV than previous estimates that range from around 6-10 % [14,16,28,30] and less than 8 % [13,16,31], respectively. Many studies do not investigate cupulolithiasis that accounted for 39 % of our patients.…”

“…We argue that some of these likely have recovered from BPPV, reducing motivation for further contact to the clinic. Regardless of treatment or spontaneous remission, there is often a relapse in BPPV mostly within the first year and the relapse rate after 5 years is 33-50 % with higher incidence among BPPV secondary to trauma [23,29,31,32]. In our population, 12 % of the patients experienced relapse approximately year after ended treatment.…”

Posttraumatic Refractory Multi-Channel Benign Paroxysmal Positional Vertigo ‘'Case Report'’

“…In mixed-type vertigo, most prevalent combinations seen are posterior and horizontal canal pathologies, as was the case with our patient [1, 2, 4]. In a multicenter study presented by Leopardi et al, in only 4.4% of BPPV cases were multi-canal etiologies observed, and the authors reported combination of posterior and horizontal canal pathologies as most frequently seen type of BPPV [9].…”

Comments on an Update of Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo

“…An incidence of up to 10% of bilateral posterior canal BPPV among BPPV cases has been reported in several studies [2][3][4][5][6][7][8]. Thus if the Dix-Hallpike test should not be repeated with the opposite side when the test on initial side is positive, potential cases with bilateral posterior canal BPPV would not be diagnosed and treated appropriately.…”

“…Multicanal BPPV may also simultaneously involve in the posterior and lateral canals, either on the same side or on 2 sides, with a reported incidence of up to 13% among BPPV cases [4][5][6][7][8]. Thus if the supine roll test to evaluate lateral canal BPPV should not be performed since the patient presents with a history corresponding BPPV and shows a positive DixHallpike test, potential cases with multicanal BPPV involving the posterior and lateral canals would not be diagnosed and treated appropriately.…”