Epley 法施行中の眼振について

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1 Epley Observations of nystagmus during the Epley maneuver Kohichiro Shigeno Shigeno Otolaryngology Vertigo-Hearing Impairment Clinic A single Epley maneuver was performed for 145 patients with unilateral posterior canal-benign paroxysmal positional vertigo (BPPV) caused by canalolithiasis, and the efficacy of repositioning was evaluated using the Dix-Hallpike test on the following day. The nystagmus pattern observed during the Epley maneuver and the results of repositioning were analyzed. Of the 145 patients, 114 (79%) exhibited a resolution of BPPV, whereas 19 (13%) exhibited typical posterior canal-bppv caused by canalolithiasis, 7 (5%) exhibited a variant of posterior canal-bppv inducing a positional downbeat nystagmus, and the remaining 5 (3%) exhibited conversion to other forms of BPPV such as lateral canal-bppv. During the Epley maneuver, upbeat-rotatory toward the affected ear nystagmus, downbeat rotatory toward the healthy ear nystagmus, downbeat-rotatory toward the affected ear nystagmus, and no nystagmus were observed. However, the nystagmus pattern during the Epley maneuver was not correlated with the results of repositioning. An upbeat-rotatory toward the affected ear nystagmus indicates the movement of free debris toward the nonampullated end of the posterior canal. A downbeat-rotatory toward the healthy ear nystagmus might imply a secondary phase of nystagmus elicited in the previous head position or the co-existence of a posterior canal-bppv caused by canalolithiasis of the short-arm. A downbeat-rotatory toward the affected ear nystagmus indicates free debris moving toward the non-ampullated end of the anterior canal to the common crus. No nystagmus indicates that the debris did not move during the head positioning, possibly suggesting that free debris moving through the common crus did not result in the development of nystagmus. Key words: Epley maneuver, nystagmus, anterior canal, common crus Benign Paroxysmal Positional Vertigo BPPV BPPV Canalith repositioning procedure Epley Particle repositioning maneuver Parnes Semont ( 165 )

2 BPPV BPPV BPPV BPPV BPPV BPPV BPPV BPPV Ewald Canalith jam BPPV Epley Dix-Hallpike Epley BPPV Epley BPPV Dix-Hallpike ( 166 )

3 BPPV Epley Epley Epley Dix-Hallpike Head roll test Dix-Hallpike BPPV BPPVshort-arm BPPV BPPV-short-arm Short-arm Epley Vibrator Epley Epley CCD SN IR 1 ImageJ VOG Epley ( 167 )

4 Epley BPPV Dix-Hallpike Epley Epley Dix- Hallpike Epley Head roll test Epley Dix-Hallpike Epley Dix-Hallpike Re-entry Epley Dix-Hallpike Epley Epley Epley BPPV Epley BPPV Dix-Hallpike BPPV ( 168 )

5 BPPV Dix-Hallpike Epley BPPV BPPV BPPV BPPV Canalith jam Vannucchi Dix-Hallpike Epley Epley Epley Mann- Whitney p 0.05 Epley Dix- Hallpike Epley Epley BPPV Epley BPPV BPPV ( 169 )

6 Epley Nose-down BPPV BPPV BPPV BPPV-short-arm Epley ( 170 )

7 Epley Epley P-BPPV P-BPPV Epley Epley Epley BPPV BPPV p 0.47 p 0.56 p 0.58 Epley Epley Head roll test BPPV BPPV BPPV BPPV ( 171 )

8 BPPV Parnes particle repositioning maneuver Furman heels over head rotation Vibrator Oh Epley BPPV Heels over head rotation Parnes Heels over head rotation Oh Epley Epley BPPV Baloh Dix-Hallpike BPPV BPPV ( 172 )

9 Epley Epley Epley Epley BPPV Epley Epley Baloh BPPV Furman Dix-Hallpike BPPV Furman BPPV Baloh BPPV Epley Epley BPPV-short-arm Herdman Epley ( 173 )

10 BPPV-short-arm Oh Epley Epley Herdman Epley long-arm Nose-down Dix-Hallpike Long-arm Long-arm long-arm Epley Nose-down Epley Epley Epley Epley Epley Longarm ( 174 )

11 BPPV BPPV Epley Furman BPPV Head roll test BPPV Epley BPPV Dix-Hallpike Epley Epley BPPV BPPV Epley Epley BPPV-short-arm Hilton MP, Pinder DK: The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev: 1 38, 2014 Epley JM: The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 107: , 1992 Parnes LS, Price-Jones RG: Particle repositioning maneuver for benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 102: , 1993 Semont A, Freyss G: Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 42: , 1988 Epley JM: Human experience with canalith repositioning maneuvers. Ann N Y Acad Sci 942: , 2001 Equilibrium Res 68: , 2009 BPPV short-arm Equilibrium Res 72: , 2013 NIH Image Equilibrium Res 61: 90 96, 2002 Parnes LS, Robichaud J: Further observations during the particle repositioning maneuver for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 116: , 1997 Foster CA, Zaccaro K, Strong D: Canal conversion and reentry: a risk of Dix-Hallpike during canalith repositioning procedures. Otol Neurotol 33: , 2012 Vannucchi P, Pecci R, Giannoni B: Posterior semicircular canal benign paroxysmal positional vertigo presenting with torsional downbeating nystagmus: an apogeotropic variant. Int J Otolaryngol 2012: 1 9, 2012 Vannucchi P, Pecci R, Giannoni B, et al.: ( 175 )

12 Apogeotropic Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: Some Clinical and Therapeutic Considerations. Audiol Res 5: 38 43, 2015 Furman JM, Cass SP, Briggs BC: Treatment of benign positional vertigo using heels-overhead rotation. Ann Otol Rhinol Laryngol 107: , 1998 Oh HJ, Kim JS, Han BI, et al.: Predicting a successful treatment in posterior canal benign paroxysmal positional vertigo. Neurology 68: , 2007 Baloh RW, Sakala SM, Honrubia V: Benign paroxysmal positional nystagmus. Am J Otolaryngol 1: 1 6, 1979 Baloh RW, Jacobson K, Honrubia V: Horizontal semicircular canal variant of benign positional vertigo. Neurology 43: , 1993 Pagnini P, Nuti D, Vannucchi P: Benign paroxysmal vertigo of the horizontal canal. ORL J Otorhinolaryngol Relat Spec 51: , 1989 Equilibrium Res 59: , 2000 Lee SH, Kim MK, Cho KH, et al.: Reversal of initial positioning nystagmus in benign paroxysmal positional vertigo involving the horizontal canal. Ann N Y Acad Sci 1164: , 2009 Ogawa Y, Ichimura A, Otsuka K, et al.: Spontaneous inversion of nystagmus without a positional change in the horizontal canal variant of benign paroxysmal positional vertigo. J Vestib Res 25: , 2015 Herdman SJ, Tusa RJ: Complications of the canalith repositioning procedure. Arch Otolaryngol Head Neck Surg 122: , 1996 Epley JM: Positional vertigo related to semicircular canalithiasis. Otolaryngol Head Neck Surg 112: , 1995 House MG, Honrubia V: Theoretical models for the mechanisms of benign paroxysmal positional vertigo. Audiol Neurootol 8: 91 99, 2003 Fernández C, Valentinuzzi M: A study on the biophysical characteristics of the cat labyrinth. Acta Otolaryngol. 65: , 1968 Equilibrium Res 74: , 2015 ( 176 )

良性発作性頭位めまい症（BPPV）に関する質疑応答集

良性発作性頭位めまい症（BPPV）に関する質疑応答集 Equilibrium Res Vol. (4) BPPV BPPV BPPV EBM BPPV Agency for Health Care Policy and Research, 1993 Abstract Table Pub Med Web ver. 4 Pub Med BPPV AND 1997: 2007 [dp] AND English[la] AND BPPV BPPV Web ver.