外側半規管型良性発作性頭位めまい症の臨床

• 高石 司

  徳島市民病院耳鼻咽喉科

書誌事項

タイトル別名

• Clinical Features of Horizontal Canal Benign Paroxysmal Positional Vertigo.

抄録

Benign paroxysmal positional vertigo of the horizontal semicircular canal (HC-BPPV) is characterized by direction-changing nystagmus. Geotropic transient positional nystagmus is caused by canalolithiasis, and apogeotropic persistent positional nystagmus is caused by cupulolithiasis of the horizontal semicircular canal.<BR>The Lempert method of particle repositioning maneuver is effective for the treatment of HC-BPPV of canalolithiasis. However, the effectiveness of the Brandt-Daroff method for the treatment of HC-BPPV of cupulolithiasis is limited, because its mechanism is non-specific. Some methods such as mastoid oscillation of the affected ear or head shaking were reported to detach the otolith clot from the cupula into the canal. The transition of cupulolithiasis to canalolithiasis followed by the Lempert method may be effective for the treatment of cupulolithiasis of horizontal semicircular canal.<BR>Because the first step of the Lempert method is head rotation toward the unaffected ear, identification of the affected ear is indispensable for successful maneuver. Canalolithiasis of the horizontal semicircular canal induces ampulofugal endolymphatic flow by a change in head position from upright to supine, resulting in nystagmus beating toward the unaffected ear. Positioning nystagmus is the most useful index to identify the affected ear in canalolithiasis. To identify the affected ear in cupulolithiasis, positional nystagmus in the supine position is the most useful index. Based on the CT imaging of the inner ear, the cupula of the horizontal semicircular canal is not precisely aligned with the sagittal plane of the head, but with a plane rotated medially around the Z-axis at an angle of about 14 degree. Therefore, cupulolithiasis of the horizontal semicircular canal induces nystagmus beating toward the affected ear when the patient is in a supine position.

収録刊行物

• Ｅｑｕｉｌｉｂｒｉｕｍ　Ｒｅｓｅａｒｃｈ

  Ｅｑｕｉｌｉｂｒｉｕｍ　Ｒｅｓｅａｒｃｈ 61 (6), 412-419, 2002

  一般社団法人 日本めまい平衡医学会

キーワード

• benign paroxysmal positional vertigo
• horizontal semicircular canal
• direction-changing positional nystagmus
• cupulolithiasis
• canalolithiasis

詳細情報

• CRID: 1390282679924942336
• NII論文ID: 10010566740
• NII書誌ID: AN00001485
• DOI: 10.3757/jser.61.412
• ISSN: 1882577X
• ISSN: 03855716
• Web Site: https://search.jamas.or.jp/link/ui/2003197703
• 本文言語コード: ja
• データソース種別:
  • JaLC
  • Crossref
  • CiNii Articles
• 抄録ライセンスフラグ: 使用不可