Anterior semicircular canal benign paroxysmal positional vertigo and positional downbeating nystagmus

Am J Otolaryngol. May-Jun 2006;27(3):173-8. doi: 10.1016/j.amjoto.2005.09.010.


Purpose: The aim of this study was to describe the clinical features and video-oculographic findings in patients with anterior semicircular canal benign paroxysmal positional vertigo (BPPV).

Study design: This is a prospective case series.

Setting: The study was set at an outpatient clinic in a general hospital.

Patients: Fourteen individuals with symptoms of BPPV and positional downbeating nystagmus (pDBN) were included in the study. The diagnosis was based on a history of brief episodes of vertigo and the presence of pDBN confirmed in the video-oculographic examination during Dix-Hallpike test (DH) or head-hanging maneuver.

Intervention: Patients were treated by particle repositioning maneuver and the effectiveness was evaluated at 7, 30, and 180 days posttreatment. The treatment was repeated up to 4 times if pDBN was persistent.

Main outcome measures: The main outcome measure is the number of patients without pDBN at 30 and 180 days.

Results: Video-oculography showed a predominant pDBN in response to DH. Of the 14 patients, 7 had arterial hypertension, and 5 of 14 cases presented abnormalities on the caloric test. Horizontal spontaneous nystagmus was found in 3 of 14 individuals. Positional nystagmus at different positional test was observed in 5 of 14 individuals, suggesting the involvement of several canals. Of the 14 patients, 10 (71%) did not present vertigo, and the positional tests were negative at 30 days. However, 3 cases presented a positive DH with persistence of BPPV episodes and pDBN at 30 days, and another developed a contralateral posterior canal affectation. One of the patients maintained a persistent pDBN at 180 days despite the repeated maneuvers.

Conclusions: Video-oculography demonstrates that anterior canal BPPV is characterized by a predominant downbeating nystagmus in response to DH. These individuals may show alterations in the vestibular caloric, and they can have multicanal affectation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nystagmus, Physiologic / physiology*
  • Prospective Studies
  • Semicircular Canals / physiopathology*
  • Vertigo / diagnosis*
  • Vertigo / physiopathology
  • Vertigo / therapy
  • Video Recording