Clinical Analysis of the Canal Paresis in Patients with Benign Paroxysmal Positional Vertigo

Kim, Beom Gyu; Lee, Jong Sun; Chun, Jin Hyoung; Chang, Jai Hyuk; Kim, Il Woo; Choi, Dong Joon; Park, Il Seok; Kim, Yong Bok

Abstract

BACKGROUND AND OBJECTIVES: Canal paresis in patients with BPPV has been variously reported to present in 13% to 57%. Should disorders affecting the peripheral vestibular system, such as vestibular neuronitis, head trauma precede or coexist the onset of BPPV, then particle repositioning maneuver (PRM) may be less effective or ineffective and need further vestibular rehabilitation after the particle repositioning maneuver. The purpose of this study is to investigate the clinical feature and importance of vestibular rehabilitation in patients with BPPV associated with canal paresis.
MATERIALS AND METHODS
A retrospective review was made of 212 patients who visited and diagnosed as BPPV at Hallym university medical center from March 2004 to September 2006. We evaluated the coexistence of canal paresis, methods of treatment and outcome of 128 patients who performed bithermal caloric test.
RESULTS
The vestibular assessment by bithermal caloric test showed the canal paresis in 28 patients. In 21 patients, the canal paresis was ipsilateral, in 2 patients, it was contralateral to the BPPV, and in 5 patients, canal paresis was bilateral. Among 28 patients with canal paresis, 12 patients demonstrated as primary BPPV, 16 patients as secondary BPPV. 28 patients with canal paresis were performed PRM. Vestibular rehabilitation was performed in 18 patients who had ongoing symptoms such as nonspecific continuous dizziness after PRM. Among 18 patients, 14 patients were improved, 4 patients were treatment resistant.
CONCLUSION
This study shows the importance of detailed vestibular testing such as bithermal caloric test in BPPV patients. Patients with evidence of concomitant vestibular pathology would be expected to require further vestibular rehabilitation.