Clin Exp Otorhinolaryngol.  2019 Aug;12(3):255-260. 10.21053/ceo.2018.00038.

Direction-Changing and Direction-Fixed Positional Nystagmus in Patients With Vestibular Neuritis and Meniere Disease

• Kim CH
• Shin JE
• Yoo MH
• Park HJ

• KMID: 2455365
• DOI: http://doi.org/10.21053/ceo.2018.00038

Abstract

OBJECTIVES
Direction-changing positional nystagmus (PN) was considered to indicate the presence of benign paroxysmal positional vertigo involving lateral semicircular canal in most cases. We investigated the incidence of PN on the supine head-roll test and compared the characteristics of nystagmus in patients with vestibular neuritis (VN) and Meniere disease (MD).
METHODS
A retrospective review of patients, who were diagnosed with unilateral VN or unilateral definite MD between September 2005 and November 2011, was conducted. Sixty-five VN patients and 65 MD patients were enrolled. Eye movements were recorded for 30-60 seconds at the positions of sitting, head roll to the right, and head roll to the left, and maximum slow-phase eye velocity was calculated. PN was classified as direction-fixed (paretic or recovery) and direction-changing (geotropic or apogeotropic).
RESULTS
Spontaneous nystagmus was observed in 57 patients (87%, the slow-phase eye velocity of 7°/sec±5°/sec) with acute VN, 39 (60%, 2°/sec±1°/sec) with follow-up VN, and 32 (49%, 2°/sec±2°/sec) with MD. Direction-fixed PN was the most common type. Direction-fixed paretic type was most common in acute VN (80%) and follow-up VN (42%), and direction-fixed recovery type was most common in MD (31%). Paretic type was significantly more common in acute VN (80%) than in follow-up VN (42%) and MD (26%), and the recovery type was significantly more common in MD (31%) than in acute VN (3%) and follow-up VN (14%). Direction-changing PN was more common in MD (22%), followed by follow-up VN (14%) and acute VN (9%).
CONCLUSION
Though direction-fixed paretic PN was most common in VN and MD patients, direction-changing PN could be observed in a few patients (9%-20%) with peripheral vestibular disorders regardless of the duration from the onset of dizziness, suggesting the presence of otolith-related dizziness.

Keyword

Vestibular Neuritis; Meniere Disease; Benign Paroxysmal Positional Vertigo; Nystagmus; Positional

MeSH Terms

Benign Paroxysmal Positional Vertigo
Dizziness
Eye Movements
Follow-Up Studies
Head
Humans
Incidence
Meniere Disease*
Nystagmus, Physiologic*
Retrospective Studies
Semicircular Canals
Vestibular Neuronitis*

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