Benign Paroxysmal Positional Vertigo (BPPV) is a leading cause of dizziness, and while the posterior canal variant is the most common, Horizontal Canal BPPV (HC-BPPV) presents unique challenges.
The KHM maneuver aims for simplicity and efficacy. Its limited evidence (just 9 pts without a control group) suggested that it may be efficacious. However, it should not be prioritized over other classical maneuvers with targeted movements. This maneuver should only be the last resort for cases with very-hard-to-identify the affected side.
What I know from treating most Apo HSC is that identification of side is crucial. ROLL into a petal flow and a lot of symptoms - could be avoided.
With advent of upright BPPV protocol we can maintain a minimal stimulus to allow isolation of the affected ear - just a few additional steps to keep patient from getting sick.
I don’t know if this maneuver should be tried on geotropic HC-BPPV who are resistant to classical maneuvers. I’ve had several patients with side-identified HC-BPPV and failed to treat them with Lempert and Gufoni geo. Some was successfully treated with FPP, some wasn’t.
I suppose other off-standard positioning may help. Do you have any experience dealing with those patients. I assume they’re quite close from successful treatment, no symptoms at all rolling to the sound ear, but intense symptoms rolling to the affected side, then rolling toward the sound side causes a direction-changing nystagmus (still geotropic). I feel like the otolith sits at the exit of the posterior arm of the horizontal semicircular canal.
Do you have any idea for me to try? Thank you very much.
Crucial, in my opinion, is to be a nystagmus detective. Be keen on nystagmus patterns and debris flow to guide you. I have been there when an apo hsc doesn't want to respond or a persistent non-fatiguing geo end up being a vestibular migraine. We do the best we can with these patients.
I assume the otoconia lies at the very end of the HSC, and it stucks there. Turning the head to the sound ear doesn’t cause vertigo or nystagmus at all, but turning the head to the affected side causes intense vertigo and geotropic horizontal nystagmus. After that, turning the head back to the sound ear causing the nystagmus to change side toward the sound ear (geotropic).
I assume the otoconia gets stuck at the very end of HSC due to something related to the canal anatomy. I’ve got those patients lie on their sound side as part of Forced prolonged position maneuver. It worked for some, but the other got back to me without any better.
Do you have any experience dealing with this situation. I was sure they are BPPV patients and I identified the right affected side.
The KHM maneuver aims for simplicity and efficacy. Its limited evidence (just 9 pts without a control group) suggested that it may be efficacious. However, it should not be prioritized over other classical maneuvers with targeted movements. This maneuver should only be the last resort for cases with very-hard-to-identify the affected side.
What I know from treating most Apo HSC is that identification of side is crucial. ROLL into a petal flow and a lot of symptoms - could be avoided.
With advent of upright BPPV protocol we can maintain a minimal stimulus to allow isolation of the affected ear - just a few additional steps to keep patient from getting sick.
I don’t know if this maneuver should be tried on geotropic HC-BPPV who are resistant to classical maneuvers. I’ve had several patients with side-identified HC-BPPV and failed to treat them with Lempert and Gufoni geo. Some was successfully treated with FPP, some wasn’t.
I suppose other off-standard positioning may help. Do you have any experience dealing with those patients. I assume they’re quite close from successful treatment, no symptoms at all rolling to the sound ear, but intense symptoms rolling to the affected side, then rolling toward the sound side causes a direction-changing nystagmus (still geotropic). I feel like the otolith sits at the exit of the posterior arm of the horizontal semicircular canal.
Do you have any idea for me to try? Thank you very much.
Crucial, in my opinion, is to be a nystagmus detective. Be keen on nystagmus patterns and debris flow to guide you. I have been there when an apo hsc doesn't want to respond or a persistent non-fatiguing geo end up being a vestibular migraine. We do the best we can with these patients.
I assume the otoconia lies at the very end of the HSC, and it stucks there. Turning the head to the sound ear doesn’t cause vertigo or nystagmus at all, but turning the head to the affected side causes intense vertigo and geotropic horizontal nystagmus. After that, turning the head back to the sound ear causing the nystagmus to change side toward the sound ear (geotropic).
I assume the otoconia gets stuck at the very end of HSC due to something related to the canal anatomy. I’ve got those patients lie on their sound side as part of Forced prolonged position maneuver. It worked for some, but the other got back to me without any better.
Do you have any experience dealing with this situation. I was sure they are BPPV patients and I identified the right affected side.