Treatment of anterior semi-circular canalithiasis by a sedimentation procedure in a vertical rotatory chair.

OBJECTIVES: To describe the video-nystagmographic characteristics, treatment, and results of a specific canalith repositioning procedure (CRP) on patients with canalolithiasis of the anterior semicircular canal (ASC).

MATERIAL AND METHODS: This was a retrospective study conducted from January 2005 to March 2006 on 16 patients treated for a benign paroxysmal positional vertigo (BPPV) of the ASC. Each patient after analysis and diagnosis using two-dimensional video-nystagmography (2DVNG) was treated with a specific CRP in a specific vertical rotatory chair with control of pulse and blood pressure. The effect of this procedure was determined after 1 week with video-nystagmoscopic (VNS) positional control. A 2DVNG bithermic caloric test, an impulse rotatory test, and a vibratory test were performed. Patients were contacted in May 2006 to measure the long-term effect of the CRP results.

RESULTS: In this retrospective study of 16 anterior BPPVs (a BPPV), the sex ratio, the average age, and the symptoms were comparable to those in patients with posterior BPPV (p BPPV). The sedimentation CRP proved to be effective, with all patients cured after 8 days, even though the length of illness before treatment was 11.68 weeks on average. At the time of the study, 13 patients were already cured, 8.07 months on average after the CRP. Three patients relapsed (one in an anterior form, two in a posterior form).

CONCLUSIONS: ASC BPPV is rare, possibly because the DIX HALLPIKE (DH) test does not sufficiently provoke the condition. The hyperextension with the head in the 45-degree upper position, especially in a rotatory chair, is probably more effective. It seems that the prolonged sedimentation in this position is the key to the treatment.