4/10/2024 0 Comments Epley vertigo maneuverBased on the orientation of the canal during these maneuvers and the underlying biomechanics, each maneuver theoretically has its advantages and disadvantages similar to treatment maneuvers for posterior and horizontal canal BPPV ( 4, 16, 21, 22). ![]() Various other maneuvers described in literature, which require identification of the side of involvement, have been described ( 17– 20). The short canal repositioning maneuver (short CRP maneuver) works on the basis of a modified form of the Epley maneuver, which can be used in the treatment of ac-BPPV after determining the side of involvement ( 6). The Yacovino maneuver was proposed as a treatment option with the distinct advantage that the side of involvement does not need to be identified for treatment ( 16). The reversed maneuver is started from the healthy side. Considering the posterior and anterior canals as co-planar, reversal of maneuvers used for posterior canal-BPPV treatment, such as the Epley and Sémont maneuvers, were recommended to treat ac-BPPV ( 13– 15). Various therapeutic maneuvers have been described for the treatment of ac-BPPV. Down-beat nystagmus on positional tests can be associated with central disorders and should be excluded from peripheral down-beating nystagmus ( 12). However, there is, so far, no generally accepted diagnostic maneuver for ac-BPPV. The supine head-hanging test is considered to be a more sensitive test for ac-BPPV as it acts in the sagittal plane and, thus, stimulates both anterior canals at the same time ( 5, 10, 11). Therefore, determining the affected side based on the Dix–Hallpike examination can often be difficult, thus, further complicating proper diagnosis and treatment ( 8– 10). However, the torsional component is not always clear and is less intense than the vertical one and, hence, needs to be differentiated from posterior canal down-beating BPPV ( 6, 7). ac-BPPV is characterized by a vertical downbeat nystagmus with a torsional component toward the affected side ( 5) evoked by the Dix–Hallpike and supine head-hanging tests. The positional tests described for diagnosis are the Dix–Hallpike and supine head-hanging tests. In addition to its low incidence, there are many ambiguous issues in terms of the diagnosis and the treatment (see below) of ac-BPPV. Short CRP is useful in ac-BPPV treatment however, it requires determination of side of involvement.Ĭonclusion: The 3D simulator of the movement of the otoconial debris presented here can be used to test the mechanism of action and the theoretical efficacy of existing diagnostic tests and maneuvers as well as to develop new treatment maneuvers to optimize BPPV treatment. The reverse Epley maneuver was not an effective treatment. To overcome this risk, a modified Yacovino maneuver is suggested. However, simulations showed that the classical Yacovino maneuver carried a risk of canal switch to the posterior canal. The Yacovino maneuver was seen to be an effective treatment option for ac-BPPV without having to determine the side involved. Results: The simulation showed that the supine head-hanging test is a good test for diagnosis of ac-BPPV affecting both labyrinths and demonstrated why there is no inversion of nystagmus on sitting up. Three repositioning maneuvers were simulated: 1) the Yacovino maneuver and its modifications, 2) the reverse Epley maneuver and 3) the short canal repositioning (CRP) maneuver. Simulations of the supine head-hanging test for diagnosis of ac-BPPV were studied. Methods: Based on reconstructed MRI images and fluid dynamics, a 3D dynamic simulation model (as a function of time) was developed and applied. This can help to optimize existing treatment maneuvers and help in the development of better management protocols. ![]() The aim of this study was to use three-dimensional simulation models to visualize otoconial debris movement within the anterior canal during diagnostic tests and different liberatory maneuvers. Various diagnostic and therapeutic maneuvers have been described for its management. ![]() 6Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilian University of Munich, Munich, Germanyīackground and Objectives: Anterior canal BPPV is a rare BPPV variant.5Department of ENT, Aalborg University, Aalborg, Denmark.4Faculty of Physics, Tomsk State University, Tomsk, Russia.3Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.2NeuroEquilibrium Diagnostic Systems Pvt Ltd., Jaipur, India.Anita Bhandari 1 * Rajneesh Bhandari 2 Herman Kingma 3,4,5 Michael Strupp 6
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