Horizontal Canal BPPV

Above is a VNG tracing of a patient with right horizontal canal canalithiasis (BPPV).  The patient develops right-beating nystagmus when laying on their right side which is greater than the left-beating nystagmus that develops when the head is turned to the left side.  Thus, this is called geotropic nystagmus and represents BPPV involving the right horizontal semicircular canal.

Below is a video animation (from Dr. Tim Hain, Northwestern University) illustrating the basic head movement needed to treat this type of BPPV.  This maneuver has been called 'log roll', 'BBQ roll' and 'Lempert roll' and is over 90% curative for this condition.

Below is a video of a patient with left horizontal canal BPPV being treated with a Lempert roll.
  Horizontal canal BPPV is cured over 90% of the time with a single treatment.

BPPV of the horizontal canal occurs in about 10-15% in all cases of BPPV.  It is important to recognize this type of BPPV, as the treatment is different than BPPV involving the posterior semicircular canal.  This type of BPPV is characterized by 'geotropic' nystagmus, the side of involvement defined by the greater amount of nystagmus.  'Geotropic' simply means nystagmus that beats toward the ground.  For example, the proper head positioning to check for this type of nystagmus is to lay back with the head elevated (neck flexed) 30 degrees, then the head is turned to the right (observing for the development of nystagmus), then to the left (observing for the development of nystagmus).  In this condition, we observe right-beating nystagmus when the head is turned to the right and left-beating nystagmus when the head is turned to the left, thus 'geotropic' nystagmus.

Above, the video reveals findings consistent with left horizontal canal BPPV.  At the beginning of the video, the patient's head is turned to the right and right-beating nystagmus is observed.  About half way into the video, the patient's head is turned to the left and left-beating nystagmus develops.  The left-beating nystagmus is greater than the right-beating nystagmus, thus the side of involvement is the left side.

Below, the VNG tracing reveals the same pattern, that of right-beating nystagmus in head position right which is less than the left-beating nystagmus which develops in head position left.  This represents left horizontal canal BPPV.

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