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. Background and Objectives: Anterior canal BPPV is a rare BPPV variant.
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