Abstract
This study was performed to determine if a new treatment was effective for cases with benign paroxysmal positional vertigo (BPPV) suggesting cupulolithiasis of the horizontal semicircular canal as characterized by apogeotropic direction-changing nystagmus. We describe herein our head-tilt hopping (HtH) exercise designed to release and move otoconia adhesive to the cupula. Subjects were trained to hop with their heads tilted laterally. They completed 3-5 training sessions a day over a 4-week period. Each session ended with a 20-hop trial. HtH exercises were performed in 14 cases with intractable horizontal canal BPPV exhibiting persistent nystagmus beating toward the uppermost ear. The spine roll test was tested on all subjects before and immediately after the first trial, as well as after 1 and 4 weeks of the training to evaluate the effect of this treatment on the apogeotropic nystagmus. The nystagmus disappeared or decreased immediately after the first trial with the exercise in 3 and 2 of 14 cases, respectively. The number of subjects showing improvement as assessed by the disappearance or decrease of the nystagmus were in 9 (64.3%) and 11 (78.6%) of all cases tested at 1 and 4 weeks' time, respectively. However the remaining 3 subjects were not affected by this treatment program after 4 week of the training. These results suggest that HtH exercises based on the concepts of release of otoconia from the cupula would appear to be feasible as a new therapy for cupulolithiasis associated with intractable horizontal canal BPPV
