Abstract
Although the duration of benign paroxysmal positional vertigo (BPPV) is generally short, it can sometimes be long and intractable. We report on a case of intractable BPPV in which the duration of disease was four years. The patient was a 38-year-old woman. She had suffered from bilateral hearing loss since childhood. Since October 2005, she experienced severe vertigo whenever she turned her head. She had consulted other doctors, but the symptoms persisted. On June 20, 2007, she was referred to the Otolaryngology Department of Tachikawa General Hospital. The positional nystagmus test demonstrated apogeotropic nystagmus in a bilateral position with a duration of more than one minute. Upbeat nystagmus with a clockwise direction (from the examiner) was seen in sitting position using the Dix-Hallpike method. A pure tone audiogram showed high tone damage causing sensorineural hearing loss bilaterally. A caloric test did not show canal paresis. Magnetic resonance imaging (MRI) of the brain showed normal findings. MRI of the inner ears showed narrowing throughout the entire semicircular canal bilaterally (mainly the bilateral anterior semicircular canals). The Brandt-Daroff method induced nausea; therefore that examination method was abandoned. Habitual training advocated by St. Marianna University, the Head shaking method from Yamaguchi University, and the Non-specific training method from Toho University did not improve the nystagmus. Vestibular training by Kitazato University improved her vertiginous feeling. The direction of nystagmus changed variously during the course. The vertiginous feeling had almost disappeared in June 2009, but nystagmus persisted. We considered that cupulolithiasis in the bilateral lateral semicircular canals often shifted to canalolithiasis in various portions of the semicircular canals. Appropriate physical therapy improved the subjective symptoms.
