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o Bulletin N#30 : Focus on the BPPV: Semont maneuver for the horizontal canal and anterior canal - differential diagnosis. o

Authors : A. C. Migueis, A. Sémont, C. Stapleton Garcia, J. Paço (Coimbra, Paris, Lisbonne)

Ref. : Rev Laryngol Otol Rhinol. 2005;126,3:193-199.

The paroxystic benign positional vertigo (BPV) of the horizontal (lateral) and anterior (superior) semi circular canals are much less frequent than the BPV of the posterior canal. However it is necessary to know how to recognize them and treat them by a suitable manoeuvre. This 2nd Teaching Buletin with Alain Sémont makes it possible to answer it while following step by step under videoscopy the course of the diagnosis like its treatment. We thank the authors to have carried out this simple and didactic Teaching Buletin.

The BPV can interest the three semicircular canals. The BPV of the posterior canal is the most frequent, that of the horizontal canal is found in around 15 % of the cases and the canalolithiasis of the anterior canal is exceptional. The distinction between the three BPV results from the direction of nystagmus observed.
Perhaps the frequency of only 15 % of the BPV of the lateral canal has an explanation: the opening of the horizontal canal in the utricule is of narrow diameter. On the other hand this narrowness will return difficult to push out some remains. With regard to the BPV of the vertical canal (anterior) one thinks it is very exceptional, because its orientation is favorable to a spontaneous migration of the lithiasis.
The BPV of the posterior canal was the subject of the last Teaching Buletin. In this one Alain Sémont focuses itself on the BPV of the horizontal canal and the anterior canal by describing their liberatory manoeuvres. The final chapter is dedicated to the BPV and its differential diagnostic.

One should carry out a liberatory manoeuvre only among patients who have a positive diagnostic manoeuvre. Sometimes the patients having been treated for a posterior canal develops a pathology of the horizontal canal. After a manoeuvre for posterior canal the majority of the patients have an otolythic syndrome of instability and this even after a successful manoeuvre. That can require some rehabilitation of the balance. This is particularly true with the aging people because the BPV could decompensated a latent pathology or not very symptomatic (osteoarticular for example).
It is necessary to pay attention to the patients who have been treated by several manoeuvers and especially after a trauma and who can have a perilymphatic fistula. These patients do not want to be rocked any more. They must sleep sitted, to move the least possible their head during 10 to 15 days. Then one can secondarily reexaminate them to take stock before practising if necessary a "soft" news manoeuvre.
The legal tender man_uvres of the superior canal will be readily effective on this type of canalolithiase.


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