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J Audiol Otol > Epub ahead of print
DOI: https://doi.org/10.7874/jao.2021.00297    [Epub ahead of print] Published online November 23, 2021.
Spontaneous Upbeat Nystagmus and Selective Anterior Semicircular Canal Hypofunction on Video Head Impulse Test: A New Variant of Canalith Jam?
Andrea Castellucci1  , Cecilia Botti1,2  , Salvatore Martellucci3  , Pasquale Malara4  , Silvia Delmonte1  , Francesca Lusetti1  , Angelo Ghidini1 
1ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
2PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
3ENT Unit, Santa Maria Goretti Hospital, Azienda USL Latina, Latina, Italy
4Audiology & Vestibology Service, Centromedico, Bellinzona, Switzerland
Correspondence  Andrea Castellucci ,Tel: +39-0522-296273, Fax: +39-0522-295839, Email: andrea.castellucci@ausl.re.it
Submitted: May 7, 2021  Accepted after revision: September 4, 2021
Abstract
We describe a rare case of spontaneous upbeat nystagmus (UBN) attributable to a canalith jam involving the anterior semicircular canal (ASC) in a patient in whom comprehensive vestibular assessment was useful to identify the underlying pathomechanism. A 56-year-old woman with unsteadiness following repositioning procedures for left-sided benign paroxysmal positional vertigo (BPPV) presented with spontaneous UBN that showed slight right torsional components. A vestibular test battery detected isolated left ASC hypofunction on a video-head impulse test (Video-HIT). We postulated a persistent utriculopetal deflection of the left ASC cupula, which was attributable to entrapment of debris in a narrow canal tract, with consequent sustained inhibition of the ampullary afferents. Although spontaneous UBN receded after impulsive physical therapy, unsteadiness deteriorated into positional vertigo secondary to canalolithiasis involving the ipsilateral posterior canal. In our view, physical therapy possibly fragmented the canalith jam and released free-floating otoconia that eventually settled into the ipsilateral posterior canal. Video HIT revealed normalization of ASC hypofunction, and leftsided posterior canal canalolithiasis was successfully treated using appropriate repositioning procedures. We propose that a canalith jam involving the ASC should be considered in the differential diagnosis of spontaneous UBN, particularly in patients with a history of BPPV and isolated ASC hypofunction detected on video HIT.
Keywords: Vertical nystagmus; Otoconia; Head impulse test; Benign paroxysmal positional vertigo; Semicircular canals
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