Anterior Canal BPPV- A Rare Form of Vertical Canaloliathiasis: Series of 11 Cases

The most common cause of peripheral vertigo is Benign Paroxysmal Positional Vertigo (BPPV) primarily due to involvement of posterior semicircular canal. BPPV due to anterior canal is rare entity. This is a retrospective study, in which data of 628 patients who underwent vertigo test were analyzed. Amongst which 354 were patients of BPPV. It was found that 305 patients had posterior canal BPPV, 18 patients had lateral canal BPPV and 11 patients had anterior canal BPPV. The VNG data of 11 patients with anterior canal BPPV along with their treatment outcomes was analyzed. Of the eleven patients of anterior canal BPPV, ten patients had torsional nystagmus with or without downbeat nystagmus in Deep Head Hanging test. Only one patient had isolated downbeat nystagmus in Supine Head Hanging Test. Patients were treated with modified Yacovino's maneuver. Eight patients had immediate relief with modified Yacovino's repositioning maneuver. One patient had immediate conversion to left posterior canal BPPV and was treated for the same. Two patients presented with delayed conversion to posterior canal BPPV and were treated for the same. Anterior canal BPPV is rare but existent entity. It has a typical torsional and downbeat Nystagmus which is induced by Dix-Hallpike and Deep head hanging test. There is no reversal of nystagmus on getting up. It can be easily corrected by Yacovino's maneuver in the majority of the cases.