Background:The diagnosis of benign paroxysmal positional vertigo (BPPV) involving the lateral semicircular canal (LSC) is traditionally entrusted to the supine head roll test, also known as supine head yaw test (SHYT), which usually allows identification of the pathologic side and BPPV form (geotropic vs. apogeotropic). Nevertheless, SHYT may not always allow easy detection of the affected canal, resulting in similar responses on both sides and intense autonomic symptoms in patients with recent onset of vertigo. The newly introduced upright head roll test (UHRT) represents a diagnostic maneuver for LSC-BPPV, supplementing the already-known head pitch test (HPT) in the sitting position. The combination of these two tests should enable clinicians to determine the precise location of debris within LSC, avoiding disturbing symptoms related to supine positionings. Therefore, we proposed the upright BPPV protocol (UBP), a test battery exclusively performed in the upright position, including the evaluation of pseudo-spontaneous nystagmus (PSN), HPT and UHRT. The purpose of this multicenter study is to determine the feasibility of UBP in the diagnosis of LSC-BPPV.Methods:We retrospectively reviewed the clinical data of 134 consecutive patients diagnosed with LSC-BPPV. All of them received both UBP and the complete diagnostic protocol (CDP), including the evaluation of PSN and data resulting from HPT, UHRT, seated-supine positioning test (SSPT), and SHYT.Results:A correct diagnosis for LSC-BPPV was achieved in 95.5% of cases using exclusively the UBP, with a highly significant concordance with the CDP (p< 0.000, Cohen's kappa = 0.94), regardless of the time elapsed from symptom onset to diagnosis. The concordance between UBP and CDP was not impaired even when cases in which HPT and/or UHRT provided incomplete results were included (p< 0.000). Correct diagnosis using the supine diagnostic protocol (SDP, including SSPT + SHYT) or the sole SHYT was achieved in 85.1% of cases, with similar statistical concordance (p< 0.000) and weaker strength of relationship (Cohen's kappa = 0.80).Conclusion:UBP allows correct diagnosis in LSC-BPPV from the sitting position in most cases, sparing the patient supine positionings and related symptoms. UBP could also allow clinicians to proceed directly with repositioning maneuvers from the upright position.

Auditory brainstem-evoked responses (ABR) were recorded from the scalp of 30 normoacoustic insulin-dependent diabetic subjects, aged between 15 and 41 yr (29 ± 7 yr). Three different stimulus repetition rates (11, 37, and 87 cps) were used. The results were compared with those obtained from 20 age- and sex-matched, normoacoustic control subjects. In diabetic patients, metabolic control (mean daily plasma glucose, glycosylated hemoglobin) and the presence of retinopathy, nephropathy, and somatic neuropathy were also investigated. The latencies (ms) of ABR waves were significantly impaired in diabetic subjects as compared with normals. Peripheral transmission time (wave I) and central transmission time (waves I–V) were also significantly delayed in diabetic subjects. Moreover, by increasing stimulus repetition rates, a significant increase in waves I–V shift was observed in diabetic patients. ABR impairment was not related to glucose balance, to the duration of diabetes, or to the presence of the diabetic retinopathy, nephropathy, and somatic neuropathy. In conclusion, diabetic neuropathy is characterized not only by somatic and autonomie nerve dysfunctions, but also by the early involvement of the central nervous system (CNS). ABR recording can represent a useful, noninvasive, simple procedure to detect both acoustic nerve and CNS damage.

Objective: Canalith jam refers to a condition caused by an otolithic clump blocked inside a semicircular canal, generally provoked by canalith repositioning procedure. We describe the first case of spontaneous canalith jam mimicking an acute vestibular deficit. Patient: We report the case of an 82-year-old woman who suffered a sudden episode of persistent rotational vertigo with nausea and vomiting, not provoked by head movements. Interventions: Videonystagmography revealed a horizontal right-beating spontaneous nystagmus, inhibited by visual fixation. Surprisingly, the positional test showed a direction changing apogeotropic horizontal nystagmus weaker in the left side, compatible with a left side horizontal canal canalolithiasis of the apogetropic type. Returning to the sitting position, a spontaneous nystagmus was observed again, not tilt sensitive. A left side caloric paresis was found. Results: After performing liberatory maneuvers, the spontaneous nystagmus disappeared and a horizontal canal benign paroxysmal positional vertigo of geotropic type was documented. The canal paresis also disappeared. Conclusions: Canalith jam is rarely described and is overall observed as a repositioning manoeuvre complication, not as a mimicker of a vestibular neuritis. Furthermore, our case represents the first observation of a recurrent canalith jam and apogeotropic variant of horizontal canal benign paroxysmal positional vertigo.

Martini A, Comacchio F, Magnavita V. Auditory evoked responses (ABR, MLR, SVR) and brain mapping in the elderly. Acta Otolaryngol (Stockh) 1991; Suppl. 476: 97—104. The influence of age on evoked auditory brainstem responses (ABRs) is still a matter of controversy. It is well known that in the elderly the ABRs show a progressive latency shift of the principal components. While many authors have reported a I—V interval latency shift, others claim that there is not a delay in the central conduction time (CCT) with ageing. Middle latency auditory evoked responses (MLRs) are also reported to be impaired in the elderly, but the few results published need further investigations. This study investigates some of the controversial aspects of electrophysiological assessment of the auditory system in the elderly. 36 healthy subjects (18 males and 18 females), mean age 67.2 years±5.8, underwent ABRs, MLRs and SVRs and SVRs brain mapping evaluation. All the data were compared with our normative data for young adults. Our results confirm previous reports of a latency shift of all principal components of ABR, but do not demonstrate a significant CCT impairment in the elderly. The MLRs, SVRs and brain mapping analysis also support this conclusion.