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Posterior semicircular canal nystagmus is conjugate and its axis is parallel to that of the canal

From the Eye and Ear Research Unit and the Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, and the University of Sydney, Australia.

Address correspondence and reprint requests to Dr. Phillip D. Cremer, Department of Neurology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.

A patient with a postoperative fistula of the left posterior semicircular canal is presented. Negative pressure in the external ear canal produced upbeat-torsional nystagmus, which was recorded in three dimensions using binocular scleral search coils. The nystagmus was conjugate, without skew deviation, and its trajectory corresponded to the anatomic axis of the left posterior canal. The current study helps validate Ewald’s first law in humans: the axis of nystagmus should match the anatomic axis of the semicircular canal that generated it. This law is clinically useful in diagnosing pathology of the vestibular end-organ, such as benign paroxysmal positional vertigo or the superior semicircular canal dehiscence syndrome.

Key words: Vestibular—Skew—Scleral search coil—Binocular—Ewald.

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