良性发作性位置性眩晕手法复位后残余症状分析

目的探讨应用眩晕残障量表(DHI)调查问卷的形式评估良性发作性位置性眩晕患者手法复位后的残余症状。方法对120例患者进行手法复位直到位置试验时眩晕症状及眼球震颤完全消失。患者在复位前和复位后5~7d内分别完成问卷调查。随机选择120例正常志愿者为对照组,在年龄及性别上与实验组进行交叉配对,将复位前、复位后和对照组数据进行对比分析。结果在DHI分值上,手法复位后较复位前有显著改善(P=0.000),其中有6项显示未完全改善。手法复位后DHI分值与对照组对比,结果显示在一些项目上仍有差异,症状改善并不完全。结论DHI分值提示即使在成功的手法复后,患者仍会遗留一些残余的主观症状,对于这些患者,后续的处理很重要。     

手法复位联合药物治疗良性发作性位置性眩晕60例疗效观察

良性发作性位置性眩晕(BPPV)发作原因有多种,是一种外周性眩晕,在临床上比较常见,占眩晕症的1/3左右[1].笔者2008-01～2009-12利用手法复位及药物治疗118例BPPV患者,观察结果如下.     

颗粒复位手法治疗后半规管良性发作性位置性眩晕的对照研究

目的 评价颗粒复位手法(PRM)在治疗后半规管良性发作性位置性眩晕(PC-BPPV)中的作用.方法 将PC-BPPV患者随机分成2组,复位组给予PRM治疗,对照组给予假复位治疗.结果 复位组43例,对照组45例,第4天随访时复位组和对照组的治疗成功率分别为86.05%(37/43)和8.89%(4/45),两者差异显著(X2=49.56,P＜0.01);第7天时,两者的成功率分别为95.35%(41/43)和17.78%(8/45),仍差异显著(X2=50.52,P＜0.01).结论 PRM疗效明显高于对照组,凡PC-BPPV诊断明确者均应给予PRM治疗.     

184例良性发作性位置性眩晕的耳石定位与手法复位治疗的临床分析

目的观察不同半规管所致良性发作性位置性眩晕(BPPV)发生率,及不同复位手法治疗的疗效,探讨其最佳治疗方法。方法回顾性分析2011年1月²012年6月间在我院住院的184例BPPV患者的临床资料,对不同复位手法(Epley法、Barbecue翻滚法、Semont摆动法)的疗效进行比较。结果 184例患者中单半规管受累141例(76.63%),复位有效136例(96.45%);多半规管受累43例(23.37%),复位有效37例(86.04%)。总有效率94.02%。Epley手法复位有效率92.76%、Barbecue翻滚法复位有效率85.93%、Semont摆动法复位有效率95.35%。复发率3.26%,复位>2次103例。结论 BPPV患者中单半规管受累最常见;手法复位是BPPV的最有效的治疗方法。而半规管定位及复位手法的选择是影响疗效的主要因素。     

耳石复位对主观性良性阵发性位置性眩晕的疗效观察

目的探讨手法复位对主观性良性阵发性位置性眩晕(S-BPPV)的临床疗效。方法通过变位试验(Roll试验和Dix-hallpike试验)对50例诊断S-BPPV患者进行分型及侧别判定,对可能的后半规管S-BPPV患者采用Epley手法复位,对水平半规管S-BPPV患者采用Barbecue翻滚法复位,对混合型S-BPPV患者采用Epley手法联合Barbecue翻滚法复位,连续治疗3周,观察临床疗效及不良反应。结果 3周后随访时治愈38/50例(76%),有效46/50例(92%),无效4/50例(8%),无严重不良反应。结论根据典型病史及变位试验可判断S-BPPV的类型及侧别,给予相应的手法复位治疗效果显著、简便、安全,适于临床推广。     

良性发作性位置性眩晕抗抑郁焦虑治疗疗效分析

目的探讨良性发作性位置性眩晕患者抗焦虑抑郁治疗疗效。方法我院2009—2012年收治病程>2周的良性发作性位置性眩晕患者58例,随机分为治疗组和对照组,治疗组进行常规眩晕治疗(药物及手法复位)+氟哌塞顿美利曲辛治疗,对照组进行常规眩晕治疗。2组患者在初诊时、治疗2周后分别进行DHI量表评分测定。结果治疗组DHI量表分值明显低于对照组,眩晕症状改善明显优于对照组。结论良性发作性位置性眩晕患者常伴随抑郁焦虑情绪,针对性进行抗抑郁焦虑治疗有益于改善患者眩晕症状。     

后半规管良性发作性位置性眩晕不同手法复位的临床研究

目的比较改良Epley耳石复位法(即颗粒复位法)和Semont法治疗后半规管良性发作性位置性眩晕(PC-BPPV)的疗效。方法将50例PC-BPPV患者随机分为两组,分别使用改良Epley耳石复位法(耳石复位组,26例)和Semont法(Semont组,24例)进行治疗并观察疗效。结果耳石复位组复位总成功率和首次复位成功率分别为92.3%和38.5%,Semont组分别为62.5%和8.3%,两组比较差异均有统计学意义(均P0.05)。改良Epley耳石复位组复位成功所需次数较Semont组少(P0.01)。结论改良Epley耳石复位法治疗PC-BPPV患者的复位总成功率及首次复位成功率高于Semont法,且安全、易操作,有一定推广价值。     

手法复位联合乳突叩击治疗良性位置性眩晕的临床研究

目的探讨手法复位联合乳突叩击治疗良性阵发性位置性眩晕(BPPV)的有效性及安全性。方法回顾分析了2010年1月～2012年3月间我院治疗的BPPV患者62例,分别采用Epley管石复位法、Barbecue翻滚疗法治疗,复位过程中均联合乳突叩击。结果 54例PC-BPPV使用Epley手法复位治疗,治愈49例(90.7%),有效3例(5.6%),无效2例(2.7%);6例HC-BPPV使用Barbecue翻滚复位治疗,治愈5例(83.3%),有效例1(16.7%)。C-BPPV2例,采用联合手法复位,治愈率100%。总有效率96.8%。结论手法复位联合乳突叩击治疗BPPV疗效确切,安全经济有效。     

良性发作性位置性眩晕

目的 探讨良性发作性位置性眩晕（BPPV）的临床特点和诊治方案。方法 总结20例BPPV患者的临床资料。并结合文献进行分析。结果 BPPV临床特点是有潜伏期，发作时间短暂，呈旋转性，有转换性和疲劳性，Dix-Hallpike测验是确诊的主要方法，管石复位治疗有效。结论 BPPV诊断容易，手法治疗简便有效。     

颗粒复位手法治疗36例后半规管良性发作性位置性眩晕

目的　探讨颗粒复位手法 (PRM)对后半规管良性发作性位置性眩晕 (BPPV)的治疗效果。方法　从2 0 0 3年 1～ 12月 ,对 36例后半规管BPPV进行PRM治疗。结果　经 1次PRM治疗后 ,2 8例症状消失 ,首次治疗成功率为 77 8% ,其中病程在 1周内的 18例患者有 16例症状消失。 4例经 2次PRM治疗 ,2例经 3次PRM治疗后症状也消失 ,总治疗成功率为 94 4 %。 2例无效者行Semont锻炼 ,症状缓解 ,随访至今 ,3例复发 ,复发率 8 8% ,复发者再行PRM治疗仍有效。结论　PRM治疗后半规管BPPV安全有效 ,凡诊断明确均应给予PRM治疗。     

Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is characterized by brief recurrent episodes of vertigo triggered by changes in head position. BPPV is the most common etiology of recurrent vertigo and is caused by abnormal stimulation of the cupula by free-floating otoliths (canalolithiasis) or otoliths that have adhered to the cupula (cupulolithiasis) within any of the three semicircular canals. Typical symptoms and signs of BPPV are evoked when the head is positioned so that the plane of the affected semicircular canal is spatially vertical and thus aligned with gravity. Paroxysm of vertigo and nystagmus develops after a brief latency during the Dix-Hallpike maneuver in posterior-canal BPPV, and during the supine roll test in horizontal-canal BPPV. Positioning the head in the opposite direction usually reverses the direction of the nystagmus. The duration, frequency, and symptom intensity of BPPV vary depending on the involved canals and the location of otolithic debris. Spontaneous recovery may be expected even with conservative treatments. However, canalithrepositioning maneuvers usually provide an immediate resolution of symptoms by clearing the canaliths from the semicircular canal into the vestibule.     

Residual Dizziness after Successful Repositioning Treatment in Patients with Benign Paroxysmal Positional Vertigo

Background and purpose

Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo. Although the repositioning maneuver dramatically improves the vertigo, some patients complain of residual dizziness. We evaluated the incidence and characteristics of persistent dizziness after successful particle repositioning and the clinical factors associated with the residual dizziness.

Methods

We performed a prospective investigation in 49 consecutive patients with confirmed BPPV. The patients were treated with a repositioning maneuver appropriate for the type of BPPV. Success was defined by the resolution of nystagmus and positional vertigo. All patients were followed up until complete resolution of all dizziness, for a maximum of 3 months. We collected data on the characteristics and duration of any residual dizziness and analyzed the clinical factors associated with the residual dizziness.

Results

Of the 49 patients, 11 were men and 38 were women aged 60.4±13.0 years (mean ±SD), and 30 (61%) of them complained of residual dizziness after successful repositioning treatment. There were two types of residual dizziness: continuous lightheadedness and short-lasting unsteadiness occurring during head movement, standing, or walking. The dizziness lasted for 16.4±17.6 days (range=2-80 days, median=10 days). A longer duration of BPPV before treatment was significantly associated with residual dizziness (p=0.04).

Conclusions

Residual dizziness after successful repositioning was observed in two-thirds of the patients with BPPV and disappeared within 3 months without specific treatment in all cases. The results indicate that early successful repositioning can reduce the incidence of residual dizziness.     

良性阵发性位置性眩晕诊疗系统对良性阵发性位置性眩晕诊疗效果的临床研究

目的 观察良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）诊疗系统对BPPV的诊疗效果。 方法 选取2010年6月至2012年12月就诊于武警总医院耳鼻咽喉头颈外科中美眩晕病研究所门诊和病房BPPV患者120例,随机分为BPPV诊疗系统组和手法复位组各60例,比较两种治疗方法对BPPV的诊疗效果。 结果 BPPV组间诊断符合率为100%（Kappa检验值1.000）。BPPV诊疗系统组的次日有效率为96.7%,1周有效率为100%,而BPPV手法组次日有效率为88.3%,1周有效率为91.7%,两组组间比较差异无显著性（P=0.057）。 结论 BPPV诊疗系统对BPPV诊断准确,治疗效果好,有助于实现对BPPV高效标准化的诊断和治疗。     

Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

Background and PurposeTo determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV).MethodsWe retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before (n=29, group A) or after (n=33, group B) the Dix-Hallpike maneuver.ResultsTorsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p=0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0–60.0°/s (median=18.5°/s) vs. range=2.7–40.0°/s (median=13.4°/s), p<0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups (p=0.082).ConclusionsSHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.     

Diagnosis and Treatment of Anterior-Canal Benign Paroxysmal Positional Vertigo: A Systematic Review

Background and Purpose

In contrast to the posterior- and horizontal-canal variants, data on the frequency and therapeutic management of anterior-canal benign paroxysmal positional vertigo (AC-BPPV) are sparse. To synthesize the existing body of evidence into a systematic review regarding the incidence and treatment of AC-BPPV.

Methods

Systematic search of medical databases employing predefined criteria, using the term "anterior canal benign paroxysmal positional vertigo."

Results

The electronic search retrieved 178 unique citations, 31 of which were considered eligible for further analysis. Analysis of the collected data revealed an estimated occurrence of AC-BPPV among benign paroxysmal positional vertigo patients of 3% (range 1-17.1%). No controlled therapeutic trials could be identified, and so the analysis was focused on uncontrolled case series. Treatment was categorized into three groups: Epley maneuver, Yacovino maneuver, and specific, nonstandard maneuvers described in individual articles. All three categories demonstrated success rates of over 75%, and the overall sample-size-weighted mean was 85.6%.

Conclusions

The present analysis demonstrated that AC-BPPV comprises about 3% of all BPPV cases. It can be treated safely using the Epley, Yacovino, and other maneuvers with rates of symptom resolution lying in the range of that reported for the other, more frequent canal variants. Multicenter controlled trials are needed in order to develop evidence-based guidelines for the treatment of AC-BPPV.     

良性阵发性位置性眩晕复发的影响因素分析

目的 探讨良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）复发的影响因素。 方法 收集2009年9月～2010年10月在首都医科大学附属北京同仁医院耳鼻咽喉头颈外科眩晕中心确诊并治疗的100例BPPV患者的资料,于诊治后12个月进行电话随访。对出现复发患者的年龄、性别、治疗方法、双温试验结果和共患颈椎病、高/低血压病、后循环缺血、高脂血症、糖尿病等情况比较,并采用二值Logistic回归分析BPPV复发的影响因素。 结果 年龄≥45岁的患者（38.89%）较年龄＜45岁的患者（14.29%）易复发（P=0.018）;血压异常［P=0.032,95%可信区间（confidence interval,CI）1.097～7.634,优势比（odds ratio,OR）=2.893］和非复位治疗（P=0.014,95%CI 1.261～7.940,OR 3.165）为BPPV复发的危险因素;性别、颈椎病、后循环缺血、高脂血症、糖尿病、双温试验异常与复发无显著相关。 结论 中老年BPPV患者易复发,血压异常和治疗方式与复发相关。     

良性阵发性位置性眩晕临床特征与预后

目的 探讨良性阵发性位置性眩晕（benign p aroxysmal p ositional v ertigo,BPPV）的临床特征以及预后 情况。 方法 收集2009年7月-2015年6月在首都医科大学附属北京天坛医院门诊或住院确诊并经复位治疗 痊愈的BPPV患者1046例。所有患者于2015年12月进行随访以了解预后状况,所有数据应用SPSS 22.0 进行统计分析。 结果 ①BPPV多见于女性,发病高峰年龄为50～60岁,女男比例为2∶1。②BPPV复发率为27.20%, Logistic回归多因素分析发现伴有梅尼埃病的患者复发的风险是不伴有梅尼埃病患者的15.567倍（P ＜0.001）;有偏头痛的患者复发的风险是没有偏头痛的患者的3.003倍（P＜0.01）;伴有高血压和高脂 血症的患者复发的风险分别是不伴有高血压和高脂血症患者的1.554倍和1.457倍（P＜0.05）。 结论 BPPV多见于中年患者,女性多于男性,受累半规管中后半规管型BPPV占绝大多数。梅尼埃病、 偏头痛、高血压、高脂血症可能为BPPV复发的危险因素。     

体位限制预防BPPV复发的随机对照临床研究

目的 评价体位限制预防良性阵发性位置性眩晕(BPPV)近期复发的疗效.方法 将2018年3月至2019年2月在朝阳医院西区神经内科门诊就诊的217例单侧后半规管BPPV患者随机分为观察组和对照组.记录两组患者的一般资料,如年龄、性别、发病时间、伴随疾病及是否给予甲磺酸倍他司汀治疗.观察组Epley手法复位后采用床头抬高...