良性阵发性位置性眩晕

良性阵发性位置性眩晕是最常见的周围性眩晕,除部分继发于头部外伤、病毒性迷路炎、梅尼埃病和内耳手术后等病因外,大多数均无明确病因。在发病机制上,"半规管结石学说"已得到了大多数学者认可。诊断主要依靠典型的病史、阳性体位诱发试验和眼震的方向。大多数患者经耳石复位法等非手术治疗可取得满意疗效,少数保守治疗效果不理想的患者可行手术治疗。     

耳石复位法治疗良性阵发性位置性眩晕42例临床分析

目的 探讨耳石复位法治疗良性阵发性位置性眩晕(BPPV)的效果.方法 应用 Epley管石复位法、 Semont管石解脱法、Barbecue翻滚法治疗良性阵发性位置性眩晕42例.结果 42 例中经耳石复位法治愈36例(85.7%),有效4例(9.5%),复位失败2例(4.8%).失败的2例经前庭功能训练治愈.结论 耳石复位法是BPPV的首选治疗方法,对于复位失败的患者可试行前庭功能训练.     

良性阵发性位置眩晕患者临床特征分析

目的分析良性阵发性位置性眩晕患者的临床特征。方法对132例良性阵发性位置性眩晕患者的临床资料进行回顾性分析。结果 BPPV发病率女性高于男性,50~59岁为高发年龄段,绝大多数患者有明显潜伏期,眩晕持续时间短暂,病变部位受累以单侧为主,右侧发病明显高于左侧,PC-BPPV发病率明显高于HC-BPPV及AC-BPPV;耳石复位法治疗BPPV效果肯定,1次治疗有效率为81.82%,2次治疗总有效率为93.18%,对123例治疗有效患者随访观察半年,复发率为17.89%;PC-BPPV潜伏期明显长于HC-BPPV(P<0.05),无明显潜伏期比例显著少于HC-BPPV(P<0.01)。结论 BPPV患者具有明显的临床特征,应根据实际情况给予合适的治疗方法,以提高临床治疗效果。     

良性阵发性位置性眩晕

良性阵发性位置性眩晕(BPPV)的临床特点表现为头部位置变化所引起的短暂性、发作性眩晕和眼球震颤。BP-PV的发病机理有嵴顶石学说和管石学说。BPPV症状的严重程度、持续时间和频率与所累及的半规管及结石碎片的位置有关。不同类型的BPPV可以通过观察体位诱发试验中出现的眼球震颤特点来诊断。BPPV可在保守治疗时自行缓解。管石复位法能将结石碎片从半规管转移到前庭,从而快速消除症状。     

Epley法治疗良性阵发性位置性眩晕60例分析

目的探讨良性阵发性位置性眩晕（BPPV）的治疗方法和影响因素。方法对2009-01~2009-07诊断的60例BPPV的治疗情况进行回顾性分析。60例患者通过常规耳科检查和Dix-Hallpike诱发实验确诊,病程3个月~22年,Epley法治疗后2~4周复诊。结果Epley法治疗38例治愈,52例有效,8例无效。结论Epley法治疗BPPV效果良好,临床医生应了解和掌握。     

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。     

女性原发性良性阵发性位置性眩晕的骨密度研究

目的探讨女性原发性良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)和骨密度的关系。方法选取2016年1月~2016年12月在宁波市第二医院神经内科就诊并符合标准的58例女性原发性BPPV患者和84例健康对照者为研究对象。所有入选者均采用双能X线吸收法对腰椎和股骨颈骨密度进行检测。结果 BPPV组中,骨密度正常18例(31.03%),骨密度下降40例(68.97%),其中骨量减少26例(44.83%),骨质疏松14例(24.14%)。对照组中,骨密度正常44例(52.38%),骨密度下降40例(47.62%),其中骨量减少30例(35.71%),骨质疏松10例(11.91%)。2组骨密度下降率比较差异有统计学意义(P0.05)。BPPV组骨密度T值-1.08±1.65明显低于对照组-0.41±1.01,差异有统计学意义(P0.05)。结论女性原发性良性阵发性位置性眩晕的发病可能与骨密度下降有关。     

Epley耳石复位法治疗后半规管良性阵发性位置性眩晕的疗效观察

目的观察Epley耳石复位法治疗后半规管良性阵发性位置性眩晕(PC-BPPV)的临床疗效。方法对72例PC-BPPV患者采用Epley耳石复位法进行治疗,观察治疗后即刻、15 d、1个月及3个月的疗效。结果本组患者经1次Epley手法复位治疗后痊愈47例(65.3%),改善15例,总有效率86.1%。15 d后痊愈55例(76.4%),改善12例,总有效率93.0%;1个月痊愈52例(72.2%),改善13例,总有效率90.2%;至3个月时,痊愈54例(75.0%),改善12例,总有效率91.7%。结论 Epley耳石复位法治疗PC-BPPV安全有效。     

良性阵发性位置性眩晕

良性阵发性位置性眩晕（benign paroxysmal positional vetigo,BPPV）系指当头部快速移动至某一特定的位置时,所激发的短暂的阵发性眩晕与水平型或旋转眼震,眼震具有潜伏期、短暂性和疲劳性特点,属位置性眼震Ⅲ型.由于良性阵发性位置性眩晕为自限性疾病,绝大多数可以自愈,故被称为良性眩晕,迁延不愈甚少.     

青年、中老年良性阵发性位置性眩晕的诊疗体会

目的对青年、中老年良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者的病因、复位治疗效果及复发率等方面的特征进行对比分析。方法对确诊BPPV的门诊及住院患者进行回顾性分析,比较2组资料在诱发因素、性别、病变部位、复位治疗效果及复发率等方面的区别。结果青年组BPPV继发因素多为偏头痛、梅尼埃病,而中老年组继发因素多为后循环缺血,且中老年组合并疾病如高血压、高脂血症、糖尿病等基础疾病明显高于青年组。结论青年组及中老年组病因各不相同,其临床特点也不同,但手法复位治疗对于青年组及中、老年组均安全有效,能够缩短病程,临床值得推广。     

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.     

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。     

变位试验结合手法复位诊治良性发作性位置性眩晕

目的:探讨变位试验诊断良性发作性位置性眩晕(BPPV)及耳石手法复位的疗效。方法:回顾性分析50例BPPV患者的资料,对所有患者进行全面病史采集,行变位试验(Roll试验和Dix-hallpike试验)判定BPPV的类型及侧别,对后半规管BPPV(PC-BPPV)患者采用Epley手法复位,对水平半规管BPPV(HC-BPPV)管石症患者采用Barbecue翻滚法复位,对水平半规管嵴顶结石症患者采用Gufoni疗法、Casani解脱法和Barbecue翻滚法复位。结果:随访3周时治愈42例(84%),有效49例(98%),无效1例(2%),且无明显不良反应。结论:根据典型病史及变位试验可判断BPPV的类型及侧别。手法复位治疗BPPV效果显著、简便、安全,适于临床推广。     

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。     

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.     

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。     

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.