良性阵发性位置性眩晕患者温度试验结果比较

目的比较后半规管良性阵发性位置性眩晕 （posterior semicircular canal benign paroxysmal positional vertigo, PSC-BPPV）和外半规管BPPV（horizontalsemicircularcanalBPPV,HSC-BPPV）温度实验结果的差异。方法2006～2008年门诊原发性BPPV患者177例,其中单侧PSC—BPPV患者152例,单侧HSC-BPPV患者25例,Dix-Hallpike及翻转试验检查后做温度实验检查,分析半规管轻瘫（canalparesis,CP）和优势偏向（directi0138Ipreponderance,DP）。结果①CP结果：PSC—BPPV患侧CP64例（42．1％）,健侧CP44例（28。9％）,两者差异有显著性（X2=5．74,P〈0．05）;HSC-BPPV患侧CP16例（64％）,健侧CP9例（36％）,两者差异有显著性（X2=3．92,P〈0．05）;PSC-BPPV患者实际病变侧别与温度试验显示的CP侧别一致的有46例（30．3％）,HSC．BPPV患者实际病变侧别与温度试验显示的CP侧别一致的有13例（52％）,两者差异有显著性（X2=4．56,P〈0．05）：②DP结果：PSC-BPPV患者DP13例,HSC．BPPV患者DP1O例,经统计学分析有显著性差异（X2=16．10,P〈0．01）。结论①HSC—BPPV及PSC．BPPV患者温度试验患侧CP发生率明显高于健侧;②HSC-BPPV患者温度试验CP发生率明显高于PSC．BPPV患者;⑨HSC．BPPV患者温度试验DP发生率明显高于PSC—BPPV患者。     

良性阵发性位置性眩晕发病侧别和患者睡眠侧别的相关性

目的探讨良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者发病侧别和患者习惯性的睡眠侧别的相关性。方法详细记录2007年1月～2008年4月头晕门诊经Dix-Hallpike及rolltest试验明确诊断BPPV患者261例,将患者按照有无诱因分为特发性BPPV和继发性BPPV两组,比较两组患者发病侧别和睡眠侧别的相关性;再将患者按照累及半规管的类型分为后半规管良性阵发性位置性眩晕(posterior semicircular BPPV,PC-BPPV)、水平半规管BPPV(horizontal semicircular BPPV,HC-BPPV)和前半规管BPPV(anterior semicircular BPPV,AC-BPPV),分别比较3个组患者中发病侧别和睡眠侧别的相关性。结果 261例患者中,男性75例,女性186例,男:女为1:2.48。患者年龄14～85岁,平均(57±13.764)岁,BPPV病史1d～10年。①按照有无诱因将BPPV患者分为无诱因的特发性BPPV和有诱因的继发性BPPV,将特发性BPPV组患者和继发性BPPV组患者发病侧别和睡眠侧别进行Spearman Correlation相关性检验,特发性组r=0.233,P<0.05,相关性有统计学意义,继发性组r=0.157,P>0.05,相关性无统计学意义。②按照病变部位分为PC-BPPV、HC-BPPV和AC-BPPV,将3个组发病侧别和睡眠侧别进行Spearman Correlation相关性检验,PC组r=0.175,P=0.052>0.05,AC组r=0.730,P=0.062>0.05,HC组r=0.252,P=0.117>0.05,3个组都没有统计学意义。结论特发性BPPV组患者发病侧别和睡眠侧别有一定的相关性,对于判断患病侧别有一定意义。     

水平半规管良性阵发位置性眩晕的诊治

目的探讨水平半规管良性阵发位置性眩晕（horizontalcanalbenignparoxysmalpositionalvertigo,HC-BPPV）的诊治方法。方法回顾分析1996年7月～2000年3月间南京医科大学第一附属医院耳鼻咽喉科诊治的9例HC-BPPV患者的临床资料。对所有患者全面采集病史,行纯音听阈测试和耳神经学检查,常规施行仰卧侧头位试验和Dix-Hallpike试验,并按Barbecue翻滚法行耳石复位治疗。结果本病以头位改变所诱发的短暂旋转性眩晕为特征,常见诱发体位为床上翻身（9/9例）和转头（5/9例）。仰卧侧头位试验可诱发水平向地性眼震,无潜伏期和疲劳性。采用Barbecue翻滚法治疗后全部患者症状立刻消失,随访4～15个月无复发。结论根据典型表现和体位试验结果,可明确区分水平半规管性和后半规管性BPPV以及其他原因引起的眩晕。Barbecue翻滚是治疗HC-BPPV有效的方法。     

水平半规管良性阵发位置性眩晕的诊治

目的 探讨水平半规管良性阵发位置性眩晕（horizontal canal benign paroxymal positional vertigo ,HC- BPPV)的诊治 方法。方法 回顾分析1996年7月－2000年3年间南京医科大学第一附属医院耳鼻咽喉科诊治的9例HC－BPPV患者的临床资料。对所有患者全面采集病史,行纯音听阈测试和耳神经学检查,常规施行仰卧侧头位试验和Dix-Hallpike试验,并按Barbecue翻滚法行耳石复位治疗。结果 本病以头位改变所诱发的短暂旋转性眩晕为特征,常见诱发体位为床上翻身（9／9例）和转头（5／9例）。仰卧侧头位可诱发水平向地性眼震, 无潜伏期和疲劳性。采用Barbecue翻滚法治疗后全部患者症状立刻消失,随访4－15个月无复发。结论 根据典型表现和体位试验结果,可明确区分水平半规管性和后半规管性BPPV以 春他原因引起的 眩晕。Barbecue翻滚是治疗HC－BPPV有效的方法。     

后半规管良性阵发性位置性眩晕急性发作时的临床表现

目的 观察和总结后半规管良性阵发性位置性眩晕(PSC-BPPV)急性发作时的临床特征,为临床诊断提供依据。 方法 回顾性分析115例PSC-BPPV患者急性发作时的临床表现,分析并总结患者的性别和年龄分布、发病时状态、头晕性质、眩晕发作与头部活动间的关系、眼震、伴随症状、辅助检查等临床特征。 结果 PSC-BPPV急性发作时的临床表现具有以下特征:(1)女性多于男性;(2)易累及50岁以上人群;(3)在起床、躺卧、翻身或活动中头部主动或被动到某一位置时突然发病,特别是晨起发病居多;(4)剧烈的眩晕伴有恶心、呕吐;(5)部分患者在初次查体时表现出旋转性眼震;(6)不伴有耳蜗和神经系统症状和体征;(7)颅脑影像学检查无阳性相关发现。 结论 急诊时如患者在起床、躺下、翻身或头部活动到某一位置时突然出现剧烈的眩晕发作,不伴有耳蜗和神经系统症状体征,颅脑影像学检查无相关阳性发现,应当考虑PSC-BPPV的诊断,及早行Dix-Hallpke诱发试验能够确立诊断。     

梅尼埃病合并良性阵发性位置性眩晕患者的临床特征

目的：了解梅尼埃病（Meniere’s disease,MD）患者合并良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的发生率及临床特征。方法详细询问并记录116例确诊为 MD患者的体位相关性眩晕病史,对有体位性眩晕者行体位试验及前庭诱发肌源性电位（vestibular evoked myogenic potentials,VEMP）检查;对确诊合并BPPV的患者行手法复位治疗。结果116例 MD患者中4例为病史支持的BPPV,4例确诊合并BPPV,MD合并BPPV发生率为3．45％（4／116）。这8例患者BPPV眩晕均在MD发病之后出现;4例确诊BPPV患者中,2例BPPV患耳与 MD同侧,1例为非 MD 患耳,1例不确定;6例病史支持或确诊合并 BPPV 并可提供VEMP结果的 MD患者中眼性前庭诱发肌源性电位（oVEMP）异常5例,这5例异常者中4例与 MD同侧;MD合并BPPV患者手法复位均治愈。结论本组病例MD合并BPPV发生率为3．45％,详细询问眩晕病史结合体位试验及VEMP检测可有效筛选 MD合并BPPV的患者。     

体位限制对手法复位后良性阵发性位置性眩晕的疗效观察

目的 探讨手法复位后体位限制对良性阵发性位置性眩晕(BPPV)患者的疗效。 方法 2015年12月至2016年6月共收治BPPV患者210例,随机分为手法复位后联合体位限制组(观察组)105例和单纯手法复位组(对照组)105例,其中后半规管BPPV(PSC-BPPV)患者两组各70例,向地性水平半规管BPPV(HSC-BPPV)患者两组各25例,背地性HSC-BPPV患者两组各10例。 结果 PSC-BPPV两组短期7 d和3个月疗效差异均无统计学意义(P=0.515, P=0.967); 向地性HSC-BPPV和背地性HSC-BPPV患者两组短期7 d疗效差异均有统计学意义(P=0.030, P=0.040),长期疗效评价无统计学意义(P=0.972)。 结论 PSC-BPPV患者行手法复位后可不予体位限制,HSC-BPPV患者手法复位后需要行体位限制,待患者无任何症状后可以自由体位。     

后半规管良性阵发性位置性眩晕的诊治分析

1921年Barany首次提出良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）,流性病学显示普通人群BPPV年发病率0.6%[1],是最常见前庭源性眩晕疾病。BPPV是常见内耳自限性疾病,指头部移动至某一特定位置时所激发短暂性、阵发性眩晕、三个半规管均可以累及,后半规管良性阵发性位置性眩晕（PSC-BPPV）是最常见的,占57.2%～90.2%[2,3]。目前主要采用Epley复位法治疗PSC-BPPV。本研究对我院2011年7月～2015年7月收治的130例PSC-BPPV患者进行诊治分析,现总结如下。     

儿童眩晕症

总结８７例１３岁下儿童眩晕症的病因及位、听功能检查。绝大多数为前道末梢性病变，占９５．４％，儿童良性阵发性眩晕多见，占３４．５％，其次为Ｍｅｎｉｅｒｅ病１３例（１４．９％）及耳毒性药物中毒１０例（１１．５％）。眼震电检查半规管功能异常者５７例（６５．５％），其中少数有视动功能异常，与儿童中枢系统尚不稳定有关。眩晕合并半规管功能低下者，证明前庭末梢有器质性损害，其中１３例进行姿势图检查，患儿人体重心     

DHM阴性的非典型PSC-BPPV诊断策略探讨

目的 探讨Dix-Hallpike诱发试验(DHM)阴性的非典型后半规管良性阵发性位置性眩晕(PSC-BPPV)的诊断策略。 方法 回顾性分析DHM阴性的非典型PSC-BPPV的诊断过程,对55例存在Dix-Hallpike诱发试验阴性的非典型PSC-BPPV患者,进行双侧Epley复位治疗及疗效观察,对比按照阳性DHM诊断和根据Epley复位治疗结合疗效进行诊断间的早期确诊率。 结果 双侧进行DHM和双侧Epley复位治疗法治疗效果的确诊率分别为35.6%、100.0%。 结论 与按照阳性DHM诊断PSC-BPPV对比,Epley复位治疗结合疗效观察能够显著提高PSC-BPPV的早期确诊率,且能避免漏诊双侧PSC-BPPV。     

以持续性眩晕为表现的水平半规管良性阵发性位置性眩晕的诊治

目的　探讨以持续性眩晕为表现的良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）患者的诊治。方法　回顾性分析2例以持续性眩晕为表现的BPPV患者的临床资料。结果　此2例患者在坐位及平躺位见方向向患侧的水平自发持续性眼震,甩头试验健侧阳性,平卧侧头试验双侧均诱发出水平离地性眼震,平躺后头部向患侧连续转360°时分别出现2个眼震消失点和2个眼震最强点,给予手法复位后患者眩晕症状缓解。结论　水平半规管BPPV患者偶可表现为持续性眩晕发作,其病因为壶腹嵴帽耳石症,临床表现与耳石重力因素和水平半规管空间位置相关。     

外半规管良性阵发性位置性眩晕的诊疗

良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)是最常见的周围性眩晕,主要表现为随头位变化出现的短暂性眩晕发作,该病分为后半规管型、外半规管型、上半规管型及多半规管.其中后半规管BPPV最常见,其次为外半规管BPPVo外半规管BPPV根据发病机制、原理、眼震方向等有多种分类方法.近年来外半规管BPPV的手法复位逐渐被熟悉,但一些患者复位后效果不佳,如外半规管嵴帽结石症,部分患者行常规手法复位后发作性眩晕仍然存在.我们将这部分手法复位后眩晕症状改善不明显的类型归结为难治型外半规管嵴帽结石症.本文主要围绕外半规管BPPV的概念及分类、流行病学、病因、发病机制、诊断及复位方法,尤其对于难治型外半规管嵴帽结石症的复位方法做一综述.     

Position in bed is associated with left or right location in benign paroxysmal positional vertigo of the posterior semicircular canal

PURPOSE: To determine if position during bedrest is related to the canal affected in posterior canal benign paroxysmal positional vertigo (BPPV). MATERIALS AND METHODS: Fifty-five individuals with posterior canal BPPV were investigated. Diagnosis was established if a consistent clinical history was found with vertigo and induced positional nystagmus elicited on the Dix-Hallpike test (DHT). Preference for left or right position during bed rest was determined before performing the DHT. All patients were treated by a single particle repositioning procedure, and relapses were investigated at the seventh and 30 days posttreatment. RESULTS: Forty-five individuals always slept on the same side (29 on the right, 16 on the left side), and 10 patients preferred to change sides during bed rest. Among those patients able to maintain a constant position during bed rest, 27 and 18 presented a positive DHT on the right and left sides, respectively. The canal affected was found to be significantly associated with side during bed rest (relative risk = 2.75; P = 0.01, Fisher exact test). DHT was negative in 86% of patients at 30 days. No differences were found between individuals who presented a constant position in bed and those who changed positions. CONCLUSIONS: Lateral supine position during bed rest is associated with the canal affected in BPPV. We speculate that gravity might facilitate the deposition of particulate material on the posterior semicircular near the ampulla canal during bed rest.     

Is it possible to diagnose Posterior Semicircular Canal BPPV from the sitting position? The role of the Head Pitch Test and the upright tests along the RALP and LARP planes

PurposeThe diagnosis of benign paroxysmal positional vertigo (BPPV) involving the posterior semicircular canal (PSC) is traditionally entrusted to positioning tests where patients are rapidly brought in the supine position. This prospective study aims to define the role of a diagnostic protocol for PSC-BPPV including only upright tests.Materials and methods109 patients with PSC-BPPV were enrolled. The Head Pitch Test (HPT) was carried out first. If uneventful, the patient's head was turned 45° to each side and bent back-and-forth along the plane aligning either with the right anterior-left posterior (RALP) or left anterior-right posterior (LARP) canals, thus performing the upright RALP / upright LARP (uRALP/uLARP) test. Nystagmus observed was used to predict the diagnosis, which was therefore confirmed by Dix-Hallpike tests.ResultsPSC-BPPV could be correctly diagnosed in 75.2% of cases with the sole HPT and in 87.2% of cases by adding the uRALP/uLARP test (Upright Protocol). The time elapsed from symptoms onset was closely related to the protocol sensitivity, as it reached 100% (64/64) in acute patients while decreased to 68.9% (31/45) in cases evaluated after 7 days (p < 0.001).ConclusionsUpright maneuvers could correctly diagnose PSC-BPPV in most cases. uRALP/uLARP test demonstrated to improve the sensitivity of the HPT, mainly in recent-onset BPPV.     

Subjective visual horizontal in the upright posture and asymmetry in roll-tilt perception: independent measures of vestibular function

The subjective visual horizontal (SVH) was measured in the upright position and at 10, 20, and 30 degrees of head and body tilt to the right and left. Normal subjects (n=25) were tested on two separate occasions with an interval of 1-14 days. Test variables considered were the SVH in the upright position, the perception of tilt to the right and left, calculated on the basis of the SVH in the upright and tilted positions, and the asymmetry in tilt perception. There was no correlation between the perception of tilt to the right and to the left r=0.10). Neither was there any correlation between the SVH in the upright position, representing a resting asymmetry, and the asymmetry in tilt perception, i.e. the response asymmetry (r=0.17). However, for each variable, there was a high correspondence between data obtained at test and retest (r ranged from 0.68 to 0.89, p<0.001), suggesting that the independence between variables is not due to noise. Findings are discussed taking into consideration the possible roles of otoliths and semicircular canals in the formation of the SVH. In an attempt to explain the independence between the two measures of asymmetry it is hypothesized that while the otoliths must be essential for the perception of static lateral tilt, the SVH in the upright position to a considerable degree reflects semicircular canal function.     

Hunt综合征伴眩晕患者的半规管损伤频率特征

目的 探讨Hunt综合征伴眩晕患者的前庭半规管损伤频率特征以及视频头脉冲试验(video head impulse test,vHIT)在评估其前庭功能中的应用价值.方法 Hunt综合征伴眩晕患者26例(病例组)分别进行高频vHIT、中频摇头试验(head shaking test)和低频冷热试验(caloric test);30例健康人为对照组进行vHIT.以冷热试验单侧半规管反应非对称值(unilateral weakness,UW)、摇头试验诱发摇头眼震(head shaking nystagmus,HSN)、vHIT的增益值(video head impulse test gain,vHIT-G)为观察指标,应用SPSS 16.0统计软件分析对照组vHIT-G、病例组的三项试验结果特点及其相关性.结果 对照组6个半规管的vHIT-G均符合正态分布,方差分析,相互间差异无统计学意义(F=0.005,P＜0.01);双侧前、水平和后半规管平均vHIT-G((x)±s,下同)分别为16.80％±9.80％、16.57％±10.30％、16.52％±11.12％;病例组的患耳前、水平和后半规管vHIT-G分别为46.96％±34.54％、75.35％±35.29％、41.65％±32.87％,均符合正态分布,与对照组对应半规管比较差异有统计学意义(P值均＜0.01);vHIT、摇头试验和冷热试验阳性者分别为23例(88.46％)、22例(84.61％)和24例(92.31％),双侧确切概率法x2检验,P值均＞0.05,差异无统计学意义;UW与水平半规管vHIT-G之间存在正相关(r=0.692,P＜0.01).结论 Hunt综合征伴眩晕患者的半规管功能损伤呈多频或近乎全频性损伤,具有传导阻滞性神经损伤特点;vHIT可以作为Hunt综合征伴眩晕患者前庭功能评定的有效检查方法.     

Persistent geotropic nystagmus--a different kind of cupular pathology and its localizing signs

CONCLUSION: A persistent geotropic positional nystagmus indicates a dysfunction in the lateral semicircular canal with a cupula of less specific weight than the surrounding endolymph. It is possible to determine the side of the affected cupula by recording the nystagmus pattern in yaw and pitch plane. OBJECTIVES: To identify the clinical features in patients with a persistent geotropic positional nystagmus, establish lateralizing signs and relate the findings to a pathophysiologic mechanism. PATIENTS AND METHODS: Six patients with acute onset vertigo of a peripheral origin and persistent geotropic nystagmus were examined with videonystagmoscopy and the nystagmus characteristics in different positions of the head in yaw and pitch plane were studied. RESULTS: Besides the persistent geotropic nystagmus, a zero zone was found with no nystagmus, beyond which the nystagmus changed direction when the head of the patient in supine position was gradually rotated from side to side. The zero zone was present when the head was turned slightly towards one side and is thought to represent a position where the affected cupula is aligned with the gravitational vertical. With the head bent forwards the nystagmus direction was to the non-affected side and when the head was bent backwards to the affected side.