1240例良性阵发性位置性眩晕患者手法复位治疗

目的 总结分析1999年12月至2008年9月期间1240例良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者应用管石复位治疗后的短期和长期疗效.方法 对1240例BPPV患者应用改良Epley 手法和Barbecue 360°体位翻滚复位法进行手法复位治疗.并于一周后复查,随访一年.结果 1240名患者中,男500例,女740例,年龄5～92岁,平均(46.5±2.3)岁.其中单侧后半规管BPPV患者1149例,单侧水平半规管BPPV患者69例,同时性双侧后半规管BPPV患者17例,同时性双侧水平半规管BPPV患者2例,同时性后半规管与水平半规管BPPV患者3例;特发性BPPV 968例,继发性BPPV 472例,继发病因包括头部外伤、感染、各种耳部疾病、高血压、手术等.利用手法复位治疗后,首次治愈率85.6%(1062/1240),其中后半规管BPPV86.2%(991/1149),水平半规管BPPV 81.2%(56/69),混合性半规管BPPV 68.2%(15/22);观察随访1年后,总治愈率94.2%(1168/1240),复发率5.7%.结论 BPPV患者采用手法复位治疗,疗效肯定,见效快.方法 简单,短期复发率低,可作为治疗BPPV患者的首选治疗方法.     

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。     

多半规管受累的良性阵发性位置性眩晕

目的　探讨多半规管受累的良性阵发性位置性眩晕（BPPV）的类型、临床特点及治疗效果。方法  回顾性分析1502例诊断BPPV患者,通过Dix-Hallpike及滚转试验同时出现相对应的复合特征性眼震,诊断多半规管BPPV,并进行复位治疗。结果　多半规管BPPV162例（10.8%）,外半规管合并后半规管者74例（45.7%）,双侧后半规管48例（29.6%）,后半规管合并前半规管20例（12.3%）,双侧外半规管10例（6.2%）,外半规管合并前半规管6例（3.7%）,双侧前半规管4例（2.5%）。多半规管耳石与头部外伤明显相关,多半规管BPPV比单半规管BPPV需要更长的治疗时间及复位次数。结论　多半规管BPPV中最常见的是外半规管合并后半规管,多半规管BPPV通过复位治疗效果好。     

手法复位治疗良性阵发性位置性眩晕36例

目的 评价体位治疗在良性阵发性位置性眩晕（BPPV）的应用价值。方法 回顾性分析36例原发性或继发性BPPV的临床资料,后半规管BPPV采用改良Epley手法或Semont手法复位,水平半规管采用Barbecue翻滚疗法复位治疗,评价其治疗效果。结果 33例后半规管BPPV患者应用改良Epley手法或Semont手法复位,有效率为93.9%。3例水平半规管BPPV患者采取Barbecue翻滚法复位后症状均明显改善。结论 手法复位治疗良性阵发性位置性眩晕方法简单,疗效可靠,治愈率高。     

良性阵发性位置性眩晕复位短期疗效不佳的分析

目的探讨短期内多次手法复位疗效不佳的良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的影响因素。方法回顾性分析2014年1月-2015年6月39例在本院耳鼻喉门诊首诊,2周以内经反复(3次以上)手法复位疗效不佳的BPPV患者其2周后的临床表现、治疗及随诊结果,探讨其影响因素。结果此类患者占同期全部BPPV患者的9.8%(39/396),其中,男15例,女24例,年龄26岁~81岁,平均63.0±14.5岁,60岁以上的28例,占71.8%。单侧后半规管BPPV 5例,单侧后半规管嵴顶BPPV 7例,单侧水平半规管BPPV 7例,单侧水平嵴顶BPPV 10例,上半规管BPPV 3例,混合型BPPV 7例。其中特发性的25例,继发性的14例(头部外伤7例,梅尼埃病2例,前庭神经炎1例,突发性耳聋1例,中耳炎1例,偏头痛2例)。所有患者均经过超过2周3次以上的手法复位,后半规管及后半规管壶腹嵴受累者采用Epley+Semont法,水平半规管及水平壶腹嵴顶受累者多采用Barbecue+Gufoni或Casani+强迫健侧卧位法,上半规管受累者采用Yacovino法进行复位,39例中28例结合Brandt-daroff体位训练及其药物辅助治疗。2周后-1个月内眩晕和变位性眼震能够完全缓解的19例,1个月后能够完全缓解的26例,2个月后和3个月后能够完全缓解的分别为31例和34例,随诊1年手法复位完全无效的5例,完全缓解的34例中1年内复发的21例(占61.8%)。结论 2周内经历多次手法复位疗效欠佳的BPPV患者多为60岁以上的老年患者,嵴顶结石、多管受累、头部外伤、梅尼埃病等内耳疾病是可能是其复位效果不佳的影响因素。此类患者一次手法复位难以成功,多数需要联合多种复位方法,结合体位训练和药物辅助治疗;个别患者手法复位完全无效;复位有效者,部分容易复发。     

李氏复位法治疗良性阵发性位置性眩晕的远期疗效分析

目的探讨良性阵发性位置性眩晕(BPPV)的临床特征,观察李氏复位法治疗BPPV的远期疗效。方法回顾分析2009年7月至2014年4月诊治的258例行李氏手法复位的单半规管BPPV患者的临床特征,并根据受累半规管的情况行李氏手法复位治疗,观察并分析远期疗效。本组资料中,后半规管BPPV72例(27.9%),水平半规管BPPV120例(46.5%),"上半规管"BPPV66例(25.6%)。结果 258例患者随访1周后痊愈196例(76.0%),有效45例(17.4%),无效17例(6.6%),总有效241例(93.4%);随访3月后痊愈209例(81.0%),有效15例(5.8%),无效15例(5.8%),复发19例(7.4%),总有效224例(86.8%)。其中经1次李氏手法复位后痊愈者163例(63.2%),有效80例(31.0%),无效15例(5.8%),1次复位总有效率为94.2%。各种类型半规管BPPV患者之间的远期总有效率无统计学差异。结论应用李氏手法复位法对BPPV患者进行治疗,疗效确切,且不需要判断眼震的有无及方向,操作简洁,过程迅速,可在临床应用。     

165例良性阵发性位置性眩晕患者管石复位治疗疗效观察

目的评估BPPV患者管石复位治疗短期和长期疗效。方法回顾分析了后半规管和上半规管BPPV患者165例，男53例、女112例，年龄范围18岁至84岁（平均53岁），分为2组，手法复位治疗（治疗组）125例，非手法复位（对照组）40例。结果治疗组中，后半规管BPPV患者81例，上半规管BPPV患者31例，双侧后半规管BPPV13例。65岁以上老年BPPV患者41例。治疗结果分析．治疗组首次治愈83人（66．4％），其中后半规管BPPV60人（74．1％），上半规管BPPV14人（45．2％），双侧后半规管BPPV9人（69．2％），老年BPPV32人（78．0％）。对照组16人（40％）在一周后症状消失。在4个月至41个月的随访中，治疗组和对照组治愈率分别为92％和82．5％。有30人（24％）在随访中复发。有2例病史超过40个月的患者，手法复位治疗无效而进行后半规管阻塞术。结论手法复位治疗BPPV患者是一种非常有效的方法，它能有效的缩短病程，减轻患者痛苦，其方法简单、易行且费用低，可以在临床广泛使用。     

咳嗽对良性阵发性位置性眩晕手法复位疗效的影响

目的：分析患良性阵发性位置性眩晕（BPPV）的慢性咳嗽患者经手法复位治疗后的疗效,为BPPV的综合治疗及病因探索提供帮助。方法：分析2009—10—2012—12期间400例BPPV患者的治疗效果,包括观察患者的症状和行体位试验检查。结果：后半规管BPPV的一次治疗成功率为93．4％,水平半规管BPPV治疗成功率为83．0％。在400例BPPV患者中随访到372例,一次治疗成功的复诊患者中,有35例复位治疗好转后又出现阵发性眩晕发作,再次行手法复位仍取得良好效果。追问病史,有29例存在不同程度的咳嗽。控制咳嗽后再行手法复位治疗,眩晕症状消失,随访半年未再发作。结论：BPPV的发生机制可能与咳嗽所致的头部震动有关。     

多管受累的老年良性阵发性位置性眩晕的临床研究

目的探讨累及多个半规管的老年性良性阵发性位置性眩晕(Benign paroxysmal positional vertigo,BPPV)的临床特点和手法复位的治疗效果。方法回顾性分析2012年9月至2015年9月我院诊治的48例多管受累的老年良性阵发性位置性眩晕患者的临床资料并观察手法复位的疗效。结果多管受累的老年性BPPV患者占同期全部老年BPPV患者的21.7%(48/221)。Dix-Hallpike和(或)Roll试验中,两个或两个以上头位可诱发出相同或不同的眼震。对称性双侧半规管同时受累的BPPV患者17例(35.42%),其中16例患者双侧后半规管同时受累,1例患者双侧前半规管同时受累,3例(6.25%)患者诊断为后半规管并同侧前半规管BPPV,25例(52.08%)患者诊断为后半规管并同侧或对侧水平半规管BPPV,1例(2.08%)患者诊断为一侧前半规管合并同侧水平半规管BPPV,2例(4.17%)患者诊断为多个半规管同时受累。根据患者眼震持续时间其中43例(89.58%)诊断为管结石症,5例(10.42%)诊断为嵴顶结石症。全部患者根据受累半规管及耳石类型采用相应手法复位治疗,首次手法复位后有效率为68.75%,多次复位后总有效率为87.50%。结论多管受累的老年BPPV患者临床中比较常见,尤其以后半规管合并水平半规管的管结石症较为多见,手法复位治疗可取得较为满意的疗效,准确判断受累半规管及耳石类型是复位成功的关键。     

手法复位治疗良性阵发性位置性眩晕疗效观察

目的 探讨手法复位治疗良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的方法和效果.方法 根据受累半规管的不同,将对64 例明确诊断为BPPV的患者分为两组,后半规管BPPV(PC-BPPV)组61例,行改良Epley 方法治疗,水平半规管BPPV(HC-BPPV)组3例,行改良Semont方法治疗,7~10天后观察治疗效果.结果 61例PC- BBPV患者中,治愈56例(91.8%),有效3例(4.92%),无效2例(3.28%);3例HC-BPPV患者中治愈2例,有效1例.结论 应用Epley法和Semont法手法复位治疗PC-BPPV和HC-BPPV方法简单,安全可靠,疗效肯定.     

Brandt-Daroff康复练习对半规管良性阵发性位置性眩晕患者的疗效

目的探讨Brandt-Daroff康复练习对半规管良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者的疗效。方法选取2016年9月~2018年3月就诊于我院的60例半规管BPPV患者,根据随机数字表法将其分为观察组和对照组各30例,对照组采取手法复位进行治疗,观察组在其基础上行Brandt-Daroff康复练习,连续治疗1个月并随访半年。治疗前后采用眩晕障碍评分量表(dizziness handicap inventory,DHI),不良反应发生率、半年复发率,比较两组临床疗效。结果与对照组比较,观察组临床总有效率(93.33%)显著升高,差异有统计学意义(P<0.05);治疗后,两组DHI评分显著降低,且观察组降低幅度显著大于对照组,差异有统计学意义(P<0.05);两组在不良发生率的比较中差异无统计学意义(P>0.05);与对照组(20.00%)比较,观察组半年复发率(6.67%)显著降低,差异有统计学意义(P<0.05)。结论Brandt-Daroff康复练习不仅可有效提高半规管BPPV患者临床疗效,减轻其功能障碍,而且复发率低,安全性高,值得临床参考。     

Particulate Matter in the Posterior Semicircular Canal

The pathoetiology of benign paroxysmal positional vertigo (BPPV) is controversial. Particulate matter within the posterior semicircular canal has been identified intraoperatively in patients with BPPV but has also been reported in non-BPPV patients at the time of translabyrinthine surgery (Parnes LS, McClure JA. Free-floating endolymphatic particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 1992;102:988-92; Schuknecht HF, Ruby RRF. Cupulolithiasis. Adv Otorhinolaryngol 1973;20:434-43; Kveton JF, Kashgarian M. Particulate matter within the membranous labyrinth: pathologic or normal? Am J Otol 1994;15:173-6). The nature of the particulate matter remains unknown. The purpose of this study was to prospectively examine the posterior semicircular canal of patients with and without a clinical history of BPPV for the presence of particulate matter. Seventy-three patients without BPPV symptoms undergoing labyrinthine surgery (vestibular schwannoma excision or labyrinthectomy) and 26 patients with BPPV undergoing the posterior semicircular canal occlusion procedure were compared. Additionally, 70 archived temporal bones without a history of BPPV were examined microscopically for the presence of particulate matter within the lumen of the membranous labyrinth. No particles were observed intraoperatively in any of the 73 patients without a history of BPPV. Particulate matter was observed in 8 of 26 patients at the time of the posterior semicircular canal occlusion procedure for intractable BPPV. Of the 70 temporal bones examined, 31 did not show significant postmortem changes and also did not demonstrate cupulolithiasis or canalithiasis. Particulate matter from within the membranous posterior semicircular canal was removed from one patient at the time of posterior semicircular canal occlusion for intractable BPPV symptoms and was examined by scanning electron microscopy. The particulate matter appeared morphologically consistent with degenerating otoconia. These data show a statistically significant association between the presence of particles within the posterior semicircular canal in this study and the symptom complex of BPPV.     

Effectiveness of treatments for benign paroxysmal positional vertigo of the posterior canal.

OBJECTIVE: To determine which common, nonpharmacological, nonsurgical treatments are most effective for treatment of benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Prospective, randomized, sham-controlled. PATIENTS: Patients (n = 124) with BPPV of the posterior semicircular canal. SETTING: Tertiary care center. INTERVENTIONS: Random assignment to one of five groups: modified canalith repositioning maneuver (CRP), modified liberatory maneuver (LM), sham maneuver, Brandt and Daroff's exercise, and vertigo habituation exercises. Subjects received a standard educational lecture about BPPV and the purpose of the intervention. No vestibular-suppressant medication or special instructions for head positioning were used. Post-tests were given at 1 week after treatment and at approximately 3 months and 6 months later. MAIN OUTCOME MEASURES: Vertigo intensity and frequency. RESULTS: Multilevel analyses showed that vertigo decreased significantly after LM, CRP, and Brandt-Daroff exercise; those three groups did not differ significantly. The habituation group did not differ from sham, Brandt-Daroff, LM, or CRP groups. Changes in scores were maintained throughout the 6-month follow-up period. CONCLUSION: LM, CRP, and exercises are all effective interventions; patient education plus the sham maneuver, however, had some beneficial effect. These results support two possible mechanisms of BPPV: displaced otoconia and a neural mechanism affecting interpretation of semicircular canal signals.     

Benign Paroxysmal Positional Vertigo without nystagmus: diagnosis and treatment

Nystagmus tests to diagnose BPPV are still relevant in the clinical evaluation of BPPV. However, in everyday practice, there are cases of vertigo caused by head movements, which do not follow this sign in the Dix-Hallpike maneuver and the turn test.AimTo characterize BPPV without nystagmus and treatment for it.Materials and methodsA non-systematic review of diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) without nystagmus in the PubMed, SciELO, Cochrane, BIREME, LILACS and MEDLINE databases in the years between 2001 and 2009.ResultsWe found nine papers dealing with BPPV without nystagmus, whose diagnoses were based solely on clinical history and physical examination. The treatment of BPPV without nystagmus was made by Epley maneuvers, Sémont, modified releasing for posterior semicircular canal and Brandt-Daroff exercises.ConclusionFrom 50% to 97.1% of the patients with BPPV without nystagmus had symptom remission, while patients with BPPV with nystagmus with symptom remission ranged from 76% to 100%. These differences may not be significant, which points to the need for more studies on BPPV without nystagmus.     

Surgery of the posterior semicircular duct for the treatment of BPPV

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in the otolaryngology clinic. The liberatory maneuvers are the treatment of choice in this entity. In a low percentage of patients, about 5-10%, we found no response to the maneuvers. The occlusion of the posterior semicircular canal is offered for intractable cases. We report a case of woman with an intractable BPPV in which an occlusion of the posterior semicircular was done. We describe the indications, how to perform the surgery and the functional results of this technique.     

190例特发性良性阵发性位置性眩晕患者半规管功能分析

目的 分析特发性良性阵发性位置性眩晕(benign paroxysmal position vertigo,BPPV)患者半规管功能的特征,为患者的治疗提供进一步帮助.方法 选择本院2019年8月至2020年2月收治的单侧特发性BPPV患者190例,包括后半规管BPPV患者162例,水平半规管BPPV患者28例.行冷热...     

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.     

突发性聋伴发良性阵发性位置性眩晕的临床特点及疗效观察

目的　探讨突发性聋伴发良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的临床特点,观察其疗效。方法　观察2012年10月～2014年6月耳 鼻咽喉科收治的36例突发性聋伴发BPPV发病情况,并与同期原发性BPPV患者40例及突发性聋不伴眩晕患者40例进行疗效比较。结果　伴发BPPV的36例突发性聋患者,受累半规管均与突发性聋发病侧一致,其中水平半规管BPPV 6例,占16.7%（6/36）;后半规管BPPV 27例,占75.0%（27/36）;混合管BPPV 3例,占8.3%（3/36）。36例患者出现BPPV的时间均在突发性聋发病后数小时至数天（＜10天）发生。突发性聋伴发BPPV组1次治愈率明显低于原发性BPPV组,但两种治疗方法的总治愈率均为100%。不伴眩晕突发性聋组的痊愈率、显效率及有效率均高于伴发BPPV组。结论　伴发于突发性聋的BPPV以后半规管多见,与原发性BPPV经耳石复位治疗后均可取得较好疗效。而不伴眩晕的突发性聋其疗效优于伴发BPPV的突发性聋。     

Benign paroxysmal positioning vertigo: diagnosis and therapy using video-oculographic control

In this prospective study, 82 patients (40 males, 42 females, aged between 15 and 80 years) with benign paroxysmal positioning vertigo (BPPV) were treated with different positioning manoeuvres using video-oculographic control. The maximum age for females and males was 31 and 40 years respectively. After an interview about the special history related to vertigo imbalance symptoms and using video-oculographic control, we diagnosed 79 patients with BPPV of the posterior semicircular canal and 3 of the horizontal semicircular canal. The Dix-Hallpike and Cawthorne manoeuvres were used for the diagnosis of BPPV of the posterior semicircular canal and the McClure manoeuvre for the diagnosis of BPPV of the horizontal semicircular canal. 72% of the patients had an idiopathic BPPV and 12.2% were post-traumatic. 3.7% had BPPV after ear surgery and 2.4% were pregnant. 39 patients with posterior BPPV were treated with Semont's manoeuvre and 40 with Epley's. The 3 patients with horizontal BPPV were treated with Baloh's manoeuvre. More than half of the patients (52.5%) were free of symptoms after one session of Epley's manoeuvre and all of them after four sessions. 51.3% had no further symptoms after one session of Semont's manoeuvre and all of them after four sessions. These results, in agreement with the literature, show that the success rate of Semont's and Epley's manoeuvres is approximately the same. Video-oculographic control is helpful for the diagnosis and for the registration of the eye movements during the therapeutic manoeuvres.     

Non-ampullary plugging of the posterior semicircular canal for benign paroxysmal positional vertigo.

Benign paroxysmal positional vertigo (BPPV) is a common condition which is usually self-limiting. Surgical treatment is rarely required and for many years the mainstay of such treatment has been singular neurectomy (posterior ampullary nerve section). A new operation has recently been described for the treatment of BPPV involving occlusion of the posterior semicircular canal. We have performed this operation on five patients with intractable BPPV and report our results with follow up of between 12 and 36 months from operation. The excellent results of posterior semicircular canal occlusion which have been previously reported in the literature are confirmed by our experience. In our opinion the operation is a safe and effective alternative to singular neurectomy.