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。     

不同复位手法治疗后半规管良性阵发性位置性眩晕疗效及原因分析

目的　探讨不同复位手法治疗后半规管良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）疗效及原因。方法　回顾性分析我院2013年6月 ～2016年12月300例后半规管BPPV患者临床资料，按照患者治疗方法不同分为A组156例，施行Epley复位手法；B组144例，施行Semont管石解脱法。比较两组患者治疗效果、复发率并分析效果不佳的原因。结果　B组患者首次疗效、1周疗效及1个月疗效均明显好于A组（χ2=4.371、5.294及4.542，P 均＜0.05）；Semont管石解脱法治疗管结石症与嵴顶结石症疗效均较好，Epley管石复位法治疗嵴顶结石症疗效较差；两组复发率无明显差异（P＞0.05）。结论　Semont 管石解脱法治疗后半规管BPPV管结石症与嵴顶结石症疗效均较好，Epley管石复位法治疗嵴顶结石症疗效较差。两组BPPV复发率均较高。     

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.     

药物与耳石复位治疗后半规管良性阵发性位置性眩晕的疗效分析

目的：比较药物治疗、手法复位和耳石复位仪复位治疗后半规管良性阵发性位置性眩晕（PC －BP_PV ）的疗效。方法将2012年8月～2013年4月收治的168例PC －BPPV患者随机分为三组,每组各56例,分别为药物治疗组、手法复位组和耳石复位仪复位组,其中药物治疗组予甲磺酸倍他司汀12 mg、甲钴胺500 ug、维生素B110 mg口服,3次／d ,银杏叶提取物注射液25 ml（87．5 mg）静脉滴注,每日2次,疗程7 d;手法复位组使用Epley复位法治疗;耳石复位仪复位组采用全自动SRM －IV型前庭功能诊断治疗系统治疗。三组均于治疗后7、28 d时复查,比较其疗效。随访半年,比较手法复位和耳石复位仪复位的复发率。结果治疗7天后药物治疗组、手法复位组及仪器复位组的总有效率分别为35．72％（20／56）、89．29％（50／56）、92．85％（52／56）,治疗28天后三组总有效率分别为46．42％（26／56）、94．64％（53／56）、96．43％（54／56）,药物治疗组疗效明显低于其他两组（ P＜0．05）,手法复位组与复位仪复位组疗效差异无统计学意义（P＞0．05）。半年后随访,手法复位组和仪器复位组复发率分别为15．79％及19．05％,差异无统计学意义（P＞0．05）。结论手法复位及耳石复位仪治疗PC－BPPV患者的疗效相当,总有效率高,均可作为治疗PC－BPPV的首选方法。     

前庭康复训练联合药物治疗对良性阵发性位置性眩晕复位后残余症状的疗效分析

目的分析前庭康复训练联合药物治疗对良性阵发性位置性眩晕（BPPV）患者复位后残余症状的改善情况。方法选取2013年6月—2016年2月确诊为BPPV且行手法复位成功患者66例,根据随机数字表法,将患者平均分为药物组、前庭康复组和联合组,每组各22例。比较患者治疗前后的眩晕残障程度量表（DHI）和医院焦虑抑郁量表（HADS）评分情况;治疗结束后随访6个月,并记录各组患者复发率。结果治疗2、4、6周时,联合组DHI评分均明显低于前庭康复组和药物组,差异具有统计学意义（P＜0.05）。治疗6周后,联合组HADS T评分明显低于前庭康复组和药物组,差异均具有统计学意义（P均＜0.05）;联合组复发率低于药物组（χ2=3.511,P<0.05）和前庭康复组（χ2=2.387,P<0.05）,差异均具有统计学意义（P均<0.05）。结论对BPPV且行手法复位成功患者在药物治疗的同时辅以前庭康复训练,可有效改善BPPV患者的残余症状,并且降低了眩晕复发率,改善患者焦虑和抑郁状态,疗效显著。     

单纯手法复位与手法复位加敏使朗口服治疗良性阵发性位置性眩晕疗效分析

目的比较单纯手法复位和手法复位加口服抗眩晕药治疗后半规管良性阵发性位置性眩晕(PC-BPPV)的疗效。方法将2004年1月～2011年6月期间收治的236例BPPV患者随机分为两组,对照组112例采用单纯手法复位,治疗组124例在手法复位基础上加敏使朗口服,两组均于治疗后1周和3个月时复查,比较其疗效。结果治疗后1周时,对照组和治疗组的有效率分别为86.61%和89.52%,治疗后3个月时对照组有效率为92.86%(104/112),治疗组有效率为93.55%(116/124),两者比较差异均无统计学意义(P>0.05)。结论单纯手法复位法和手法复位加口服抗眩晕药物治疗BPPV疗效相当。     

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。     

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。     

摇头试验在水平半规管壶腹嵴帽结石症手法复位恢复周期的临床观察

目的探讨摇头试验对水平半规管壶腹嵴帽结石症（horizontal semicircular canal cupulolithiasis,HSC Cup）手法复位恢复周期的评估价值。方法对59例HSC Cup患者分别进行摇头试验，根据有无摇头眼震分为A组30例（无眼震）、B组29例（有眼震），两组以同样复位手法进行治疗。按照疗效分级标准对患者进行随访，记录分析两组患者的恢复周期，并分析影响患者恢复周期的因素。结果A组中28例在1 d内恢复，余下2例在1周内恢复，平均恢复周期为1.2 d；B组中16例在1 d内恢复，13例在2~4周内恢复,平均恢复周期为19 d。A组平均恢复周期明显短于B组，且摇头眼震的方向、摇头眼震幅度、摇头眼震持续时间、患者既往相关眩晕病史等因素均对恢复周期产生影响（P＜0.05），但性别、年龄不影响恢复周期。结论摇头试验可预测HSC Cup患者手法复位后的恢复周期，为后续治疗提供帮助。     

管石复位次数对良性阵发性位置性眩晕的疗效影响分析

目的：探讨管石复位术次数对良性阵发性位置性眩晕（BPPV）疗效的影响。方法对68例BPPV患者随机分为治疗组（34例）和对照组（34例）,治疗组每日行一次管石复位术,连续复位治疗3天,对照组仅行管石复位术治疗一次,两组患者在手法复位的基础上配合服用甲磺酸倍他司汀片、盐酸氟桂利嗪治疗。1周及3个月后进行疗效评定。结果治疗1周后治疗组治愈率为82．4％,对照组治愈率为58．8％,两组差异有统计学意义（P＜0．05）;治疗3个月后,治疗组治愈率为91．2％,对照组治愈率为85．3％,两组差异无统计学意义（P＞0．05）。结论在准确判断 BPPV 分型的基础上,采用多次手法复位术治疗并配合药物治疗,可提高 BPPV 的短期治愈率,缩短治愈时间。     

Repositioning intervals in the modified Epley’s maneuver and their effect on benign paroxysmal positional vertigo treatment outcome

Introduction: This study showed that short and long interval treatments achieved comparable success rates. There was no statistically significant difference in the rate of early and late recurrences between the two groups. Modified Epley maneuver can be applied in a short interval time with comparable success and recurrence rates which are as effective as in a long interval time.

Objective: The Epley maneuver is called the particle repositioning or canalith repositioning procedure. If a short time interval in each position is effective, it will allow for reduced time and avoid unnecessary physical burden. How long of a stay in each position is not determined in the literature. There is an absence of comparative studies of the BPPV repositioning time. The aim of this study is to compare the treatment time in patients with benign paroxysmal positional vertigo (BPPV).

Study design: Longitudinal prospective study.

Setting: Outpatient practice in a tertiary care facility.

Subjects and methods: Sixty consecutive patients with BPPV were included in this study. These patients were sequentially allocated to one of two groups (A or B). The interval times between each position in group A and B were 15 and 120?s, respectively. Modified Epley maneuver was performed in all patients. The maneuvers in both groups were exactly the same sequence of movements, except interval times.

Results: The mean age of the patients was 49.25 years (range =19–76 years). Of the 60 patients, 48 (80%) were women and 12 (20%) were men. Successful outcome was achieved in 26 patients (86.7%) after the first modified Epley maneuver in both groups. Three patients from each group (total six patients) responded to the third modified Epley maneuver and the remaining two patients did not respond to any modified Epley maneuver. Therefore, the Semont maneuver was applied with a successful result.     

Unintentional conversion of benign paroxysmal positional vertigo caused by repositioning procedures for canalithiasis: transitional BPPV

BPPV when diagnosed before any repositioning procedure is called primary BPPV. Primary BPPV canalithiasis treatment with repositioning procedures sometimes results in unintentional conversion of BPPV form: transitional BPPV. Objectives were to find transitional BPPV forms, how they influence relative rate of canal involvement and how to be treated. This study is a retrospective case review performed at an ambulatory, tertiary referral center. Participants were 189 consecutive BPPV patients. Main outcome measures were detection of transitional BPPV, outcome of repositioning procedures for transitional canalithiasis BPPV and spontaneous recovery for transitional cupulolithiasis BPPV. Canal distribution of primary BPPV was: posterior canal (Pc): 85.7 % (162/189), horizontal canal (Hc): 11.6 % (22/189), anterior canal (Ac): 2.6 % (5/189); taken together with transitional BPPV it was: Pc: 71.3 % (164/230), Hc: 26.5 % (61/230), Ac: 2.2 % (5/230). Transitional BPPV forms were: Hc canalithiasis 58 % (24/41), Hc cupulolithiasis 37 % (15/41) and common crux reentry 5 % (2/41). Treated with barbecue maneuver transitional Hc canalithiasis cases either resolved in 58 % (14/24) or transitioned further to transitional Hc cupulolithiasis in 42 % (10/24). In follow-up of transitional Hc cupulolithiasis we confirmed spontaneous recovery in 14/15 cases in less than 2 days. The most frequent transitional BPPV form was Hc canalithiasis so it raises importance of barbecue maneuver treatment. Second most frequent was transitional Hc cupulolithiasis which very quickly spontaneously recovers and does not require any intervention. The rarest found transitional BPPV form was common crux reentry which is treated by Canalith repositioning procedure. Transitional BPPV taken together with primary BPPV may decrease relative rate of Pc BPPV, considerably increase relative rate of Hc BPPV and negligibly influence relative rate of Ac BPPV. Transitional BPPV forms can be produced by repositioning maneuvers (transitional Hc cupulolithiasis) or by the subsequent controlling positional test (transitional Hc canalithiasis and common crux reentry); underlying mechanisms are discussed.     

The effect of postural restrictions in the treatment of benign paroxysmal positional vertigo

The treatment of benign paroxysmal positional vertigo (BPPV) consists of a repositioning maneuver in order to remove otoliths from the posterior semicircular canal and subsequent postural restrictions to prevent debris from reentering the canal. However, the extent to which postural restrictions affect the final outcomes of BPPV is still uncertain. The purpose of this study is to determine the effects of postural restrictions in the treatment of BPPV, which is caused by otoliths in the posterior semicircular canal, and to evaluate its usefulness as a therapy. Seventy cases diagnosed as BPPV of the posterior semicircular canal were studied. All patients were treated utilizing the modified Epley maneuver. They were divided into two groups. The first group (group A, 35 patients) was instructed to sleep in a semi-sitting position and to avoid moving their heads forward or backward, whereas no instructions were given to the second group (group B, 35 patients). The information gathered from the patients was analyzed by age of onset, gender, duration of the disease and cure rates or recurrence rates. In group A, the average age was 54.5 years and the mean duration of symptoms was 116.5 days, whereas in group B, these measurements were 54.8 years and 86.7 days. The cure rates were 91.4 and 94.3%, respectively. Symptoms recurred in 12.5% of group A patients, while in group B, there was a 9.1% recurrence rate. Our study did not show any significant difference between the two groups. Postural restriction therapy, practiced after the modified Epley repositioning maneuver, did not have a significant effect on the final outcomes of BPPV. Based on our results, we do not recommend this therapy since there was no significant benefit for the patients who utilized postural restrictions.     

不同类型良性阵发性位置性眩晕的诊断和治疗

目的探讨不同类型良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）的诊断和治疗方法。方法对我科2004年4月-2006年3月就诊的BPPV病人131例．应用红外线视频眼动记录分析变位试验诱发的眼震特点，进行分型、定侧，并采用相应的耳石复位技术治疗。结果（1）后半规管BPPV94例（71．8％），随机分组采用Epley管石复位法和Semont管石解脱法各47例。（2）水平半规管BPPV29例（22．1％），水平向地性眼震者16例，另13例为水平背地性眼震者，自行或采用Gufoni疗法后转换为水平向地性9例，方向不能转换4例。采用barbecue翻滚和／或强迫侧卧体位疗法。（3）前半规管BPPV6例（4．6％），采用Epley管石复位法。（4）混合型BPPV2例（1．5％），行上述相应半规管的疗法。1周后随访总有效率85．5％（112／131），3个月后92.4％（121／131）。结论BPPV的诊断和治疗应根据不同变位试验诱发的眼震特征判别不同半规管及不同发病机理类型，并选择合适的耳石复位技术治疗。     

颗粒复位法治疗后半规管良性阵发位置性眩晕

目的 评价颗粒复位法治疗良性阵发性位置性眩晕的效果。方法 对１９９６年７月－１９９８年６月间治疗的３１一半规管性良性性位置性眩晕患者进行回顾分析。地规管耳右症假说,患者接受１次颗粒复位法治疗。治疗结束２周后复查并评价疗效。结果 ２１例患者的眩晕和眼一立刻或在１－２周内逐渐消失。６例改善,４例无效。总有效率８７．１％。结论 颗粒复位法对大多数良性阵发性位置性眩晕患者有效,推荐作为治疗该的首选方法。     

Efficacy of BPPV diagnosis and treatment system for benign paroxysmal positional vertigo

ObjectivesTo evaluate the efficacy of automatic benign paroxysmal positional vertigo (BPPV) diagnosis and treatment system for BPPV compared with the manual repositioning group.MethodsTwo hundred thirty patients diagnosed as idiopathic BPPV who were admitted from August 2018 to July 2019 in Zhejiang Hospital were included. Among them, 150 patients of posterior semicircular canal BPPV(pc-BPPV), 53 patients of horizontal semicircular canal BPPV(hc-BPPV), and 27 patients of horizontal semicircular canal calculus (hc-BPPV-cu) were randomly treated with BPPV diagnosis and treatment system(the experimental group) or manual repositioning (the control group). Resolution of vertigo and nystagmus on the Dix-Hallpike and Roll test on day 3,day 7,day 14 and day 28 follow-up after first treatment was the main outcome measure to assess the efficacy of treatment.ResultsAt 3-day and 7-day follow-up after treatment with BPPV diagnosis and treatment system, 79%, 91%had complete resolution of vertigo and nystagmus, the effective rate in the experimental group were significantly higher than those in the control group, the differences were statistically significant(P < .05). On day 14, the effective rate in the experimental group (96%) was slightly higher than that in the control group(91%), but there was no significant difference between the two groups. And at 28-day after the first treatment, the effective rate was 100% in the experimental group and the control group. The repositioning efficiency of pc-BPPV (the first, second, third treatment), hc-BPPV (the first, second, third treatment), hc-BPPV-cu(the first, second treatment) in the experimental group were higher than the control group, and the secondary reposition of pc-BPPV in the experimental group was significantly higher than the control group(96%vs.84%; P < .05). While for the hc-BPPV-cu patients, the effective rate of the third treatment in the experimental group was slightly lower than that of the control group, but the differences were not statistically significant.ConclusionsBPPV diagnosis and treatment system is effective for the treatment of BPPV, with a better effective rate than those treated with manual maneuver, and is safe and easy to perform on patients.     

耳石复位法治疗良性阵发性位置性眩晕32例

目的 探讨耳石复位法治疗良性阵发性位置性眩晕（BPPV）的的效果。方法 应用Epley管石复位法、Semont管石解脱法及Barbecue翻滚法对良性阵发性位置性眩晕32例予以治疗。结果 32例中经耳石复位法治愈27例(84.4%)，有效 3例(9.4%)，复位失败2例(6.3%)，后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前庭功能训练可获得较好的疗效。     

318例良性阵发性位置性眩晕的诊治分析

目的:研究不同类型良性阵发性位置性眩晕(BPPV)的诊断、治疗及疗效。方法:回顾性分析318例BPPV患者的资料,根据变位试验诱发的眼震特点进行分型,并采用相应的耳石复位技术治疗,对治疗1次无效者间隔7d重复治疗,重复3次无效者采用Brandt-Daroff习服练习;完成治疗后随访观察总有效率。结果:①后半规管BPPV患者221例(69.5%),采用Epley管石复位法;②水平半规管BPPV患者62例(19.5%),采用Bar-becue翻滚加强迫侧卧体位疗法;③前半规管BPPV患者23例(7.2%),采用Epley管石复位法;④混合型BPPV患者12例(3.8%),采用Epley加Barbecue翻滚联合治疗。1周后随访总有效率为82.1%(261/318),3个月后随访总有效率为91.8%(292/318)。结论:结合病史,根据不同变位试验诱发的眼震特征对BPPV患者进行诊断并采用相应手法复位治疗是一种非常有效的方法,能有效缩短病程,减轻患者痛苦,可在临床广泛应用。     

Effectiveness of treatment techniques in 923 cases of benign paroxysmal positional vertigo

OBJECTIVE: To present treatment effectiveness of 923 consecutive cases of benign paroxysmal positional vertigo (BPPV) using canalith repositioning, liberatory, and log roll maneuvers combined with redistribution exercises. STUDY DESIGN: Retrospective case review. METHODS: Patients presented with either posterior semicircular canal (P-SCC) BPPV or horizontal semicircular canal (H-SCC) BPPV. Diagnosis was based on patient history of transient paroxysmal vertigo and a positive Dix-Hallpike response with either torsional or horizontal nystagmus. Patients with P-SCC BPPV numbered 840, and 83 patients had H-SCC BPPV. In the original study, there were 1,000 patients; however, 77 patients were dropped from the study because of lack of follow-through. Intervention was canalith repositioning, liberatory maneuvers, log roll maneuvers, and redistribution exercises. Patients numbering 607 were treated with canalith repositioning, 233 patients had liberatory maneuvers, and 83 received log roll maneuvers. All patients received redistribution exercises before treatment maneuvers. After intervention, patients were reassessed at 6 months. RESULTS: There were 601 women and 322 men from ages 12 to 94 (median 55) years. The average duration of symptoms before intervention was 30 months. Outcome measures were considered met when symptoms of BPPV had abated and patients demonstrated a negative Dix-Hallpike response. In the repositioning group, 94% of patients were symptom free or improved, 98% in the liberatory maneuver group and 100% in the log roll group. The average number of sessions was three for all groups. Recurrence of symptoms was demonstrated in 140 (16%) patients at 6 months. CONCLUSIONS: Treatment of BPPV can be effective using either repositioning, liberatory, or log roll maneuvers in combination with redistribution exercises.     

Delayed diagnosis and treatment of benign paroxysmal positional vertigo associated with current practice

The purposes of this study were to demonstrate the current status of benign paroxysmal positional vertigo (BPPV) management and the advantages of repositioning maneuvers as well as to facilitate the accurate and efficient diagnosis and management of BPPV. Of 131 participants with severe dizziness/vertigo who were examined and treated, 31 (23.7 %) fulfilled the diagnostic criteria for BPPV. All patients in the study had a diagnosis of BPPV confirmed by their history, typical subjective symptom reports, and characteristic positional nystagmus during the Dix–Hallpike test and/or roll test. All participants were comprehensively interviewed regarding their medical history, characteristics of the first attack of vertigo, associated symptoms, previous financial costs, and number of hospital visits. The average duration from the appearance of the first symptoms until a final diagnostic positional maneuver was >70 months. On average, patients visited hospitals more than eight times before the final diagnosis due to initial visits to inappropriate departments, including neurology, emergency, orthopaedic surgery, and Traditional Chinese Medicine, with a corresponding average financial cost of more than 5,000 RMB. The canalith repositioning procedure (CRP) was effective in 80.65 % of patients after the first repositioning maneuver. Our data demonstrated that despite the significant prevalence of BPPV, delays in diagnosis and treatment frequently occur, which have both cost and quality-of-life impacts on both patients and their caregivers. The CRP is very effective for patients with BPPV. It is important for patients to pay more attention to the impact of BPPV on their lives and recognize its nature to ensure compliant follow-up in otolaryngology.