三维滚轮耳石复位系统及其临床应用

目的 观察三维滚轮耳石复位系统治疗良性阵发性位置性眩晕的临床效果.方法 回顾性分析40例后半规管和水平半规管良性阵发性位置性眩晕患者的临床资料,其中20例采用三维滚轮耳石复位系统进行复位治疗,20例采用手法复位治疗,对其疗效进行比较.结果 采用三维滚轮耳石复位系统治疗的患者中第1次治疗后有17例(85%)治愈,3例经过第2次治疗痊愈;采用手法复位的患者中第1次治疗后有16例(80%)治愈,4例经过第2次治疗痊愈.应用x2检验二者的差异没有统计学意义.结论 应用三维滚轮耳石复位系统治疗良性阵发性位置性眩晕临床效果可靠,弥补了手法复位的缺陷,效果直观,可重复性强.     

管石复位法治疗良性阵发性位置性眩晕

目的 探讨管石复位法治疗良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的效果与方法.方法 回顾分析了2006年4月至2010年3月间我院治疗的BPPV患者96例,其中男性34例,女性62例,年龄43～70岁(平均55.5岁),后半规管BPPV 78例,水平半规管BPPV 16例,同时合并同侧后、水平半规管BPPV 2例,分别采用Epley管石复位法、Barbecue翻滚疗法及Brandt-Daroff习服疗法治疗.结果 后半规管BPPV 78例,经用Epley管石复位法治疗1～3次眩晕消失;水平半规管BPPV 16例,14例采用Barbecue翻滚疗法治疗1～2次眩晕消失,2例复位4次仍有眩晕,考虑嵴顶结石症,改用Brandt-Daroff习服疗法治疗半月眩晕消失;2例同时合并同侧后、水平半规管BPPV患者各复位2次眩晕消失.结论 管石复位法治疗BPPV安全有效,可疑嵴顶结石症患者,改用Brandt-Daroff习服疗法治疗效果良好.     

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。     

耳石复位法治疗良性阵发性位置性眩晕疗效观察

目的观察耳石复位法治疗良性阵发性位置性眩晕(BPPV)的疗效。方法对100例BPPV患者行耳石复位法治疗,其中后上半规管型患者80例采用Epley复位法治疗,水平半规管型患者20例采用Barbecue翻滚法治疗,治疗2周后复查,观察治疗效果。结果 80例一次性治愈,10例经2～3次治愈,5例改善,5例无效,总有效率为95%(95/100)。结论 Epley法和Barbecue翻滚法治疗BPPV效果好,操作简单,适于推广。     

管石复位法治疗良性阵发性位置性眩晕的影响因素分析

目的观察管石复位法治疗良性阵发性位置性眩晕的长期效果，探讨影响治疗预后的相关因素。方法回顾性分析59例后半规管良性阵发性位置性眩晕患者治疗和随访结果．并对管石复位法治疗成功的良性阵发性位置性眩晕患者进行多因素COX回归分析。结果59例患者中有54例（91．5％）治愈。治愈的54例患者在随访中有21例（38．9％）复发，其中有10例患者伴有半规管轻瘫。对患者的性别、年龄、发病时间、病因、半规管功能等指标进行多因素分析，只有半规管轻瘫一项指标进入COX模型，说明半规管轻瘫是影响治疗预后的因素。结论半规管轻瘫是影响BPPV患者管石复位法治疗预后的影响因素。     

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。     

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.     

Epley法和Semont法治疗后半规管良性阵发性位置性眩晕的疗效比较

目的探讨采用Epley管石复位法和Semont管石解脱法治疗后半规管良性阵发性位置性眩晕的疗效。方法将100例确诊为原发性后半规管良性阵发性位置性眩晕的患者随机分为Epley法组和Semont法组,Epley法组给予Epley管石复位法治疗,Semont法组给予Semont管石解脱法治疗,统计治疗1周后的疗效,并随访6个月。结果 Epley法50例,治愈40例,有效3例,无效7例,6个月后复发6例;Semont法50例,治愈31例,有效13例,无效6例,6个月后复发7例。治愈率:Epley法为80%,Semont法为62%,两组比较差异有统计学意义(χ~2=3.93,P0.05);总有效率:Epley法为86%,Semont法为88%,两组比较差异无统计学意义(χ~2=0.019,P0.05);6个月后复发率:Epley法为12%,Semont法为14%,两组比较差异无统计学意义(χ~2=0.019,P0.05)。结论Epley法治疗后半规管BPPV的短期治愈率明显高于Semont法,Epley法应被视为后半规管BPPV的一线首选治疗方法。     

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。     

手法复位治疗良性阵发性位置性眩晕

目的回顾性分析60例良性阵发性位置性眩晕（BPPV）诊断和治疗方法,为提高BPPV疗效提供参考依据。方法60例患者（男34例,女26例）通过常规神经耳科学检查、Dix—Hallpike和滚转试验确诊为BPPV。40例在发病10天内就诊,6N在发病1月内就诊,10例在5月内就诊,4例在6月以上就诊。采用Semont摆动手法、Epley颗粒复位法和Barbecue翻滚疗法治疗。对治疗1次无效者间隔7天重复治疗,重复3次无效者采用其它方法治疗。完成冶疗后2周复查评定疗效。结果后半规管BPPV54例,22例采用Semont手法复位治疗,14例痊愈,4例改善,4例无效。4例无效改用Epley颗粒复位法。Epley颗粒复位法治疗36例,28例痊愈,4例改善,4例无效。6例外半规管BPPV采用Barbecue翻滚疗法治疗4例痊愈,2例无效。40例10天内就诊者治愈32例,8例改善。6例发病1月内就诊者治愈2例,改善4例。10例5月内就诊者4例痊愈,4例改善,2例无效。4例6月以上就诊者治疗3次均无效。46例治疗1次有效,4例患者治疗2次有效,4例患者治疗3次有效。结论手法复位治疗BPPV有效率高,BPPV治疗效果与发病至就诊时间相关。     

The 360-degree maneuver for treatment of benign positional vertigo.

OBJECTIVE: The purpose of this study was to determine whether rotating a patient 360 degrees in the plane of the posterior semicircular canal is effective in treating classic benign paroxysmal positional vertigo. The study also compares the features of the Epley maneuver and the Semont maneuver and correlates them to the 360-degree maneuver. STUDY DESIGN: A prospective analysis of 31 patients presenting with benign paroxysmal positional vertigo who were treated using the multiaxial positioning device. A questionnaire was administered immediately after each treatment. SETTING: The study was carried out in a private practice referral clinic for benign paroxysmal positional vertigo. PATIENTS: Subjects consisted of 31 adults who ranged in age from 44 to 95 years. INTERVENTION: Thirty-one patients were treated using the 360-degree maneuver. A multiaxial positioning device was used to rotate patients completely upside down and back into the starting position in the proper plane. MAIN OUTCOME MEASURES: Subjective improvement scores, tolerability, objective nystagmus observations, and complications were recorded. RESULTS: Subjective improvement rates were 90% after one treatment; 97% were symptom-free and nystagmus-free after a maximum of three treatment sessions. Eighty-seven percent found the procedure quite tolerable from an ergonomic standpoint. CONCLUSION: The 360-degree maneuver can be effective in treating benign paroxysmal positional vertigo. Its rate of success is comparable to the rate of success of the standard Epley maneuver. On analysis, it is strikingly similar to the Epley and Semont maneuvers.     

Persistent vertigo following particle repositioning maneuvers: an analysis of causes

OBJECTIVE: To analyze the causes of persistent vertigo following treatment with particle repositioning maneuvers (PRMs) in patients with benign paroxysmal positional vertigo. DESIGN: Prospective study of outcomes in patients with benign paroxysmal positional vertigo. STUDY SETTING: Outpatient clinic of a tertiary care referral center. PATIENTS: A sample of 90 consecutive patients with documented benign paroxysmal positional vertigo of the posterior semicircular canal who had persistent vertigo after at least 3 sessions of PRMs during a period of 2 weeks. INTERVENTION: Particle repositioning using a modified Epley maneuver. MAIN OUTCOME MEASURE: Persistent vertigo following at least 3 sessions of PRMs over a period of 2 weeks. RESULTS: Seven patients showed partial or no improvement following treatment. The causes subsequently determined included coincident horizontal canal positional vertigo (2 cases), Ménière's disease (2 cases), persistent posterior canal benign paroxysmal positional vertigo in association with cervical spondylosis (2 cases), and a posterior fossa meningioma (1 case). CONCLUSIONS: Patients with persistent or frequently recurring positional vertigo following treatment with PRMs should undergo detailed investigation to exclude coincidental pathology for which specific treatment is required. In patients in whom no coincident pathology requiring therapy is identified, treatment options other than the PRM already instituted should be considered.     

继发性后半规管良性阵发性位置性眩晕的诊治

目的 探讨继发性良性阵发性位置性眩晕(BPPV)的诊断和治疗。方法研究继发性后半规管BPPV的内耳疾病6例病历资料,诊断依据为病史及Dix-Hallpike试验诱导出现的眼震结果。结果 6例内耳疾病(分别为突发性聋3例, 梅尼埃病2例, 前庭神经元炎1例)伴有后半规管良性阵发性位置性眩晕被确诊,通过Dix-Hallpike试验诱发出垂直扭转型眼震。结论 继发性BPPV临床较少见,常为后半规管受累,通过Dix-Hallpike试验和Epley手法复位可以确诊和治愈。     

氟桂利嗪联合手法复位治疗后半规管原发性良性阵发性位置性眩晕的临床疗效观察

目的探讨氟桂利嗪联合手法复位治疗后半规管原发性良性阵发性位置性眩晕(posterior semicircular canal benign paroxysman positional vertigo,PC-BPPV)的治疗效果。方法对96例原发性PC-BPPV患者随机分为单纯手法治疗(Epley管石复位法)与联合氟桂利嗪进行治疗,观察治疗效果。结果经1次手法复位治疗后症状消失或明显减轻,一次治愈率两组基本相同。治疗4wk后,治疗组的治愈率为高于对照组(P<0.05)。随访3个月,共计有8例患者复发,总复发率为9.6%,其中治疗组为2.2%,对照组为18.4%。结论 Epley手法复位联合氟桂利嗪治疗PC-BPPV疗效显著,复发率低。     

Efficacy of treatments for posterior canal benign paroxysmal positional vertigo

OBJECTIVE: This study was performed to determine the relative effectiveness of several passive head maneuvers for treating benign paroxysmal positional vertigo. STUDY DESIGN: This prospective study used 87 subjects diagnosed by their physicians with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal. METHODS: Subjects were randomly assigned to three treatment groups: modified Epley maneuver, modified Epley maneuver with augmented head rotations, and modified Semont maneuver. They were interviewed 1 week after receiving one maneuver. If subjects desired further treatment, they were treated again with the same maneuver, a methodology repeated until subjects desired no further treatment; they were telephoned 3 and 6 months after the last treatment. RESULTS: The groups did not differ significantly, but subjects decreased significantly on vertigo intensity and frequency and improved significantly on independence in activities of daily living. Before treatment, tasks requiring pitch rotations of the head induced vertigo; common comorbid conditions were osteoporosis, cervical spine problems, and head trauma. CONCLUSIONS: These data suggest that augmented head rotations are unnecessary and that the modified Epley and Semont maneuvers are equally effective in the remediation of vertigo in this population.     

Epley加Semont联合手法复位治疗后半规管良性阵发性位置性眩晕

目的 探讨Epley与Semont联合手法复位治疗后半规管良性阵发性位置性眩晕(posterior semicircular canal benign paroxysman positional vertigo,PC-BPPV)的治疗效果.方法 对48例PC-BPPV患者随机分为单纯手法治疗(Epley管石复位法)与联合手法治疗(Epley加Semont联合复位法),观察治疗效果.结果 48例经1次手法复位治疗后症状消失或明显减轻,一次治疗有效率为83.3%,其中单纯组为78.3%,联合组为88.0%.无效患者继续重复相应手法治疗,至第三次复诊时统计总治疗有效率为93.8%,其中单纯组为91.3%,联合组为96.0%.随访3个月,共计有7例患者复发,总复发率为14.6%,其中单纯组为21.7%,联合组为8.0%.结论 Epley加Semont联合手法复位治疗PC-BPPV疗效显著,复发率低.     

Treatment variations on the Epley maneuver for benign paroxysmal positional vertigo

PURPOSE: To determine if using more head rotation during the Epley maneuver or specific posttreatment instructions for sleeping position would affect treatment effectiveness, compared with the usual maneuver without extra instructions. MATERIALS AND METHODS: Patients with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal were randomized to a standard Epley maneuver group, a group that received an additional 45 degrees head rotation during the maneuver (Augmented Epley), and a group that received instructions about sleeping position after treatment. RESULTS: Posttests from 1 week to 6 months showed no differences in vertigo intensity or frequency or responses to the Dix-Hallpike maneuver. All groups showed significant decreases in vertigo and Dix-Hallpike responses. Some subjects in each group had abnormal pretreatment scores on computerized dynamic posturography. Those subjects in the Augmented Epley group who had abnormal pretreatment posturography scores had significantly better posttreatment scores than those subjects in the Home Instruction group who had abnormal pretreatment scores. All subjects with abnormal responses, however, showed improvement. CONCLUSIONS: Although clinicians continue to give patients home instructions and to use additional head rotation during the maneuver, these variations are not essential for achieving improvement in symptoms.     

Benign positional paroxysmal vertigo in the general ear, nose, and throat clinic

Benign positional paroxysmal vertigo is a common disease which may be caused by abnormal movement of utricular debris in the posterior semicircular canal. It is diagnosed by the Dix-Hallpike positional maneuver eliciting vertigo and nystagmus. Treatment generally consists of physical exercises with the Epley or Semont maneuvers. We review 43 consecutive patients diagnosed as BPPV in the last year and treated with physical therapy (Epley maneuvers). Results were very good, with a cure rate of 88.37% (53.5% after a single maneuver). Physical therapy is an effective treatment for BPPV.