眩晕疾病的手术治疗

眩晕症是常见的临床综合征,随着生活节奏的加快和人口老龄化的到来,本病发病率日益增高。引起眩晕的病因很多,大多数眩晕属于前庭外周性眩晕。     

良性阵发性位置性眩晕发病率及发病机制新进展

良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)作为周围性眩晕发病率最高的病种已为越来越多的临床医生所熟悉,本文将BPPV的发病率及发病机制最新研究进展予以综述。     

儿童青少年良性阵发性位置性眩晕研究进展

良性阵发性位置性眩晕（Benign Paroxysmal Positional Vertigo,BPPV）是一种体位变化诱发反复发作性眩晕为临床特点的常见外周前庭疾病,其发病率随年龄增长而增加,既往认为BPPV在儿童青少年眩晕中少见而未被引起足够重视。然而,随着对儿童青少年BPPV的不断深入认识以及儿童眩晕检测技术的飞速发展,BPPV在儿童青少年眩晕患者中的诊断率呈上升趋势,BPPV逐渐被认为是导致儿童青少年眩晕的一种常见疾病而愈发引起关注。研究表明儿童青少年BPPV在流行病学、临床发病特点、诊断及治疗等方面均呈现出有异于成人BPPV的独特特点,因此本文对儿童青少年BPPV的相关研究进展进行综述。     

耳鼻喉科眩晕住院病例199例诊疗体会

目的总结耳鼻喉科住院眩晕病例的疾病构成,并对诊疗措施进行研究。方法回顾性分析2018年9月至2020年3月京东中美医院耳鼻喉科住院治疗的眩晕病例,分析其疾病构成,并对不同疾病的诊疗措施进行研究。结果 199例眩晕患者中前庭外周性眩晕比例最多,其中最多见的5大类眩晕病种为良性阵发性位置性眩晕、梅尼埃病、前庭神经炎、突发性耳聋伴眩晕及良性复发性眩晕,前庭中枢性眩晕中发病率最高的是前庭性偏头痛。不同病种治疗策略不同。结论眩晕通常采取综合治疗,多数主要采用药物治疗,物理治疗也是某些眩晕疾病的有效手段。另外,外科手术也是治疗眩晕疾病的手段之一。     

外半规管良性阵发性位置性眩晕诊断和治疗

良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）是能引起位置性眩晕的内耳疾病中最常见的一种。外半规管BPPV（horizontal canal BPPV,HC-BPPV）是第二常见的BPPV类型,其发病机制复杂,实际发病率常被低估,自1985年首次报道以来,诊断和治疗方面取得了显著成果。本文就HC-BPPV的病因、发病机制、诊断和治疗研究进展做一综述。     

强化良性阵发性位置性眩晕和梅尼埃病诊疗指南的临床指导

眩晕是普通人群常见的症状,1年患病率为5％,成年人发病率为1.4％[1].眩晕症状是临床医师每天都可能面对的普遍问题,准确的鉴别、合理的治疗是控制眩晕性疾病反复发作的核心环节.为规范临床医师工作习惯和工作流程并获得优良的诊疗结果,国内外耳鼻咽喉头颈外科学会和神经科学会制定了一系列临床指南,其中良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)作为外周性眩晕疾病的典型代表是目前最受关注的焦点;同样由于梅尼埃病(Ménière's disease,MD)发病机制不清、诊断困难等特点也引起各国科学家的更多关注和研究.     

儿童良性阵发性位置性眩晕1例

<正>良性阵发性位置性眩晕(Benign paroxysmal positionai vertigo,BPPV),是成人最常见的前庭性眩晕疾病,占前庭性眩晕患者的20-30%,其高发年龄为40岁以上,且发病率随年龄增长呈上升趋势,但在儿童眩晕性疾病中较为少见^[1,2]。本文报道1例儿童BPPV,以进一步加强对儿童BPPV的认识。     

169例急性前庭性眩晕的临床研究

目的了解各种急性前庭病(眩晕)的发病情况,重点鉴别急性单发性眩晕中的椎基底动脉供血不足导致的眩晕和偏头痛性眩晕。方法回顾分析169例各种急性前庭病(眩晕)的发病率,重点分析神经耳科学检查在急性单发性眩晕中因椎基底动脉供血不足导致的眩晕和偏头痛性眩晕的鉴别诊断中的作用。结果各种急性前庭病的发病率依次为:梅尼埃病、椎基底动脉供血不足、良性阵发性位置性眩晕、偏头痛伴眩晕、前庭神经炎、突聋伴眩晕和迟发性膜迷路积水、外淋巴漏。椎基底动脉供血不足导致的眩晕和偏头痛性眩晕在病史、神经耳科学检查方面有诸多不同。结论在临床上,椎基底动脉供血不足与偏头痛相关的急性前庭病的鉴别诊断可能是鉴别的重点。鉴别的方法目前主要依靠详细的病史、神经耳科学检查、易患因素的特点以及其它必要的辅助检查。椎基底动脉供血不足更多出现在中年以上,一般都有心-脑血管方面的异常;而偏头痛性眩晕的发病平均年龄明显早于前者,均有一项或几项下列现象:偏头痛家族史,运动敏感,声、光敏感。     

气象数据与耳鼻咽喉科眩晕门诊常见疾病的关系

目的:初步探索耳鼻咽喉科眩晕门诊常见疾病的发病率与气象数据的关系.方法:对2019年在山西医科大学第一医院眩晕门诊就诊的患者进行回顾性分析,并记录基本信息、发病日期及相关数据,同时记录12个月的气象数据.采用Spearman秩相关分析良性阵发性位置性眩晕(BPPV)、前庭性偏头痛(VM)、梅尼埃病(MD)各月发病数与气...     

150例眩晕患者临床分析

目的 探讨眩晕患者的病因、病变部位及前庭功能检测的特点.方法对2001～2002年我院门诊病房共计150例眩晕患者行纯音测听、声导抗、听性脑干反应（ABR）、耳蜗电图、眼震电图（ENG）、颅脑CT、颈部动脉多普勒超声检查等,并对结果进行分析.结果诊断为梅尼埃病30例,占20%,突发性聋伴眩晕19例,占12.7%,前庭神经炎4例,占2.7%,耳毒性药物中毒10例,占6.7%,良性阵发性位置性眩晕56例,占37.3%,听神经瘤1例,椎-基底动脉供血不足25例,占16.6%,脑供血不足5例,占3.3%.中枢性眩晕31例患者ENG显示眼辩障碍试验有过冲20例,自发性眼震18例,视动性眼震试验双侧不对称25例,视跟踪试验Ⅲ型曲线6例,双温试验轻瘫2例,麻痹15例.周围性眩晕119例患者ENG结果显示眼辩障碍试验有过冲42例,自发性眼震4例,视动性眼震34例,视跟踪试验Ⅰ型曲线80例,双温试验轻瘫42例.结论本组150例眩晕患者中,周围性眩晕发病率比中枢性高.周围性眩晕患者中纯音测听高频听力下降为主,ABR正常.中枢性眩晕患者中高刺激率听性脑干反应异常对听神经瘤有一定的诊断价值.中枢性眩晕患者双温试验异常率低,而周围性眩晕患者异常率偏高,说明迷路病变与周围件眩晕发病有关.     

Subjective benign paroxysmal positional vertigo in patients with osteoporosis or migraine

IntroductionSubjective benign paroxysmal positional vertigo is a form of benign paroxysmal positional vertigo in which during the diagnostic positional maneuvers patients only present vertigo symptoms with no nystagmus.ObjectiveTo study the characteristics of subjects with subjective benign paroxysmal positional vertigo.MethodsProspective multicenter case-control study. All patients presenting with vertigo in the Dix-Hallpike test that presented to the participating hospitals were included. The patients were separated into two groups depending on whether nystagmus was present or not. An Epley Maneuver of the affected side was performed. In the follow-up visit, patients were checked to see if nystagmus and vertigo were present. Both groups of patients were compared to assess the success rate of the Epley maneuver and also to compare the presence of 19 variables.Results259 patients were recruited, of which 64 belonged to the subjective group. Nystagmus was eliminated in 67.2% of the patients with benign paroxysmal positional vertigo. 89.1% of the patients with subjective benign paroxysmal positional vertigo remained unaffected by nystagmus, thus showing a significant difference (p = 0.001). Osteoporosis and migraine were the variables which reached the closest to the significance level. In those patients who were taking vestibular suppressors, the percentage of subjective benign paroxysmal positional vertigo was not significantly higher.ConclusionsSubjective benign paroxysmal positional vertigo should be treated using the Epley maneuver. More studies are needed to establish a relationship between osteoporosis, migraine and subjective benign paroxysmal positional vertigo. The use of vestibular suppressants does not affect the detection of nystagmus.     

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。     

Cerebellar vermis lesions and tumours of the fourth ventricle in patients with positional and positioning vertigo and nystagmus

Positional and positioning vertigo and nystagmus syndromes are usually due to peripheral vestibular dysfunction. The most common form is benign paroxysmal positioning. In this paper, we discuss more serious aetiologies in the differential diagnosis for patients presenting with a history suggestive of benign paroxysmal positioning vertigo. We draw attention to the diagnosis of cerebellar vermis lesions and tumours of the fourth ventricle by presenting two cases of patients with positional nystagmus of so called benign paroxysmal type. We review the literature on positional nystagmus, highlighting key findings on history and physical examination to aid in the correct diagnosis of benign paroxysmal positioning vertigo, and to differentiate it from the rare yet sinister central aetiologies that can present with positional vertigo of the benign positional type. This is with the aim to avoid over-investigating a common presentation without missing a serious diagnosis.     

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。     

Clinical characteristics of patients with multi-canal benign paroxysmal positional vertigo

IntroductionMulti-canal benign paroxysmal positional vertigo is considered to be a rare and controversial type in the new diagnostic guidelines of Bárány because the nystagmus is more complicated or atypical, which is worthy of further study.ObjectiveBased on the diagnostic criteria for multi-canal benign paroxysmal positional vertigo proposed by International Bárány Society, the study aimed to investigate the clinical characteristics, diagnosis and treatment of multi-canal benign paroxysmal positional vertigo.MethodsA total of 41 patients with multi-canal benign paroxysmal positional vertigo were included and diagnosed by Roll, Dix-Hallpike and straight head hanging tests. Manual reduction was performed according to the involvement of semicircular canals.ResultsAmong the 41 cases, 19 (46.3%) patients showed vertical up-beating nystagmus with or without torsional component and geotropic, apogeotropic horizontal nystagmus, and were diagnosed with posterior-horizontal canal. 11 (26.8%) patients showed vertical up-beating nystagmus with torsional component on one side and vertical down-beating nystagmus with or without torsional component on the other side during Dix-Hallpike test or straight head hanging test and were diagnosed with posterior-anterior canal benign paroxysmal positional vertigo 9 (26.8%) patients showed vertical down-beating nystagmus with or without torsional component and geotropic, apogeotropic horizontal nystagmus, and were diagnosed with anterior-horizontal canal 2 (4.9%) patients showed vertical geotropic torsional up-beating nystagmus on both sides and were diagnosed with bilateral posterior canal benign paroxysmal positional vertigo. High correlation between the sides with reduced vestibular function or hearing loss and the side affected by Multi-canal benign paroxysmal positional vertigo was revealed (contingency coefficient = 0.602, p = 0.010). During one-week follow up, nystagmus/vertigo has been significantly alleviated or disappeared in 87.8% (36/41) patients.ConclusionPosterior-horizontal canal benign paroxysmal positional vertigo was the most common type. Multi-canal benign paroxysmal positional vertigo involving anterior canal was also not uncommon. Caloric tests and pure tone audiometry may help in the determination of the affected side. Manual reduction was effective in most of Multi-canal benign paroxysmal positional vertigo patients.     

Extraocular muscle contraction as a tool for benign paroxysmal positional vertigo diagnosis

When diagnosing benign paroxysmal positional vertigo, extraocular muscle contraction and the nystagmus it causes, though recognized as an important indicator, is less commonly seen as a principal method of diagnosis. However, through determining the direction of resulting nystagmus during diagnostic tests such as the supine roll test and the Dix-Hallpike test, which semicircular canals are involved in individual cases of benign paroxysmal positional vertigo can be ascertained, in both cases involving only one semicircular canal or cases of multi-canal benign paroxysmal positional vertigo.     

Malignant paroxysmal positional vertigo

Objective

An insidious percentage of paroxysmal positional vertigo appears to be intractable with canalith repositioning maneuver and also is not self-limiting. This type of positional vertigo is sustained by the action of intracranial tumors that mimics the clinical aspects of benign paroxysmal positional vertigo.Aim of this study is to clarify the features of these forms of positional vertigo, which we indicate as malignant paroxysmal positional vertigo.

Methods

We retrospectively reviewed the clinical records of all the patients who presented with vertigo spells and were managed at our tertiary care referral centre over a three years period. Two hundred and eleven patients with diagnosis of positional paroxysmal vertigo were included in the final study.

Results

Seven patients were affected by intracranial tumors causing a positional vertigo and were classified as malignant paroxysmal positional vertigo patients after radiological and histological diagnosis. These patients were affected by an internal auditory canal mass alone or with extension in the cerebello pontine angle that mimicked a benign positional vertigo.

Conclusion

We can conclude that the clinician should keep in mind the differentiation between benign positional vertigo and malignant positional vertigo. When the patients with positional vertigo presents a strange behaviour of symptoms, nystagmus or response to the canalith repositioning maneuver a radiological investigation must be undertaken in every doubtful case.     

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.     

The test and treatment methods of benign paroxysmal positional vertigo and an addition to the management of vertigo due to the superior vestibular canal (BPPV-SC)

A review of the tests and treatment manoeuvres for benign paroxysmal positional vertigo of the posterior, horizontal and superior vestibular canals is presented. Additionally, a new way to test and treat positional vertigo of the superior vestibular canal is presented. In a prospective study, 57 out of 305 patients' visits are reported. They had residual symptoms and dizziness after the test and the treatment of benign paroxysmal positional vertigo of the horizontal canal (BPPV-HC) and posterior canal (PC). They were tested with a new test and treated with a new manoeuvre for superior canal benign paroxysmal positional vertigo (BPPV-SC). Results for vertigo in 53 patients were good; motion sickness and acrophobia disappeared. Reactive neck tension to BPPV was relieved. Older people were numerous among patients and their quality of life (QOL) improved.     

The test and treatment methods of benign paroxysmal positional vertigo and an addition to the management of vertigo due to the superior vestibular canal (BPPV‐SC)

A review of the tests and treatment manoeuvres for benign paroxysmal positional vertigo of the posterior, horizontal and superior vestibular canals is presented. Additionally, a new way to test and treat positional vertigo of the superior vestibular canal is presented. In a prospective study, 57 out of 305 patients' visits are reported. They had residual symptoms and dizziness after the test and the treatment of benign paroxysmal positional vertigo of the horizontal canal (BPPV‐HC) and posterior canal (PC). They were tested with a new test and treated with a new manoeuvre for superior canal benign paroxysmal positional vertigo (BPPV‐SC). Results for vertigo in 53 patients were good; motion sickness and acrophobia disappeared. Reactive neck tension to BPPV was relieved. Older people were numerous among patients and their quality of life (QOL) improved.