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。     

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。     

红外视频眼震检查在良性阵发性位置性眩晕诊断的应用

目的探讨眼震视图(VNG)应用于诊断良性阵发性位置性眩晕(BPPV)的价值。方法对50例拟诊BPPV患者,在视频眼动观察记录下完成DIX_Hallpike变位及ROLL滚转试验,判别受累半规管并采取相应手法复位。结果 (1)依据眼震特点和方向判断受累半规管[1]:后半规管(PSC-BPPV)39例,占78%;水平半规管(HSC-BPPV)6例,占12%;前半规管(ASC-BPPV)1例,占2%;2个或2个以上半规管同时受累及4例,占8%;(2)以此为基础选择适当的手法进行复位治疗,1周后随访疗效:痊愈43例,有效6例,无效1例,总有效率98%。结论眼震视图对BPPV患者眼震情况的客观记录,提高了受累半规管的准确判别率,对于良性阵发性位置性眩晕诊断可以提供一种更为客观、精确的方法。     

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。     

红外视频采集仪记录BPPV患者眼震的结果分析

目的探讨用红外视频眼动采集仪(CHARTR VNG)观察记录良性阵发性位置性眩晕(benign paroxys-mal positional vertigo,BPPV)患者的眼震特点。方法用红外视频采集仪详细记录78例BPPV患者在Dix-Hallpike试验及滚转试验中的眼震变化。结果40例(51.28%)为一侧后半规管病变;13例(16.67%)为一侧水平半规管病变;6例(7.7%)为一侧上半规管病变;19例(24.36%)出现多发位置性眼震,其中6例为双侧后半规管病变,2例双侧上半规管病变,3例为双侧水平半规管病变,8例患者在不同头位下出现眼震,提示混合半规管病变。结论红外视频眼动采集仪可以更直观地观察眼动变化,对诊断BPPV受累半规管提供可靠依据,特别是对非典型位置性的眼震,能更好的提示良性阵发性位置性眩晕患者非典型位置性的眼震发生率,包括水平半规管、上半规管病变和多个半规管联合病变。患者的治疗可以根据不同的受累半规管采取不同方法。     

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诊治分析

目的回顾性分析我科诊治的良性阵发性位置性眩晕(BPPV)患者,分析发病因素及治疗方式,旨在协助临床医生提高精准诊治。方法以眩晕问卷形式收集2010年6月-2016年11月接诊1200例BPPV患者,分别采用Epley复位法、Barbecue复位法、Semont复位法及Brandt-Daroff习服法,药物与心理辅助治疗。分析发病原因、临床特征、治疗方式。结果 1200例BPPV患者中,女性多见,男女比例为1:2.2;60-70岁年龄段发病多;症状仅表现为体位发作性眩晕,无基础病和合并症者多;诊断分型后半规管BPPV1012例(84.33%)、水平半规管BPPV162(13.50%)、上半规管BPPV0例(0.00%)、多个半规管BPPV26例(2.17%);耳石复位是首选治疗方法,首次复位有效率为88%。结论详细收集病史及临床特征,综合评估做出正确诊断,给予个性化治疗是有效治疗BPPV的关键。     

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.     

继发于突发性聋的良性阵发性位置性眩晕的诊治分析

目的回顾性分析继发于突发性聋的良性阵发性位置性眩晕(BPPV)的临床特征与诊治效果。方法回顾性分析2011年1月~2017年1月在我科诊疗的30例继发于突发性聋的良性阵发性位置性眩晕病例资料。结果在30例突发性聋合并BPPV患者中,女19例,男11例;年龄16~83岁,平均52岁;听力曲线呈全聋型、平坦型和中频下降型者分别有23例、5例和2例;BPPV中后半规管BPPV占25例,水平半规管BPPV 4例,多半规管BPPV 1例;突聋与BPPV多发生于同一侧(29例)。手法复位治疗后2周和1个月其总有效率分别为60%和73%。结论突发性聋合并BPPV患者其耳聋多呈全聋型,BPPV多为累及后半规管者,突聋与BPPV多发生于同一侧,通过手法复位治疗多数BPPV可获缓解,但其疗效不及原发性BPPV。     

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.     

咽喉部血管瘤的治疗

目的探讨咽喉部血管瘤的治疗方法及远期疗效.方法回顾分析1988年4月至2001年2月咽喉部血管瘤32例的治疗过程.结果随访1年以上,治愈率为87.5%(28/32,好转率为9.4%(3/32),无效率为3.1%(1/32),复发率为6.3%(2/32),经激光再次治疗后痊愈.结论激光或硬化剂注射是治疗咽喉部血管瘤首选方法,激光治疗出血或激光难以彻底切除者,应采用手术切除.     

面神经瘤的诊断与治疗

目的探讨面神经瘤的临床表现、早期诊断和治疗,为面神经瘤的早期诊断和治疗提供临床经验。方法采用回顾性方法,对6例面神经瘤的诊断和治疗过程进行分析。面神经瘤的手术入路为,颅中窝—乳突径路1例,乳突径路4例,乳突腮腺联合径路1例。3例面神经瘤切除后同期进行耳大神经移植。结果面神经瘤完全切除6例,术后随访一年,6例均无复发,病理检查面神经鞘膜瘤5例,面神经纤维瘤1例。面神经功能恢复House-Brackmann评级:Ⅱ级1例,Ⅲ级2例,Ⅳ级2例,Ⅵ级1例。结论虽然面神经瘤的发生率低,但是只要了解其临床特点,加以重视并借助影像学手段,可以早期诊断,早期治疗,提高疗效。对于面神经瘤的治疗根据不同情况可考虑不同径路摘除肿瘤并行面神经重建手术。     

Treatment of cholesteatoma and retraction pockets

Summary Treatment of retraction pockets (RP) and cholesteatomas depends on their nature and evolvement and the size of mastoid pneumatization. RP are secondary to vacillating middle ear negative pressure. Treatment when necessary consists of placing a ventilating tube, excision of the RP or both. In most children and adults, cholesteatoma is derived from RP (or atelectasis) of the tympanic membrane, where it can be termed retraction pocket cholesteatoma or secondary cholesteatoma. This type of cholesteatoma is associated with a non-pneumatized mastoid coupled by negative pressure. Approximately one-third of children's cholesteatomas present clinically behind an intact drum despite a pneumatized mastoid. Pathogenetically this type may be congenital or metaplastic and should be best termed primary cholesteatoma. Central perforations associated with cholesteatoma are probably derived from continuous tympanic membrane destruction by infection in cases of RP cholesteatomas or due to a primary cholesteatoma bursting out from the tympanic cavity. Canal-up surgery of cholesteatoma fails in 60% of cases at Tel Aviv University because of the inherent tendency of the tympanic membrane to retract once again. Residual disease was found in our cases to be a lesser cause for failure. Treatment depends on the type of cholesteatoma, emphasizing small radicals in sclerotic mastoids. When a pneumatized mastoid is encountered, a posterior tympanotomy should be considered.Presented at the Fourth International Conference on Cholesteatoma and Mastoid Surgery, Nigata, Japan; September 1992     

Treatment of secretory otitis and pneumatization

In 33 children, median age 4 years, with bilateral secretory otitis, adenoidectomy was performed, a grommet was inserted in the right ear, and paracentesis was done on the left side. Seven years postoperatively x-rays were taken of the children's mastoid cell systems and these were measured by planimetry. A significantly larger cell system was found on the side with grommets, which is considered to support the environmental theory of pneumatization.     

Treatment and development of thyroid carcinoma

Reporting the results of a retrospective study on 101 cases of carcinoma of the thyroid gland, treated in our Service between 1979 and 1998. Analysis of the several anatomopathological variables found, the surgical treatment and also with radioactive isotopes, the complications and the condition evolution. Epidemiologically 82 percent of patients were women and men the 18 percent. Middle age 51 years. 12 percent of patients had familiar antecedents of thyroid pathology. The histological types found were: papillary carcinoma (74.26%), follicular carcinoma (14.85%), Hürthle's cellules carcinoma (3.96%) and anaplastic carcinoma (2.97%). In our Service elective treatment of thyroid gland carcinoma is total thyroidectomy with neck dissection in 18.3 percent of affected. The survival rate amount for 81.3 percent at five years. The aim of this article is to display the therapeutics and evolution of thyroid gland cancer, based in our own 18 years of experience acquired in the Service.     

Treatment and rehabilitation in vestibular neuritis

During the acute phase, symptomatic treatment is practically the only option, and a wide variety of drugs are available. For years, much has been focused on the possibility of using corticosteroids in the treatment of vestibular neuritis. Clearly, if we suspect an inflammatory cause, a treatment that reduces that inflammatory process would, if not reduce the severity of the attack, at least help recovery. If the different studies on this matter failed to concord in many aspects, they do however agree that the use of corticosteroids in the acute phase entails long term beneficial effects for the recovery of vestibular function and allows for a better vestibular compensation. The second part of the treatment is the rehabilitation. In my experience most of the patients undergo a spontaneous vestibular compensation in a short time. Nevertheless, some exercises of visual fixation while the patient is still bed-ridden, can accelerate the recovery process. Those patients, in whom certain instability persists, who are too anxious after their experience or those who will demand this type of treatment, are candidates to undergo a rehabilitative vestibular program. In this paper I will comment on the instrumental and non-instrumental techniques that I use in my daily practice.