眩晕症患者跌倒发作的病因分析

目的分析眩晕症患者跌倒发作的病因,为临床诊疗提供借鉴。方法回顾性分析眩晕门诊10年内跌倒发作的眩晕症的病因分布,年龄趋势及就诊规律。结果眩晕症患者跌倒发作共35例,梅尼埃病耳石危象16例,无一在首次就诊时被问及;良性阵发性位置性眩晕跌倒发作7例;梅尼埃病与血管迷走神经性晕厥共患5例;继发于心源性晕厥后的BPPV 7例。随着年龄的增长,跌倒的发生率呈增长趋势。结论眩晕症患者跌倒发作的发生率被低估,病史采集不全是主要原因;难治性BPPV可能为晕厥后继发,诊疗过程需要关注患者心血管病史及相关检查;关注耳源性眩晕与晕厥的共患,进行及时正确的诊断与处理。     

老年人眩晕的病因分析

目的探讨老年人眩晕与脑血管缺血的关系.方法综合分析老年眩晕110例的ENG、TCD及眼底动脉硬化程度.结果110例中前庭功能减退占27.3%,ETⅡ型以上曲线占80.9%,OKN不对称占59.1%,TCD显示90%的患者脑血管缺血,眼底动脉硬化占97.3%,耳聋占88.2%.结论老年人眩晕不能以某一特定的诊断作为终结,应该多因素综合考虑老年人生理性退行性变.脑血管缺血性改变是引致老年人眩晕的重要因素.     

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.     

中老年眩晕患者病因及眼震电图

目的探讨中老年眩晕患者的致病原因及眼震电图特点。方法应用眼震电图(electronystagmography,ENG)结合听力学、影像学及其它检查方法对129例45～68岁的眩晕患者进行检查。结果129例患者中,病因为椎基底动脉供血不足(Vertebrobasilar insufficiency,VBI)者72例(55．8％);耳毒性药物中毒15例(11。6％);梅尼埃病(Meniere‘s disease)12例(9．3％);突发性耳聋7例(5．4％)：脑供血不足5例(3。9％);听神经瘤5例(3．9％);前庭神经元炎2例;良性位置性眩晕2例：后颅窝肿瘤1例;病因未明8例(6。2％)。结论中老年心脑血管疾病较多,常2～3种以上疾病并存,应注意鉴别,并采取综合治疗。在鉴别中枢性、外周性眩晕方面,病史的详尽分析,临床神经耳科学检查,影像学检查,包括纯音测听和脑干诱发电位(auditory brainstem response,ABR)在内的听力学检查以及ENG检查均具有重要作用。     

199例眩晕住院患者流行病学分析

目的探讨眩晕病例流行病学特点。方法回顾性分析2018年9月-2020年3月京东中美医院耳鼻咽喉头颈外科住院治疗的眩晕患者临床流行病学特点。结果共收治199例眩晕患者,其中男性80例(40.2%),女119例(59.8%);年龄11-80岁,平均(48.7±15.3)岁,60-69岁者所占比例最大(22.6%),其次为30-39岁(21.6%)和50-59 岁(20.1%)。眩晕病例中,前庭外周性眩晕162例(81.4%),包括良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)68例(34.2%)、梅尼埃病(Meniere disease,MD)27例(13.6%)、前庭神经炎(vestibular neuritis,VN)17例(8.5%)、突发性聋(sudden hearing loss,SHL)伴眩晕31例(15.6%)、良性复发性眩晕(benign recurrent vertigo,BRV)14例(7.0%)等;前庭中枢性眩晕18例(9.1%),包括前庭性偏头痛(vestibular migraine,VM)11例(5.5...     

锦屏县752例耳聋患者病因分析

目的　了解锦屏县耳聋发病情况。方法　对锦屏县 75 2例听力残疾人进行了耳聋病因问卷调查、纯音听阈测试 ,并对遗传性耳聋患者采用PCR扩增及限制酶切技术进行线粒体DNA15 5 5A -G点突变筛查。结果　在被调查人中侗、苗族患病比例为 1.35 :1,与当地居民中侗、苗族比例接近 (1.33 :1) ;0～ 14岁组听力残疾人数占被调查人数的 2 1.5 % ,明显高于 1987年全国残疾人抽样调查中 7.12 %的比例 ;个案调查中先天性耳聋占 36 % ,与我国主要大城市以后天性聋为主有较大差别 ;在 2 9例遗传性聋中发现三个家系 10例为mtDNA 12SrRNA 15 5 5A -G点突变家族 ;71例纯音测听者均有不同程度的残余听力。结论　该县耳聋患病情况与当地文化水平及卫生条件有关 ,其康复工作尚处于起步阶段 ,应引起社会的高度重视     

眩晕患者的血气分析

作者对１２１例眩晕患者在发作期向作了动脉血气分析。其中梅尼埃病３７例,中枢一外周疾病（包括颈性眩晕及椎基底动脉缺血患者）４７例,其它眩晕疾病３７例。观察指标为：碳酸氢盐（ＨＣＯ３）、碱储（ＢＥ）、ｐＨ、二氧化碳压力（ＰａＣＯ２）以及氧分压（ＰＯ２）。...     

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.     

Postural stability in patients with different durations of benign paroxysmal positional vertigo

Postural stability maintenance was investigated in patients with idiopathic benign paroxysmal positional vertigo of the posterior semicircular canal (BPPV-PSC) and compared to healthy subjects. To measure the postural stability during a quiet upright stance, we used static posturography in two conditions: with open and with closed eyes. The effect of the repositioning Epleys maneuver on the recovery of postural stability in patients with different durations of BPPV-PSC less than 60 days after the first attack of positioning vertigo (group I) and more than 60 days (group II) was examined. The investigation was made 1 h after the positive Dix-Hallpike test and 7 days after treatment with the Epley maneuver. Sway velocity (SV) and relative power spectrum (RPS) of the stabilograms were calculated to evaluate the postural stability for each subject and each experimental condition. We found a pronounced spectral density peak in the frequency range of 1.0–2.0 Hz and smaller spectral density in the range of 0.15–0.5 Hz compared to that in healthy subjects. Our results showed that the postural maintenance in BPPV-PSC patients depended on the disease duration. Patients with a duration of BPPV symptoms less than 60 days after the first attack demonstrated a high dependence on the visual input for postural stability. One week after the Epley maneuver, differences in the recovery of postural control in both groups of patients were also found. We assume that the disturbed otolith function together with the impaired dynamics of the semicircular canal generate a particular pattern of postural maintenance. The different degree of restoration of postural stability 1 week after the EM treatment in BPPV-PSC patients with different durations of the disease gives us reason to believe that after removing the otoconia from the semicircular canal, some stimulation of other sensory subsystems and adaptation mechanisms occur that lead to a new pattern of postural maintenance.     

Idiopathic benign paroxysmal positional vertigo with persistent vertigo/dizziness sensation is associated with latent canal paresis,endolymphatic hydrops,and osteoporosis

Objective

The aim of the present study was to examine the association of neuro-otological examination, blood test, and scoring questionnaire data with treatment-resistant intractability in idiopathic benign paroxysmal positional vertigo (BPPV) patients.

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.     

难治性眩晕的初步临床分析

目的当患者被诊断为难治性眩晕需要接受手术治疗或破坏性治疗时,医生应该对患者的诊断和治疗再次进行慎重的、充分的评估。方法对2006年12月至2011年6月在本科就诊诊断为难治性眩晕的病例进行回顾性分析,患者资料包括病史、听力学、前庭学和影像学检查。结果 78例患者拟诊为难治性良性阵发性位置性眩晕23例和拟诊为难治性梅尼埃病55例。其原因包括诱因未除17例(21.8%);诊断有误8例(10.2%)后被确诊为桥小脑角病变、第四脑室肿瘤、鼻窦炎、精神神经疾病;病情复杂合并其它疾病42例(54%),包括梅尼埃病合并BPPV、颈椎病、心血管疾病、脑血管疾病、先天畸形和精神神经科学疾病等;药物治疗不当2例(2.5%),手术治疗不当9例(11.5%)。结论诊断难治性眩晕需谨慎,避免误诊误治。     

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.     

突发性聋继发良性阵发性位置性眩晕的临床观察

目的了解继发于突发性聋的良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的发病情况并探讨其治疗策略。方法观察眩晕门诊及耳内科病房中心2004年1月-2010年1月收治的210例突发性聋患者（包括伴有眩晕的突发性聋）合并BPPV的发病情况,并与同期183例原发性BPPV相比较。结果本组突发性聋病例并发BPPV为19．0％（40／210）;40例患者均为高频感音神经性聋或平坦型感音神经性聋。本文40例继发于突发性聋的BPPV,出现时间均在突发性聋发病后t周内。继发性BPPV的手法复位效果与原发性BPPV相似,大多数都于1～2次就诊后治愈。结论突发性聋继发的BPPV是临床常见的现象;继发于突聋的BPPV与原发性BPPV都是以后半规管BPPV多见,并与原发性BPPV手法复位的疗效相似。     

Gait analysis in patients with vertigo

Summary Gait analysis utilizing foot switches and electromyography of antigravity muscles was performed on 31 patients with vertigo. Twenty-one cases had peripheral vestibular lesions (such as vestibular neuronitis, Meniere's disease, traumatic labyrinthitis, small acoustic neuroma), and 10 cases had central lesions (such as spinocerebellar degeneration, pontine glioma, cerebellar tumor and giant acoustic neuroma). Parameters employed for analysis included time from heel strike to forefoot strike (HA-I), time from heel off to forefoot off (HA-II) as well as durations of stance, swing and (initial) double supports (DS). Fourteen healthy adults served as controls. The overall incidence of abnormality was highest in HA-1, followed by stance and swing. The occurrence of abnormalities in stance, swing and DS was higher in the central lesion when compared with the group having peripheral lesions. The significance and usefulness of gait analysis for dizzy patients are discussed.     

Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo

A prospective cohort study was designed to evaluate the long-term outcome and health-related quality of life (HRQoL) in patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV) treated by the particle repositioning maneuver (PRM) in the outpatient clinic of a general community hospital. Fifty individuals with PC-BPPV were included, and 45 (90%) completed the study. The diagnosis was based on the history of short episodes of vertigo and a positional nystagmus during the Dix-Hallpike test (DHT). All patients were treated by a single PRM, and relapses were evaluated by DHT at 30, 180 and 360 days post-treatment; a new PRM was performed if the DHT was positive. The main outcome measures were: percentage of patients with a negative DHT after treatment, scores obtained on the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Dizziness Handicap Inventory Short Form (DHI-S) before and 30, 180 and 360 days post-treatment. The DHT was found negative in 80% (40/50) of individuals at 30 days. Ten, seven and five patients presented a positive DHT at 30, 180 and 360 days, respectively. Persistent BPPV was observed in 5% (2/50) of patients at 360 days, despite repeated PRM. Relapses (DH+ after successful PRM) were observed in 7.5% (3/50) at 180 days and 360 days. Both questionnaires showed a reliability Cronbachs alpha >0.7. The average standardized score for each SF-36 scale was compared with the reference population normative data, showing differences with norms for all scales except for vitality. After PRM, patients improved their scores with both instruments, indicating a restoration of HRQoL at 30 days. Physical dimension scores of the SF-36 improved from day 30 to 360. DHI-S scores were statistically better after PRM (P<0.001). Our results show that the effectiveness of PRM is 88% after 1 year of follow-up. Patients with BPPV experienced a decrease in HRQoL, which was restored after PRM. Although relapses were observed in 7.5% of individuals, they did not affect HRQoL.This study was presented at the Research Forum of the AAO-HNSF and the Association for Research in Otolaryngology (ARO) Annual Meeting held in Orlando, FL, on September, 23, 2003     

Differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV)

This article presents an approach to differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Such an approach is essential because of the difference in intervention between the two disorders in question. Results from evaluation of the case study presented here revealed a persistent ageotropic positional nystagmus consistent with MPV or a cupulolithiasis variant of HC-BPPV. The patient was treated with liberatory maneuvers to remove possible otoconial debris from the horizontal canal in an attempt, in turn, to provide further diagnostic information. There was no change in symptoms following treatment for HC-BPPV. This case was diagnosed subsequently as MPV, and the patient was referred for medical intervention. Treatment has been successful for 22 months. Incorporation of HC-BPPV treatment, therefore, may provide useful information in the differential diagnosis of MPV and the cupulolithiasis variant of HC-BPPV.