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。     

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。     

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。     

甲磺酸倍他司汀对良性阵发性位置性眩晕位置试验眼震的影响CSCD

目的探讨甲磺酸倍他司汀对良性阵发性位置性眩晕(BPPV)位置试验眼震的影响。方法2022年1~6月就诊的头晕患者并且予BPPV位置试验检查,其中61例检查前24h内仅口服过甲磺酸倍他司汀治疗,199例检查前24h内口服其他药物或者多种药物联合治疗。观察其停药前、后BPPV位置试验眼震变化情况:检查前24h内有用药史者,先予第1次BPPV位置试验,记录眼震情况;若第1次位置试验为阴性,嘱其停药24h后再予第2次BPPV位置试验,记录眼震情况;若第1次位置试验为阳性,予手法复位治疗,1h后复查,若复位效果欠佳,嘱其停药24h后再予第2次BPPV位置试验,记录眼震情况。位置试验眼震均通过视频眼罩观察。结果检查前24h内仅口服过甲磺酸倍他司汀的患者中,第1次BPPV位置试验眼震阳性者占16.39%(10/61),停药24h后第2次BPPV位置试验眼震阳性者占49.02%(25/51),停药前、后BPPV位置试验眼震阳性率有显著统计学差异(x2=8.89,P=0.003)。第1次位置试验眼震阳性者中,有5例(50%)在停药24h后第2次位置试验中眼震强弱程度发生变化,导致定位患侧半规管发生变化:2例左水平半规管BPPV修正为右水平半规管BPPV;1例左水平半规管帽型BPPV修正为右水平半规管帽型BPPV;2例水平半规管帽型BPPV,从第1次位置试验无法根据眼震强弱程度辨别患侧,到第2次位置试验可以根据眼震强弱程度明确患侧。结论甲磺酸倍他司汀对BPPV位置试验的精确性有一定影响,主要表现为抑制患者发病时原有的眼震,建议停药24h后再做位置试验,有助于BPPV精准诊疗。     

良性阵发性位置性眩晕误诊误治的原因分析

目的探讨良性阵发性位置性眩晕患者误诊误治的原因。方法回顾性分析2012年12月至2015年12月期间辗转就诊的105例良性阵发性位置性眩晕患者的临床资料。结果 105例BPPV患者中,男23例,女82例,年龄38—80岁,平均61岁。患者曾经接受的检查分别为头颅CT/MRI、颈椎X片/CT/MRI、脑血管多普勒等。有基础疾病或伴随疾病79例(75%),其中,颈椎病30例;高血压、糖尿病合并腔隙性脑梗塞19例;高血压合并腔隙性脑梗塞10例;慢性中耳炎9例;梅尼埃病6例;突发性聋5例。曾经被收入院治疗54例(51.4%);在门诊输液或口服药物治疗25例(23.8%);在门诊行耳石手法复位治疗26例(24.7%)。曾经被诊断为颈性眩晕29例、脑梗塞17例;被诊断梅尼埃病5例;被诊断为眩晕综合征28例;被诊断为BPPV而复位效果不佳26例。最终诊断,根据受累半规管分类:右后半规管BPPV患者59例;左后半规管BPPV患者36例;右水平半规管BPPV患者5例;左水平半规管BPPV患者3例;左前半规管BPPV患者2例。其中,需要2次以上的体位诱发试验才能诱发出典型的眼震37例(35.2%);没有典型的眼震,但是手法复位后,症状消失8例(7.6%),为可能BPPV。结论良性阵发性位置性眩晕的误诊误治,与合并的基础疾病有关、与医生的认识程度和复位技巧有关。     

无明显眼震的良性位置性眩晕

良性阵发性位置性眩晕 (BPPV)是最常见的前庭疾病 ,最常累及后半规管。其眩晕的特征是持续时间短(30～ 6 0 s) ,潜伏期 7～ 8s,呈阵发性发作 ,多在早晨刚睡醒时发生 ,常有头位突然运动诱发 ,如翻身、坐起、仰头等。本文研究目的是为了证明行 BPPV复位操作法并不一定非要有明显的位置性眼震。对 4 3例无明显眼震的 BPPV行改良的半规管耳石复位术 ,其结果与具有典型眼震的后半规管耳石患者实施同样的治疗的结果予以比较 ,无眼震的 BPPV治疗结果为 6 0 .4 6 % (2 6 /4 3)完全恢复 ,6 % (3/ 4 3)现持续眩晕 ,而 90例有典型眼震的 BPPV的…     

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。     

李氏复位法治疗良性阵发性位置性眩晕的远期疗效分析

目的探讨良性阵发性位置性眩晕(BPPV)的临床特征,观察李氏复位法治疗BPPV的远期疗效。方法回顾分析2009年7月至2014年4月诊治的258例行李氏手法复位的单半规管BPPV患者的临床特征,并根据受累半规管的情况行李氏手法复位治疗,观察并分析远期疗效。本组资料中,后半规管BPPV72例(27.9%),水平半规管BPPV120例(46.5%),"上半规管"BPPV66例(25.6%)。结果 258例患者随访1周后痊愈196例(76.0%),有效45例(17.4%),无效17例(6.6%),总有效241例(93.4%);随访3月后痊愈209例(81.0%),有效15例(5.8%),无效15例(5.8%),复发19例(7.4%),总有效224例(86.8%)。其中经1次李氏手法复位后痊愈者163例(63.2%),有效80例(31.0%),无效15例(5.8%),1次复位总有效率为94.2%。各种类型半规管BPPV患者之间的远期总有效率无统计学差异。结论应用李氏手法复位法对BPPV患者进行治疗,疗效确切,且不需要判断眼震的有无及方向,操作简洁,过程迅速,可在临床应用。     

上半规管良性阵发性位置性眩晕41例

目的 探讨上半规管良性阵发性位置性眩晕(BPPV)诊断和治疗的最佳方案。方法 回顾性分析41例上半规管BPPV患者的病历资料,并对所有患者的诊断及复位进行评估分析。结果 SRM-Ⅳ模拟Dix-Hallpike试验诱发出典型垂直向下眼震28例(68.3%),其中眼震伴有向地扭转的成分19例,不伴有扭转成分9例;SRM-Ⅳ上半规管BPPV诱发试验诱发出典型垂直向下眼震35例(84.6%),其中眼震伴有向地扭转的成分30例,不伴有扭转成分5例。在所有41例患者中有38例能通过两种诱发试验对受累侧别做出判断,其中因诱发眼震伴有扭转成分而判断侧别30例,单侧诱发诱发出垂直向下眼震且不伴有扭转成分3例,双侧诱发出垂直向下眼震5例,且不伴有扭转成分,但因眩晕及眼震的强度有明显差别而判断出侧别,患者对受累侧别不能判断3例。在能判断出侧别的38例患者中有左侧上半规管受累25例,右侧上半规管受累13例。对41例采用SRM-Ⅳ上半规管BPPV复位法进行治疗,通过一次治疗痊愈28例,有效12例,无效1例。结论 上半规管BPPV 临床上被越来越重视,应用SRM-ⅣBPPV诊疗系统对上半规管BPPV进行诊治效果好,应该在临床得到推广。     

水平背地性眼震良性阵发性位置性眩晕的诊断和手法复位

目的：验证一种新的用于治疗水平背地性眼震良性阵发性位置性眩晕（apogeotropicHSC—BPPV）的手法复位方法。方法：该研究采取改良的SupineRollTest（M-RollTest）方法共诊断出l78例水平半规管良性阵发性位置性眩晕（HSC-BPPV）患者,其中37例apogeotropicHSC—BPPV纳入该研究样本,占发病数的20．79％。采用管石重置手法先将37例apogeotropicHSC—BPPV患者水平背地性眼震转变为水平向地性眼震;此后,施行传统barbecue法进行手法复位。管石重置手法如下：①患者取仰卧头垫高30°体位静卧;②10min后头快速向患侧转90°;③2min后头向中线回旋45°;④保持体位2min后患者恢复仰卧头高30°体位;静卧10min后,采用M—RollTest检查验证患者是否出现双侧水平向地性眼震。如管石重置失败,重复以上手法多次,直至出现双侧水平向地性眼震为止。结果：36例双侧水平背地性眼震经水平背地性眼震管石重置手法全部转变为双侧不同强度的水平向地性眼震,其中,18例经1次,11例经2次,4例经3次,3例经4～6次。1例经1次管石重置手法后自觉症状减轻,再次行M—RollTest检查证明水平眼震消失,但Dix-hallpike手法复位检查出现同侧上跳性扭转性眼震,确诊为同侧后半规管良性阵发性位置性眩晕（PSC-BPPV）。该组管石重置成功率为为97．3％。36例HSC—BPPV患者经barbecue法手法复位全部一次性获得成功,1例PSC—BPPV患者经Eptey管石复位法一次性获得成功。结论：该研究设计的水平背地性管石重置手法是治疗apogeotropicHSC—BPPV的必要手段,简便易学、成功率高,患者舒适度好,相对依从性高。     

良性阵发性位置性眩晕的眼震图研究

目的:探讨视频眼震图(VNG)在良性阵发性位置性眩晕(BPPV)中的应用价值。方法:回顾126例BPPV患者的VNG资料,分析总结各型BPPV在Dix-Hallpike和滚转试验中VNG上的眼震特点。结果:126例BPPV患者中,后半规管BPPV(PSC-BPPV)98例(77.8%),水平半规管BPPV(HSC-BPPV)17例(13.5%),前半规管BPPV(ASC-BPPV)5例(3.9%),混合型BPPV6例(4.8%);28例PSC-BPPV记录到反转相眼震。VNG上显示PSC和ASC管石症Dix-Hallpike悬头位垂直相眼震分别向上、向下,水平相眼震均向对侧,回到坐位时眼震反向。HSC-BPPV滚转试验向两侧转头均可诱发出眼震,眼震与转头方向相同时,可判断为HSC管石症,以能够诱发较强眼震的转头侧为患侧;眼震与转头方向相反时,则为HSC嵴顶结石症,以能够诱发较弱眼震的转头侧为患侧。结论:VNG能够客观地记录BPPV患者的眼震情况,准确判断耳石所在的半规管,并且保存了眼震数据资料,可以进一步指导临床实践,值得推广。     

190例特发性良性阵发性位置性眩晕患者半规管功能分析

目的分析特发性良性阵发性位置性眩晕(benign paroxysmal position vertigo,BPPV)患者半规管功能的特征,为患者的治疗提供进一步帮助。方法选择本院2019年8月至2020年2月收治的单侧特发性BPPV患者190例,包括后半规管BPPV患者162例,水平半规管BPPV患者28例。行冷热试验和视频头脉冲试验(video head impulse test,vHIT)检查,分析其检测结果。结果190例特发性BPPV患者行冷热试验异常者146例(76.84%),其中后半规管BPPV异常者129例(79.63%),水平半规管BPPV异常者17例(60.71%),二者比较差异有统计学意义(χ²=4.800,P=0.028)。146例异常患者中与BPPV患者同侧半规管异常者61例(41.78%),对侧半规管异常者54例(36.99%),双侧半规管均异常31例(21.23%)。后半规管BPPV患者与水平半规管BPPV患者冷热试验异常侧别分布情况比较,差异无统计学意义(χ²=0.475,P=0.789)。26例特发性BPPV患者行视频头脉冲试验,异常者17例(65.38%),其中后半规管BPPV异常者12例(70.59%),水平半规管BPPV异常者5例(55.56%),二者比较,差异无统计学意义(P=0.667);17例异常患者中与BPPV患者同侧半规管异常者10例(58.82%),对侧半规管异常7例(41.18%)。后半规管BPPV患者与水平半规管BPPV患者vHIT检查结果异常侧别分布情况比较,差异无统计学意义(P=1.000)。结论部分特发性BPPV患者存在广泛的半规管损伤,异位耳石不是其损伤的主要原因;冷热试验联合视频头脉冲试验能提高BPPV患者半规管损伤的检出率,有助于患者的治疗与康复。     

Multiple positional nystagmus suggests multiple canal involvement in benign paroxysmal vertigo

CONCLUSION: Video-oculography demonstrates a higher occurrence of atypical positional nystagmus in patients with benign paroxysmal positional vertigo (BPPV). This includes anterior and horizontal canal variants and multiple positional nystagmus, suggesting combined lesions affecting several canals. OBJECTIVE: To analyse the video-oculographic findings of positional tests in patients with BPPV. MATERIAL AND METHODS: Seventy individuals with symptoms of BPPV and positional nystagmus were included in this study. The diagnosis was based on a history of brief episodes of vertigo and the presence of positional nystagmus as confirmed by video-oculographic examination during the Dix-Hallpike test, the McClure test or the head-hanging manoeuvre. Patients were treated by means of different particle repositioning manoeuvres according to the affected canal (Epley's manoeuvre for the posterior or anterior canals and Lempert's manoeuvre for the lateral canal) and the effectiveness was evaluated at 7 and 30 days. RESULTS: Twenty-nine individuals (41.43%) presented an affected unilateral posterior canal. Fifteen patients (21.43%) presented a pure horizontal direction-changing positional nystagmus consistent with a diagnosis of horizontal canal BPPV. Twelve individuals (17.14%) presented a unilateral down-beating nystagmus, suggesting possible anterior canal BPPV. In addition, 14 patients (20%) showed multiple positional nystagmus during the examination corresponding to simultaneous multi-canal BPPV, 5 had bilateral posterior canal BPPV and 2 presented a positional down-beating nystagmus in both left and right Dix-Hallpike manoeuvres and the head-hanging manoeuvre, which is highly suggestive of anterior canal BPPV. However, seven individuals showed positional horizontal and vertical side-changing nystagmus that could not be explained by single-canal BPPV. These patients with multiple positional nystagmus showed changing patterns of positional nystagmus at follow-up.     

Multiple positional nystagmus suggests multiple canal involvement in benign paroxysmal positional vertigo

Conclusion. Video-oculography demonstrates a higher occurrence of atypical positional nystagmus in patients with benign paroxysmal positional vertigo (BPPV). This includes anterior and horizontal canal variants and multiple positional nystagmus, suggesting combined lesions affecting several canals. Objective. To analyse the video-oculographic findings of positional tests in patients with BPPV. Material and methods. Seventy individuals with symptoms of BPPV and positional nystagmus were included in this study. The diagnosis was based on a history of brief episodes of vertigo and the presence of positional nystagmus as confirmed by video-oculographic examination during the Dix–Hallpike test, the McClure test or the head-hanging manoeuvre. Patients were treated by means of different particle repositioning manoeuvres according to the affected canal (Epley's manoeuvre for the posterior or anterior canals and Lempert's manoeuvre for the lateral canal) and the effectiveness was evaluated at 7 and 30 days. Results. Twenty-nine individuals (41.43%) presented an affected unilateral posterior canal. Fifteen patients (21.43%) presented a pure horizontal direction-changing positional nystagmus consistent with a diagnosis of horizontal canal BPPV. Twelve individuals (17.14%) presented a unilateral down-beating nystagmus, suggesting possible anterior canal BPPV. In addition, 14 patients (20%) showed multiple positional nystagmus during the examination corresponding to simultaneous multi-canal BPPV, 5 had bilateral posterior canal BPPV and 2 presented a positional down-beating nystagmus in both left and right Dix–Hallpike manoeuvres and the head-hanging manoeuvre, which is highly suggestive of anterior canal BPPV. However, seven individuals showed positional horizontal and vertical side-changing nystagmus that could not be explained by single-canal BPPV. These patients with multiple positional nystagmus showed changing patterns of positional nystagmus at follow-up.     

Clinical features of paroxysmal positional vertigo presenting combined lesions.

Benign paroxysmal positional vertigo (BPPV) is one of the common vestibular disorders. Canalolithiasis is thought to be a likely lesion. A canalith repositioning procedure (CRP by Epley) generally yields good resolution of vertigo and nystagmus. The authors confirmed the efficacy of this procedure on typical BPPV of the posterior semicircular canal type. We designed a new procedure for BPPV of the lateral canal type, which also yielded satisfactory results. BPPV sometimes presents a nystagmus pattern, which suggests multiple lesions. We have seen eight cases of BPPV showing nystagmus that combines both the posterior and the lateral canal types. Combined CRP was performed on these cases, which again gave good clinical results. Other BPPV cases were associated with central lesions. We must be aware that BPPV may involve multiple canals and may be associated with central lesions.     

Laser irradiation of the semicircular canal: occlusion of the canal or duct

The aim of this study was to evaluate the effects of argon laser irradiation of the semicircular canals using computed tomography (CT) images and to examine the basis for laser treatment for benign paroxysmal positional vertigo (BPPV). CT images of the posterior canal were evaluated postoperatively in a patient with intractable BPPV, in whom the unilateral posterior and lateral semicircular canals were irradiated with an argon laser. In addition, bootstrap analysis of 20 patients with normal CT findings of the temporal bone was performed and previous experimentally obtained histologic findings were compared. Cross-sections of the posterior canals of 20 patients were found to show no difference in size between the right and left sides. The laser-irradiated posterior canal became narrower than that on the non-irradiated healthy side in our patient. There was a discrepancy between the CT images and experimentally obtained histologic findings that showed complete occlusion of the canal. CT images of a patient with severe vertigo demonstrated that argon laser irradiation to the blue-lined semicircular canals did not occlude the canal of the corresponding areas, while the canal of the guinea pig histologically showed complete obstruction with new bone after irradiation with the same energy (1.5 W, 0.5 s, spot size: around 200 μm in diameter). The patient has been free from vertigo for 16 years. Marked constriction of the semicircular duct corresponding to the irradiated area appeared to be effective in treating intractable BPPV.     

Combined horizontal and posterior canal benign paroxysmal positional vertigo in three patients with head trauma

We report 3 patients who complained of positional vertigo shortly after head trauma. Positional maneuvers performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position with the head raised 30 degrees) revealed a complex positional nystagmus that could only be interpreted as the result of combined PC and HC benign paroxysmal positional vertigo (BPPV). Two patients had a right PC BPPV and an ageotropic HC BPPV, and 1 patient had a bilateral PC BPPV and a left geotropic HC BPPV. All 3 patients were rapidly free of vertigo after the PC BPPV was cured by the Epley maneuver and the geotropic HC BPPV was cured by the Vannucchi method. The ageotropic HC BPPV resolved spontaneously. Neuroimaging (brain computed tomography and/or magnetic resonance imaging scans) findings were normal in all 3 patients. From a physiopathological viewpoint, it is easy to conceive that head trauma could throw otoconial debris into different canals of each labyrinth and be responsible for these combined forms of BPPV. Consequently, in trauma patients with vertigo, it is mandatory to perform the Dix-Hallpike maneuver, as well as supine lateral head turns, in order to diagnose PC BPPV, HC BPPV, or the association of both. Early diagnosis and treatment of BPPV may help to reduce the postconcussion syndrome.     

Benign paroxysmal positional vertigo can interfere with the cardiac response to head-down tilt.

OBJECTIVE: To assess the pulse rate and the respiratory rate responses to head-down tilt of the whole body in the plane of the posterior canals in healthy subjects and in patients with benign paroxysmal positional vertigo (BPPV). BACKGROUND: Although BPPV attacks are usually accompanied by autonomic symptoms, there are no studies assessing autonomic responses during triggering maneuvers for BPPV, neither in healthy subjects nor in patients. METHODS: We evaluated nine healthy subjects and four BPPV patients (3 unilateral and 1 bilateral). Using a two-axis rotator, from an upright position they were rotated 135 degrees backwards to head-down tilt, either in the plane of the right or the left posterior canal. RESULTS: In healthy subjects, head-down tilt always induced a significant decrease of the pulse rate, which was similar after rotation to the right and to the left posterior canals. This response was observed in patients with unilateral BPPV only when they were rotated toward the nonaffected side, and it was not evident when they were rotated toward the affected side (p < 0.025). In the patient with bilateral BPPV, no change of the pulse rate was observed after rotation toward the right or to the left posterior canal. Although, in all the patients, the respiratory rate increased during the tilt, a similar increase was observed in two healthy subjects. CONCLUSION: After rotation in the plane of the affected semicircular canal, BPPV can interfere with the cardiac response to head-down tilt of the whole body.     

与头位改变相关眩晕患者的临床分析

目的探泔与头位改变相关的眩晕的诊断与治疗方法。方法对112例与头位改变相关的眩晕患者进行体位试验及影像学检查,对确诊和可疑为BPPV的患者进行复位治疗,对诊断为颈性眩晕的患者采用戴颈托和全身应用扩血管、营养神经类药物治疗。结果112例患者中,男45例,女67例,年龄12～75岁。确诊为良性阵发性位置性眩晕（BPPV）88例,其中后半规管BPPV76例,水平半规管BPPV9例,上半规管BPPV3例;可疑BPPV9例,这97例均用耳石复位法治疗,1周后痊愈90例,有效4例,近期总有效率96．9％。确诊为颈性眩晕15例,治疗2周后眩晕消失4例．明显好转11例。结论体位试验及影像学检查是诊断与头位改变相关的眩晕最简明的方法,物理疗法和药物治疗疗效好。