难治性良性阵发性位置性眩晕的临床分析

目的 探讨难治性良性阵发性位置性眩晕(BPPV)的临床特点及治疗。 方法 回顾分析2014年8月至2016年1月诊断为难治性BPPV的13例患者的临床资料,分析其病因相关因素、类型、临床特点及治疗效果。 结果 13例难治性BPPV中,头部外伤为最常见因素,离地性水平半规管BPPV为最常见类型。根据病因积极治疗伴随疾病,正确手法复位治疗,联合Brandt-Daroff康复训练,11例治愈,随访1年无复发;2例无效;1例后半规管、1例水平半规管BPPV,至他院行半规管堵塞术手术治疗,术后效果好。 结论 难治性BPPV可能与头部外伤及突发性聋等疾病相关,首先需根据病因积极治疗伴随疾病,同时采用正确的手法复位治疗,并联合康复训练。治疗后大部分患者疗效好,无效者行半规管堵塞术效果好。     

顽固性良性阵发性位置性眩晕的发病机制及治疗

目的 回顾性分析我科门诊及住院患者中顽固性良性阵发性位置性眩晕的患者,分析发病因素及治疗手段,为顽固性良性阵发性位置性眩晕的发病机理及治疗提供新思路.方法 收集2010年1月-2010年12月我科门诊诊断为顽固性良性阵发性位置性眩晕的患者16人,分析发病因素、治疗手段及预后.结果 16例患者经手法复位、体位训练及药物辅助治疗后,眩晕症状基本消失,随访半年未再发作.结论 顽固性良性阵发性位置性眩晕发病机制可能与内耳缺血、运动及活动减少有关,我们采用保守治疗的方法,疗效满意.     

Our experience with benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo has been considered a separate nosological entity. This status is explained by the theories of cupulolithiasis and canalolithiasis. The disorder is treated with training; success was achieved in 88% of our cases, which correlates with the literary data. Trauma and inflammation in the head and neck region may be regarded as possible etiological factors.     

High-resolution three-dimensional magnetic resonance imaging of the vestibular labyrinth in patients with atypical and intractable benign positional vertigo

Benign paroxysmal positional vertigo (BPPV) is a most common cause of dizziness and usually a self-limited disease, although a small percentage of patients suffer from a permanent form and do not respond to any treatment. This persistent form of BPPV is thought to have a different underlying pathophysiology than the generally accepted canalolithiasis theory. We investigated 5 patients who did not respond to physical treatment, presented with an atypical concomitant nystagmus or both with high-resolution three-dimensional magnetic resonance imaging of the inner ear. This method provides an excellent imaging of the inner ear fluid spaces. In all 5 patients, we found structural changes such as fractures or filling defects in the semicircular canals which we did not find in control groups. One patient clinically presented with the symptoms of a 'heavy cupula'. Whereas crosssections through the ampullary region and the adjoining utricle showed no abnormalities, there were significant structural changes in the semicircular canals, which are able to provide an explanation for the symptoms of a heavy cupula.     

Persistent benign paroxysmal positional vertigo: our experience and proposal for an alternative treatment

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Despite the great efficacy of canalith repositioning procedures (CRPs), BPPV may persist (PBPPV). The aim of the study was to evaluate whether a prolonged and self-assessed temporal bone vibration (TBV) could change the outcome of PBPPV after 12 months of repeated treatments, in order to avoid further invasive and/or drug therapies. This evaluation was also conducted with respect to the entire BPPV population treated with CRPs. Seventy-two patients affected by PBPPV were enrolled in the study: 51 and 21 of them suffering from posterior semicircular canal (PSC) and lateral semicircular canal (LSC), respectively. PBPPV patients underwent a twice-a-day self-assessed TBV, using a common low-intensity massaging cushion. Patients were re-tested 1 week later and they were considered free from disease as the results of the positioning tests continued to be negative after 1 month. 70.6 % of PSC PBPPV and 61.9 % of LSC PBPPV patients had positive and statistically significant (P < 0.01) outcomes not biased by “age” and “gender” variables. The recurrence rate of BPPV (RBPPV) was also studied in the BPPV and PBPPV groups after a 12/24-month follow-up and any statistically significant result was found in multiple regression analysis between nuisance variables and RBPPV patients previously treated by CRPs or TBV. The present study suggests that the self-assessed and prolonged TBV could be an alternative treatment in patients affected by PBPPV otherwise addressed to undergo more invasive procedures and pharmacological treatment that are not completely side effects free.     

Comorbidities and recurrence of benign paroxysmal positional vertigo: personal experience

Objective: The aim of this study is to evaluate the correlation between clinical features of benign paroxysmal positional vertigo (BPPV) and age, sex, trauma, presence of one or more comorbidities such as cardiovascular, neurological, endocrinological, metabolic, psychiatric diseases. Design: Retrospective review of medical records (chart review). Study sample: A total of 475 patients aged from 14 to 87 years, affected by BPPV. Results: Recurrence of BPPV occurred in 139/475 patients (29.2%). The recurrence rate was significantly higher in female and older patients. Comorbidities were present in 72.6% of subjects with recurrent BPPV vs. 48.9% of patients with no recurrence (p?<0.01). Forty-two patients (8.8%) reported a cranial trauma as a triggering event. Post-traumatic patients showed a significantly higher persistence rate (45.2%) compared to patients affected by non-traumatic BPPV (20.5%). Recurrence rates are overlapping between the two groups. Conclusion: Our results confirm the association between recurrence of BPPV and age, female sex, and presence of comorbidities. The correlation is stronger in patients affected by multiple associated diseases; the most frequently involved pathologies are psychiatric disorders, followed by neurological and vascular diseases. Collecting a complete medical history is important for prognostic stratification and detection of potential underlying pathological conditions.     

The subjective visual vertical in benign paroxysmal positional vertigo. A preliminary study

In Benign Paroxysmal Positional Vertigo (BPPV), the existence of otoconial debris in the cupula or canal explains most of the symptoms and signs characteristic of this common inner ear disorder. We have studied the ability of patients with BPPV to correctly determine the subjective visual vertical, as this is a good test to evaluate utricular function. Only 1 of 10 patients with BPPV displayed a clearly abnormal response, and there was no correlation between the side of the lesion and the perceived tilt. This might imply that the limited damage induced by the dislodged otoconia does not disrupt utricular function or that the saccule is the source of the problem.     

Spontaneous nystagmus in benign paroxysmal positional vertigo

Objective

The purpose of this study was to evaluate the presence and eventually to study the features of spontaneous nystagmus (Ny) in our patients with diagnosis of benign paroxysmal positional vertigo (BPPV).

Patients and methods

We retrospectively reviewed the clinical records of patients who presented with vertigo spells and were managed at our tertiary care referral center. Patients with only idiopathic BPPV presenting with typical vertigo spells and positioning Ny characteristic of the disease were included in this study. To investigate the positioning Ny, we studied the patients in the sitting position, during the head shaking test, and during the Dix-Hallpike test and the McClure-Pagnini test (Ny provoked by rotation of the head in a supine patient). Ny responses in all patients were observed using infrared videoscopy.

Results

We managed 412 patients affected by BPPV. Of the 412 patients, 292 (70.87%) were diagnosed to be having posterior canal-BPPV and 110 (26.99%) patients had horizontal canal-BPPV (HC-BPPV). The remaining 10 patients (2.44%) were identified to have anterior canal-BPPV. Spontaneous Ny in sitting position was observed, by infrared videoscopy, only in the patients affected by HC-BPPV.

Conclusion

Spontaneous Ny in BPPV can be observed with infrared videoscopy in patients affected by HC-BPPV. The origin of this Ny is most likely due to a natural inclination of horizontal semicircular canal with respect to the horizontal plane. This Ny stops after flexion of the head in neutral position, and for this reason, it should be considered as a seemingly spontaneous Ny. This Ny, in our experience, is observed in most HC-BPPV patients but does not indicate the need for a different management protocol or any different prognostic value of HC-BPPV.     

Stapedotomy and post-operative benign paroxysmal positional vertigo

In our experience some patients subjected to stapedotomy presented vestibular symptoms characterized by brief episodes of vertigo that only lasted 10 to 20 seconds, accompanied by rapid paroxysmal nystagmus similar to that found in benign paroxysmal positional vertigo (BPPV). For this study, 141 otosclerotic patients were enroled and underwent stapedotomy following the Fisch and Dillier's technique. Twelve out (8.5%) of all the patients under study complained of post-operative vertigo and the physical examination of the positional nystagmus confirmed the presence of paroxymal positional vertigo. The percentage seems particularly high and does not agree with the data reported in literature. The onset of the vestibular symptoms appeared between the 5th and 21st day after surgery. To our knowledge, this is the first prospective study existing in literature on the incidence of BPPV after surgery of the stapes. It must also be stressed that the patient should be informed beforehand during the consultation phase of the possibility of post-stapedotomy BPPV together with the other causes of post-operative vertigo.     

Electronystagmographic findings in benign paroxysmal positional vertigo

The aim of this study was to investigate the electronystagmographic findings in patients with benign paroxysmal positional vertigo. A retrospective review of the records of 168 patients with this disease during the past 3 years was performed. Epidemiological data and results from the audiological and neuro-otologic workup, including electronystagmography, were recorded. One hundred fifty-one patients had involvement of the posterior canal, 14 of the horizontal canal, and 3 of the anterior canal. Seventy-two patients (42.8%) had abnormal findings on the caloric tests. Thirty-seven of them (22%) had canal paresis and 23 (13.7%) had directional preponderance, whereas in 12 patients (7.1%) both unilateral weakness and directional preponderance were found. Finally, 21 patients (12.5%) had spontaneous nystagmus. It may be thus concluded that electronystagmographic abnormalities are quite common in patients with benign paroxysmal positional vertigo. Their presence may be explained according to several mechanisms, which are further discussed herein.     

Long-term results of posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is a common condition which is usually managed conservatively, surgical intervention being recommended only for those small number of patients in whom it becomes persistent and incapacitating. The results of surgery in 13 patients who underwent posterior semicircular canal occlusion for intractable (>12 months duration) and incapacitating BPPV are presented with special emphasis on their long-term follow-up. The mean follow-up was 66 months (range, 29–119 months). All patients reported complete and immediate resolution of their positional vertigo, which has been maintained in the long term. Most patients, however, reported some postoperative transient unsteadiness which lasted up to 4 weeks. All patients developed a transient mild conductive hearing loss secondary to a middle ear collection, which usually resolved within 4 weeks. Five patients developed a transient mild high frequency sensorineural hearing loss which resolved in all cases within 6 months. There were no reports of sensorineural hearing loss nor tinnitus in the long term. All patients believed that the operation was beneficial and would undergo it again. Our findings indicate that posterior semicircular canal occlusion is an effective and safe operation in the long term and is the procedure of choice for intractable and incapacitating BPPV rather than singular neurectomy.     

Psychological findings in benign paroxysmal positional vertigo and psychogenic vertigo

OBJECTIVE: A prospective study conducted at the Post Graduate Institute of Medical Education and Research, Chandigarh, India, to study the psychological factors in cases of benign paroxysmal positional vertigo (BPPV) and to compare them with patients with psychogenic vertigo. METHODS: In the present study, 75 subjects each (25-45 years) with BPPV and psychogenic vertigo were compared with an equal number of age- and sex-matched normal controls using the psychological and audiovestibular test batteries. RESULTS: The psychological variables tested, namely, loneliness, depression, anxiety components, introversion, and social desirability, were found to be statistically significant (p < .01) for the three groups (i.e., BPPV, psychogenic, and control). There was no significant difference among the three groups on the audiovestibular measures. CONCLUSION: Psychological factors play an important role in patients with BPPV. The provoking activities result in precipitation of an acute attack and the patients experience heightened emotionality because of the incapacitating feeling of severe vertigo.     

Magnetic resonance imaging predicts chronic dizziness after benign paroxysmal positional vertigo

Objectives

We aimed to evaluate the clinical implications of magnetic resonance imaging (MRI) findings in patients with benign paroxysmal positional vertigo (BPPV).

特发性良性阵发性位置性眩晕患者双温试验的分析

目的：探讨特发性良性阵发性位置性眩晕（BPPV）患者双温试验以及双温试验异常的可能机制。方法：2005—2008年诊断明确的96例特发性BPPV患者,随机分为2组：第1组52例,在诊断明确后复位治疗前进行双温试验;第2组44例,在复位治疗后变位试验阴性后进行双温试验。以半规管轻瘫指数作为比较参数,χ^2检验比较2组半规管轻瘫异常的比例。结果：2组患者比较,除第1组年龄较第2组低,性别比例、受累半规管比例、侧别、病程、是否反复发作各个因素之间没有明显差别。双温试验的比较以半规管轻瘫作为比较参数,2组患者温度试验半规管轻瘫异常的比例进行χ^1检验（t=0．654,P〈0．05）,2组半规管轻瘫出现的比例相似,管石复位前后温度试验异常出现的比例差别没有统计学意义。结论：双温试验异常的原因可能是因为前庭系统存在广泛病变,飘动的耳石对内淋巴液的流动影响不大。     

良性阵发性位置性眩晕临床特点

目的分析良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）患者临床特点。方法 2009年9月～2010年6月明确诊断BPPV的患者90例,详细记录病史、伴随症状、既往史,进行耳科常规检查、纯音听力测试和前庭功能检查,使用视频眼震图观察记录视动功能试验、冷热试验、水平滚转试验、变位试验等,计算半规管轻瘫（canal paresis,CP）值。结果①患者平均年龄（52.48±15.43）岁,男女比例为1∶2.1;耳鼻咽喉科首诊36例（40.0%）、神经内科首诊31例（34.4%）。②后半规管BPPV 51例（56.7%）,水平半规管BPPV 18例（20.0%）,上半规管BPPV 20例（22.2%）,混合型BPPV 1例（1.1%）。③行前庭功能检查78例患者中有52例（66.7%）出现CP,当病史≤2周、2周〈病史≤1个月、1个月〈病史≤6个月、6个月〈病史≤5年、病史〉5年,CP所占比例分别为42.9%、61.5%、75.0%、84.2%、62.5%,P〉0.05,不具有统计学意义。77例单侧BPPV患者中,患侧CP25例（32.5%）,健侧CP11例（14.3%）,双侧CP15例（19.5%）。④行纯音听力测试,67例BPPV患者（68耳）中有21例（21耳,30.9%）伴有感音神经性听力损失。结论 BPPV是常见的前庭系统疾病,病因尚不明确。可伴有前庭功能异常和感音神经性聋,临床上应重视对BPPV患者前庭功能和听功能评价,以明确相关的防治策略。     

Clinical features of benign paroxysmal positional vertigo

Our understanding of the pathomechanism of benign paroxysmal positional vertigo (BPPV) has improved dramatically. A type of BPPV featuring mixed torsional and vertical nystagmus induced by the Dix-Hallpike maneuver involves the posterior semicircular canal (P-BPPV). The other type of BPPV featuring horizontal nystagmus induced by spine-to-lateral head positioning involves the horizontal canal BPPV (H-BPPV). In complaints of vertigo or dizziness, 619 patients visited our department last year. Of these, 142 (23%) was had positional nystagmus consistent with a diagnosis of BPPV, 118 (19%) had no nystagmus but were suspected of BPPV due to vertigo episodes. BPPV was the most frequent diagnosis. H-BPPV was not rare, but accounted for 30% of BPPV. Of H-BPPV, 73% featured direction changing geotropic nystagmus, and 27% direction changing apogeotropic nystagmus. H-BPPV resolved faster than P-BPPV. Most cases caused by head trauma were P-BPPV. Transition between P- and H-BPPV was found in 6 cases. Women outnumbered men by about 3 to 2 in both P- and H-BPPV. Peak incidence was found in the those in their 60s and 70s, suggesting that the etiologies of both types of BPPV are essentially the same.