Benign positional paroxysmal vertigo in the general ear, nose, and throat clinic

Benign positional paroxysmal vertigo is a common disease which may be caused by abnormal movement of utricular debris in the posterior semicircular canal. It is diagnosed by the Dix-Hallpike positional maneuver eliciting vertigo and nystagmus. Treatment generally consists of physical exercises with the Epley or Semont maneuvers. We review 43 consecutive patients diagnosed as BPPV in the last year and treated with physical therapy (Epley maneuvers). Results were very good, with a cure rate of 88.37% (53.5% after a single maneuver). Physical therapy is an effective treatment for BPPV.     

不同变位试验在良性阵发性位置性眩晕的诊断价值

目的：探讨不同变位试验在诊断良性阵发性位置性眩晕（BPPV）中的价值。方法：对我科2000年2月～2004年4月诊断的后半规管（PC）源性良性眩晕72例,采用交叉设计,随机将其中36例先行Dix-Hallpike试验,再行侧卧试验;男36例试验排序与其相反。此后再行仰卧侧头位试验。结果：Dix-Hallpike试验和侧卧试验在诊断PC—BPPV中所得结果具有关联性（P〈0．01）,诊断阳性率差异无统计学意义（P〉0．05）;两者裸眼观察到眼震的典型阳性反应分别为77．9％及77．1％,差异亦无统计学意义（P〉0．05）。2种试验诱发眩晕和（或）眼震具有的潜伏期、持续期及性质、方向等特征无差异。1例患者同时仰卧侧头位试验阳性,诊断同时存在PC—BPPV。结论：在诊断PC—BPPV中,侧卧试验与Dix-Hallpike具有相同的客观诊断价值。在活动受限的情形下,侧卧试验更易于操作及更具安全性,可完全取代Dix-Hallpike试验。在前2种试验出现水平眼震时应同时行仰卧头位试验,以确定是否同时伴有或为水平半规管源性病变。     

Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is characterized by positional vertigo (brief attacks of rotatory vertigo triggered by head position changes in the direction of gravity) and is the most common peripheral cause of vertigo. There are two types of BPPV pathophysiology: canalolithiasis and cupulolithiasis. In canalolithiasis, otoconial debris is detached from the otolithic membrane and floats freely within the endolymph of the canal. In cupulolithiasis, the otoconial debris released from the otolithic membrane settles on the cupula of the semicircular canal and the specific gravity of the cupula is increased. Consensus has been reached regarding three subtypes of BPPV: posterior-canal-type BPPV (canalolithiasis), lateral-canal-type BPPV (canalolithiasis) and lateral-canal-type BPPV (cupulolithiasis). In the interview-based medical examination of BPPV, questions regarding the characteristics of vertigo, triggered movement of vertigo, duration of vertigo and cochlear symptoms during vertigo attacks are important for the diagnosis of BPPV. The Dix–Hallpike test is a positioning nystagmus test used for diagnosis of posterior-canal-type BPPV. The head roll test is a positional nystagmus test used for diagnosis of lateral-canal-type BPPV. When the Dix–Hallpike test is repeated, positional nystagmus and the feeling of vertigo typically become weaker. This phenomenon is called BPPV fatigue. The effect of BPPV fatigue typically disappears within 30 min, at which point the Dix–Hallpike test again induces clear positional nystagmus even though BPPV fatigue had previously caused the positional nystagmus to disappear. For the treatment of BPPV, sequential head movements of patients can cause the otoconial debris in the semicircular canal to move to the utricle. This series of head movements is called the canalith repositioning procedure (CRP). The appropriate type of CRP depends on the semicircular canal in which the otoconial debris is located. The CRP for posterior-canal-type BPPV is called the Epley maneuver, and the CRP for lateral-canal-type BPPV is called the Gufoni maneuver. Including a time interval between each head position in the Epley maneuver reduces the immediate effect of the maneuver. This finding can inform the development of methods for reducing the effort exerted by doctors and the discomfort experienced by patients with posterior-canal-type BPPV during the Epley maneuver.     

手法复位治疗良性阵发性位置性眩晕

目的回顾性分析60例良性阵发性位置性眩晕（BPPV）诊断和治疗方法,为提高BPPV疗效提供参考依据。方法60例患者（男34例,女26例）通过常规神经耳科学检查、Dix—Hallpike和滚转试验确诊为BPPV。40例在发病10天内就诊,6N在发病1月内就诊,10例在5月内就诊,4例在6月以上就诊。采用Semont摆动手法、Epley颗粒复位法和Barbecue翻滚疗法治疗。对治疗1次无效者间隔7天重复治疗,重复3次无效者采用其它方法治疗。完成冶疗后2周复查评定疗效。结果后半规管BPPV54例,22例采用Semont手法复位治疗,14例痊愈,4例改善,4例无效。4例无效改用Epley颗粒复位法。Epley颗粒复位法治疗36例,28例痊愈,4例改善,4例无效。6例外半规管BPPV采用Barbecue翻滚疗法治疗4例痊愈,2例无效。40例10天内就诊者治愈32例,8例改善。6例发病1月内就诊者治愈2例,改善4例。10例5月内就诊者4例痊愈,4例改善,2例无效。4例6月以上就诊者治疗3次均无效。46例治疗1次有效,4例患者治疗2次有效,4例患者治疗3次有效。结论手法复位治疗BPPV有效率高,BPPV治疗效果与发病至就诊时间相关。     

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。     

Evaluación del tratamiento del vértigo posicional paroxístico benigno mediante el cuestionario DHI-S

Benign paroxysmal positional vertigo (BPPV) is a recurrent chronic disease and its handicap is usually understimated. The aim of this study is to determine the impact of the treatment by Epley maneuver on short-term BPPV- related quality of life. Forty-two individuals with BPPV were included: 39 with posterior canal afected, 2 with the lateral canal and one with the anterior canal. Diagnosis was established if a consistent clinical history was found and Dix-Hallpike test (DHT) in cases with canal posterior involvement. Subjects with positive DHT were treated by a single Epley maneuver and were recommended to avoid supine for the next 48 hours. The BPPV relapses were investigated at 7th and 30th day post-treatment. BPPV-associated quality of life was evaluated by the Dizzness Handicap Inventory Short-form (DHI-S) at days 1st and 30th post-treatment. Total and partial scores for emotional, physical and functional subscales were compared by Wilcoxon test for paired samples. Dix-Hallpike test was found positive in el 59% individuals (23/39), and 41% cases did not required any treatment. Among 23 patients treated with Epley maneuver, DHT was found negative in 90% at 30th day follow-up. Mean and standard deviation of the total scores obtained in the DHI-S at the first day were 19.22 ± 9.66 in the DHT positive- patients and 19.79 ± 10.14 in the whole group (DHT positive or negative). These scores significantly decreased to 10.84 ± 10.99 at 30 days post-treatment (p= 0.002 and p=0.001, respectively). In conclusion, the DHI-S is a specific health questionnaire able to assess BPPV –related health and the effectiveness of treatment.     

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。     

继发于突发性聋的良性阵发性位置性眩晕的临床治疗分析

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（benign paroxysmal positional vertigo,BPPV）患者的临床表现,并探讨其可能的发病机制,探索合适的诊断与治疗方案。方法　观察218例突发性聋患者中BPPV的发病情况和临床治疗效果,另有37例同期原发性BPPV作为对照组。所有患者均经Dix-Hallpike实验和Barbecue滚转检查确定诊断,继发性BPPV患者的原发病（突发性聋）符合中华医学会耳鼻咽喉头颈外科学分会制定的诊断标准。按照BPPV类型,进行Epley手法复位或Barbecue翻滚手法治疗,并评价治疗效果。结果　218例突发性聋患者中有9l例出现BPPV,发生率41.7%,均为同侧患耳。BPPV经耳石复位,其中1次治愈62例（68.1%）,2次治愈16例（17.6%）,3次治愈13例（14.3%）。随访6～22个月,高频听力改善均不及低频,外半规管型BPPV复发2例,后半规管型复发5例,经过再次复位后治愈。继发性BPPV与原发性BPPV均经手法复位治愈,疗效相似。结论　BPPV可继发于突发性聋,且突发性聋继发BPPV可达41.7%,其中以后半规管BPPV常见,耳石复位治疗是最为有效的治疗方法,治愈率与原发性BPPV相似。     

改良Semont方法治疗后半规管良性阵发性位置性眩晕的短期疗效研究

目的　研究改良Semont方法治疗后半规管良性阵发性位置性眩晕（posterior semicircular canal benign paroxysmal positional vertigo,PSC-BPPV）的短期疗效。方法　2015年10月～2016年4月在耳鼻咽喉科门诊经Dix-Hallpike试验及Roll试验,确诊为单侧PSC-BPPV管结石症患者93例,应用改良Semont方法治疗,观察复位后3 d和7 d有效率。结果　治疗过程中部分患者出现不同程度眩晕、恶心症状,但所有患者均顺利完成复位治疗。93例应用改良Semont复位法复位,3 d随访,痊愈、有效和无效分别为72、16和5例,治愈率77.4%,总有效率94.6%;1周随访,痊愈、有效和无效分别为84、5和4例,治愈率90.3%,总有效率95.7%。结论　改良Semont复位法治疗PSC-BPPV可靠有效,可以作为治疗PSC-BPPV的有效补充。     

Management of 210 patients with benign paroxysmal positional vertigo: AMC protocol and outcomes

Conclusion: Benign paroxysmal positional vertigo (BPPV) could be treated with specific maneuvers for the involved canals. Management on a daily basis gave earlier relief than weekly treatment, especially in apogeotropic BPPV. Apogeotropic and multi-canal BPPVs were related to the increased numbers of follow-ups and trauma was related to the increased recurrence. Objective: We aimed to report the short-term outcomes of our protocol for BPPV and evaluate the factors influencing the results and recurrence. Methods: In 210 BPPV patients, posterior semicircular canal (PSCC), geotropic and apogeotropic lateral canal BPPVs were treated with the Epley maneuver, barbecue maneuver, and barbecue maneuver after head-shaking. The total number of follow-ups needed to have no provoked nystagmus, success rates at 1 week and 1 month, and factors for repeated maneuvers or recurrence were identified. Results: Apogeotropic and multi-canal BPPV needed more follow-ups than PSCC BPPV. Multi-canal BPPV showed a significantly lower 1-week success rate than other types. Anterior and multi-canal BPPV showed significantly lower 1-month success rates than other types. The 1-week success rates for PSCC and geotropic and apogeotropic BPPV in patients followed up on a daily basis were higher than those in patients with weekly follow-up and the difference was significant only in apogeotropic BPPV. The overall 1-year recurrence rate was 16% and higher recurrence rate was related to trauma.     

The Epley maneuver for the treatment of benign paroxysmal positional vertigo

In recent years, different forms of physical therapy have been proposed for the treatment of benign paroxysmal positional vertigo (BPPV). These mainly consist of maneuvers aiming to reposition and disperse free-floating endolymph particles in the posterior semicircular canal. We report our experience with one of these procedures, the Epley maneuver (EM), in treating 30 cases of BPPV. Twenty-six patients (87%) were cured, while four (13%) did not respond to treatment. These results are similar to those reported in the literature for the EM and the Sémont maneuver.     

Effectiveness of treatment techniques in 923 cases of benign paroxysmal positional vertigo

OBJECTIVE: To present treatment effectiveness of 923 consecutive cases of benign paroxysmal positional vertigo (BPPV) using canalith repositioning, liberatory, and log roll maneuvers combined with redistribution exercises. STUDY DESIGN: Retrospective case review. METHODS: Patients presented with either posterior semicircular canal (P-SCC) BPPV or horizontal semicircular canal (H-SCC) BPPV. Diagnosis was based on patient history of transient paroxysmal vertigo and a positive Dix-Hallpike response with either torsional or horizontal nystagmus. Patients with P-SCC BPPV numbered 840, and 83 patients had H-SCC BPPV. In the original study, there were 1,000 patients; however, 77 patients were dropped from the study because of lack of follow-through. Intervention was canalith repositioning, liberatory maneuvers, log roll maneuvers, and redistribution exercises. Patients numbering 607 were treated with canalith repositioning, 233 patients had liberatory maneuvers, and 83 received log roll maneuvers. All patients received redistribution exercises before treatment maneuvers. After intervention, patients were reassessed at 6 months. RESULTS: There were 601 women and 322 men from ages 12 to 94 (median 55) years. The average duration of symptoms before intervention was 30 months. Outcome measures were considered met when symptoms of BPPV had abated and patients demonstrated a negative Dix-Hallpike response. In the repositioning group, 94% of patients were symptom free or improved, 98% in the liberatory maneuver group and 100% in the log roll group. The average number of sessions was three for all groups. Recurrence of symptoms was demonstrated in 140 (16%) patients at 6 months. CONCLUSIONS: Treatment of BPPV can be effective using either repositioning, liberatory, or log roll maneuvers in combination with redistribution exercises.     

Treatment of benign positional vertigo using the semont maneuver: efficacy in patients presenting without nystagmus

OBJECTIVE: To evaluate and compare the efficacy of the Semont liberatory maneuver on "objective" benign paroxysmal positional vertigo (BPPV) defined as vertigo with geotropic nystagmus in Dix-Hallpike positioning versus "subjective" BPPV defined as vertigo without nystagmus in Dix-Hallpike positioning. STUDY DESIGN: Retrospective chart review. METHODS: One hundred sixty-two patients with positional vertigo during Dix- Hallpike positioning were identified. Patients were evaluated for the presence or absence of nystagmus. All patients underwent the Semont liberatory maneuver. The patient's condition at follow-up was documented at 3 weeks as complete, partial, or failure. Repeated procedures were performed if necessary. RESULTS: There were 127 cases of objective BPPV and 35 cases of subjective BPPV. Overall, 90% of all patients tested had significant improvement of their vertigo after 1.49 maneuvers on average. Improvement was seen in 91% of patients with objective BPPV after 1.59 maneuvers on average, compared with 86% in subjective BPPV after 1.13 maneuvers on average (chi2 test, not significant [P = .5]). Patients with a history of traumatic origin or cause had an overall success rate of 81% compared with 92% for nontraumatic causes or origins (chi2 test, not significant [P = .1]). Recurrences were seen in 29% of patients after a successful initial maneuver; however, 96% of these patients responded to further maneuvers. Four patients with persistent symptoms after conservative management underwent posterior semicircular canal occlusion with resolution of symptoms. CONCLUSION: The Semont liberatory maneuver provides relief of vertigo in patients with positional vertigo, even in patients without objective nystagmus.     

Success of the modified Epley maneuver in treating benign paroxysmal positional vertigo.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is a common condition seen by otolaryngologists. The purpose of this study is to determine the ability of the modified Epley maneuver to treat BPPV. STUDY DESIGN: Retrospective review. METHODS: A retrospective chart review of 107 patients diagnosed with BPPV at our institution between March of 1993 and June of 1995. Each patient was diagnosed with isolated BPPV by history and Hallpike-Dix maneuver. There were no other vestibular symptoms or electronystagmogram abnormalities. Patients diagnosed with BPPV received modified Epley maneuvers, were instructed to remain upright for 48 hours, and wore a soft collar for a week. Patients were followed up with repeat Hallpike-Dix maneuvers at 1 to 2 weeks. If symptoms persisted, the maneuver was repeated for up to a maximum of three times, at which point patients were considered to have failed treatment. RESULTS: The average age of patients was 57.8 years old. Thirty percent were male and the right ear was affected in 54%. The posterior semicircular canal was affected in 105 ears. The average patient received 1.23 Epley maneuvers, with a success rate of 93.4%. No successfully treated patients received mastoid vibration. Seven out of 107 patients failed after three Epley maneuvers. Two failure patients had a history of temporal bone fracture. Two failure patients were treated with posterior semicircular canal block surgery. CONCLUSION: The modified Epley maneuver is an excellent treatment for BPPV.     

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。     

The effect of postural restrictions in the treatment of benign paroxysmal positional vertigo

The treatment of benign paroxysmal positional vertigo (BPPV) consists of a repositioning maneuver in order to remove otoliths from the posterior semicircular canal and subsequent postural restrictions to prevent debris from reentering the canal. However, the extent to which postural restrictions affect the final outcomes of BPPV is still uncertain. The purpose of this study is to determine the effects of postural restrictions in the treatment of BPPV, which is caused by otoliths in the posterior semicircular canal, and to evaluate its usefulness as a therapy. Seventy cases diagnosed as BPPV of the posterior semicircular canal were studied. All patients were treated utilizing the modified Epley maneuver. They were divided into two groups. The first group (group A, 35 patients) was instructed to sleep in a semi-sitting position and to avoid moving their heads forward or backward, whereas no instructions were given to the second group (group B, 35 patients). The information gathered from the patients was analyzed by age of onset, gender, duration of the disease and cure rates or recurrence rates. In group A, the average age was 54.5 years and the mean duration of symptoms was 116.5 days, whereas in group B, these measurements were 54.8 years and 86.7 days. The cure rates were 91.4 and 94.3%, respectively. Symptoms recurred in 12.5% of group A patients, while in group B, there was a 9.1% recurrence rate. Our study did not show any significant difference between the two groups. Postural restriction therapy, practiced after the modified Epley repositioning maneuver, did not have a significant effect on the final outcomes of BPPV. Based on our results, we do not recommend this therapy since there was no significant benefit for the patients who utilized postural restrictions.     

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.     

The canalith repositioning maneuver in patients with benign positional vertigo

The canalith repositioning maneuver (CRM), as defined by Epley, can be an effective treatment for benign paroxysmal positional vertigo (BPPV). The staff at Başkent University’s Ear Nose and Throat Clinic performed CRM on 68 cases of canalithiasis in 64 BPPV patients from June 1996 to August 1997. Symptoms resolved after the first session in 49 patients (72%) and after the second session in 11 cases (16.2%). It was necessary to repeat the maneuver three times in two cases (2.9%) and four times in one patient (1.5%). Discounting three patients who were lost to follow-up, only two patients in our study did not respond to CRM treatment. There was no co-existing pathology found in all but two of the patients studied. Our experience indicates that unless there is no response to CRM or there is suspicion of an incorrect diagnosis, it is not necessary to perform diagnostic studies routinely for differentiating other neuro-otologic disorders prior to using CRM in BPPV patients diagnosed by the Dix-Hallpike test. Received: 10 November 1998 / Accepted: 4 March 1999     

165例良性阵发性位置性眩晕患者管石复位治疗疗效观察

目的评估BPPV患者管石复位治疗短期和长期疗效。方法回顾分析了后半规管和上半规管BPPV患者165例，男53例、女112例，年龄范围18岁至84岁（平均53岁），分为2组，手法复位治疗（治疗组）125例，非手法复位（对照组）40例。结果治疗组中，后半规管BPPV患者81例，上半规管BPPV患者31例，双侧后半规管BPPV13例。65岁以上老年BPPV患者41例。治疗结果分析．治疗组首次治愈83人（66．4％），其中后半规管BPPV60人（74．1％），上半规管BPPV14人（45．2％），双侧后半规管BPPV9人（69．2％），老年BPPV32人（78．0％）。对照组16人（40％）在一周后症状消失。在4个月至41个月的随访中，治疗组和对照组治愈率分别为92％和82．5％。有30人（24％）在随访中复发。有2例病史超过40个月的患者，手法复位治疗无效而进行后半规管阻塞术。结论手法复位治疗BPPV患者是一种非常有效的方法，它能有效的缩短病程，减轻患者痛苦，其方法简单、易行且费用低，可以在临床广泛使用。     

正中悬头位Dix-Hallpike法诊断良性阵发性位置性眩晕

目的评价正中悬头位Dix-Hallpike诱发检查法在诊断后半规管良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)中的意义。方法回顾性总结广东省人民医院耳鼻咽喉科眩晕门诊2008年4月1日到5月29日根据经典或者正中悬头位Dix-Hallpike法诊断为后半规管BPPV患者28例的临床资料,均首先进行正中悬头位Dix-Hallpike诱发试验,如结果为阴性后继续行经典Dix-Hallpike检测证实为后半规管性BPPV。比较正中悬头位Dix-Hallpike相对于经典Dix-Hallpike的阳性率。结果28例后半规管BPPV患者中,正中悬头位Dix-Hallpike诱发试验相对于经典Dix-Hallpike诱发实验的阳性率为78.57%(22/28)。结论正中悬头位Dix-Hallpike法诊断BPPV可以有效地简化诊治程序,并减轻部分患者诱发的眩晕及眼震强度,具有一定的临床意义。但由于其阳性率低于经典方法,故在临床上不能完全代替经典方法。