雌激素、血钙浓度和25-羟维生素D对绝经女性良性阵发性位置性眩晕复发的预测价值

目的　观察雌激素、血钙浓度和25-羟维生素D水平在绝经女性良性阵发性位置性眩晕（BPPV）复发中的预测价值。方法　选取2015年1月-2018年8月于我院就诊的良性阵发性位置性眩晕（BPPV）的绝经女性患者156例作为研究对象,随访1年,依据患者有无BPPV复发分为BPPV未复发组126例,BPPV复发组患者30例,同时选取同期于我院体检健康且自然绝经1年以上的女性50例作为对照组,然后对比3个组血清雌二醇、血钙浓度和25-羟维生素D水平,Pearson用于分析绝经后女性BPPV复发组患者血清雌二醇、血钙浓度与25-羟维生素D水平的相关性;ROC曲线用于评估雌二醇、血钙浓度与25-羟维生素D水平在绝经女性BPPV复发中的预测价值。结果　对照组雌二醇、血钙浓度与25-羟维生素D水平明显高于BPPV未复发组和BPPV复发组,差异具有统计学意义（P＜0.05）,BPPV复发组雌二醇、血钙浓度与25-羟维生素D水平明显高于BPPV未复发组,差异具有统计学意义（P＜0.05）;绝经女性BPPV复发患者血清中雌二醇与血钙浓度、25-羟维生素D水平均呈明显的正相关关系（r =0.7501,0.7871,P 均＜0.001）,血钙浓度与25-羟维生素D水平也呈明显的正相关关系（r =0.7904,P＜0.001）;ROC曲线分析显示,血清中雌二醇、血钙浓度与25-羟维生素D水平D对绝经女性BPPV复发均有一定诊断价值,三者联合约登指数最大值为0.476,对应个体预后（prognostic index,PI）指数为13.04,当PI≤13.04时,绝经女性BPPV复发可能性较大;单因素和多元Logistic回归分析结果显示复位次数（OR=2.356,95%CI ：1.769～2.841）、SDS评分（OR=3.480,95%CI ：2.043～4.125）、雌二醇（OR=4.964,95%CI ：3.578～6.723）、血钙浓度（OR =1.982,95%CI ：1.395～2.024）与25-羟维生素D水平（OR=3.045,95%CI ：1.467～4.638）为绝经女性BPPV复发易感因素。结论　绝经女性BPPV复发患者血清中雌二醇、血钙浓度、25-羟维生素D水平均呈明显正相关关系,三者联合可用于诊断绝经女性BPPV复发。     

良性阵发性位置性眩晕与甲状腺自身免疫相关性初步研究

目的　探讨良性阵发性位置性眩晕（BPPV）与甲状腺功能及自身抗体的相关性。方法　收集2016年1～6月在温州医科大学附属第三医院耳鼻咽喉科收治的BPPV患者40例为实验组,选取40例无眩晕健康体检人员为对照组。两组均收集血管相关危险因素（高血压、糖尿病、冠心病等）,并测定甲状腺功能5项、甲状腺过氧化物抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）,两组对比分析。结果　实验组和对照组在既往血管相关危险因素（高血压、糖尿病、冠心病）差异无统计学意义（P＞0.05）;实验组甲状腺相关指标T3、T4、FT3、FT4与对照组比较差异无统计学意义（P＞0.05）。实验组TSH与对照组比较差异有统计学意义;实验组甲状腺自身抗体总阳性率22.5%,对照组2.5%,差异有统计学意义。其中TPOAb阳性1例,两组比较差异无统计学意义,但TGAb阳性8例,与对照组比较差 异有统计学意义,全部TGAb阳性的BPPV患者均为女性。结论　BPPV与甲状腺自身免疫可能存在一定相关性。女性BPPV患者应注意甲状腺相关指标检测。     

绝经后女性良性阵发性位置性眩晕与雌激素水平相关性meta分析

目的　系统评价绝经后女性良性阵发性位置性眩晕（BPPV）与雌激素水平的关系。方法　检索PubMed、Embase、Cochrane Library、Web of Science、中国知网（CNKI）、万方数据知识服务平台和维普数据库中关于绝经后女性BPPV患者与雌激素水平关系的研究,对研究进行筛选,提取数据,使用纽卡斯尔-渥太华量表（Newcastle Ottawa Standard,NOS）对文献进行质量评价,采用Stata14软件进行meta分析。结果　最终纳入8篇文献,研究对象共计737例,其中BPPV组374例,对照组363例。meta分析结果显示绝经后女性BPPV组和对照组的雌激素水平存在统计学差异（SMD=-1.21,95%CI ：-1.57～- 0.84,P <0.05）。结论  雌激素的下降可能是绝经后女性BPPV发病的危险因素。     

老年人良性阵发性位置性眩晕与血尿酸的关系

目的　探讨血尿酸水平和老年人良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）之间的相关性。方法　收集2014年1月～2015年8月在我院住院≥60岁老年人102例BPPV患者作为BPPV组,并随机收集同期在我院≥60岁体检者85例作为对照组,分别测定血白蛋白、肌酐、尿酸、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、血压（收缩压、舒张压）,并收集记录二组病例心脑血管系统相关疾病及危险因素：高血压、糖尿病、冠心病、高血脂、脑梗死、脑出血、吸烟等病史。结果　BPPV组与对照组在性别、年龄、高血压史、糖尿病史、冠心病史、高血脂史、脑梗死史、脑出血史、吸烟史、甘油三酯、高密度脂蛋白、空腹血糖、肌酐、收缩压、舒张压等方面差异无统计学意义（P＞0.05）,但白蛋白、尿酸、总胆固醇、低密度脂蛋白在二组之间差异有统计学意义（P＜0.05）,BPPV组白蛋白、尿酸、总胆固醇、低密度脂蛋白显著高于对照组（P＜0.05）。采用多因素Logistic回归分析提示高尿酸、高低密度脂蛋白是老年人BPPV发病的危险因素。结论　血清尿酸增高与老年人BPPV发病具有相关性,是老年人BPPV发病的危险因素。     

中老年女性良性阵发性位置性眩晕反复发作者钙代谢研究

目的比较反复发病中老年女性良性阵发性位置性眩晕患者与健康对照组之间骨密度、25-(OH)维生素D、血钙浓度差异,探讨其发病及复发的相关性。方法选取2016年10月～2018年12月就诊于我院眩晕门诊纳入标准的103例明确诊断的50岁以上女性患者,首次治愈1年内,再发(≥2次)的BPPV患者为研究对象(A组),选取同期来院体检的年龄匹配且近1年无眩晕病史正常女性80例为对照组(B组)。采用超声骨密度仪检测患者足跟骨密度,运用全自动分析仪比色法检测血钙浓度,电化学法检测血清25-(OH)维生素D水平。比较各组间骨密度、血钙浓度和血清25-(OH)维生素D水平。结果 A组骨量减少占39.81%(41/103),骨质疏松占29.13%(30/103)高于B组骨量减少36.25%(29/80),骨质疏松16.25%(13/80),差异有统计学意义。血钙浓度差异无统计学意义。B组的25-(OH)维生素D(23.847±3.125 ng/ml)高于A组(17.153±2.028 ng/ml),差异有统计学意义(t=17.511,P<0.05);A组中,未绝经人数占20.39%(21/103)骨密度T(-1.738±0.923)低于绝经组(-2.392±1.142),差异有统计学意义(t=-2.426,P<0. 05);血清25(OH)D(21.589±3.037 ng/ml)高于绝经组(16.231±2.102 ng/ml),差异有统计学意义(t=9.454, P<0. 05);血钙浓度(2.365±0.521 mmol/L)与绝经组(2.353±0.514 mmol/L)相比,差异无统计学意义(t=0.095,P>0. 05)。结论反复发病中高年女性特发性BPPV患者发病可能与骨密度及血清维生素D水平下降有关,绝经后女性更易累及。     

管石复位次数对良性阵发性位置性眩晕的疗效影响分析

目的：探讨管石复位术次数对良性阵发性位置性眩晕（BPPV）疗效的影响。方法对68例BPPV患者随机分为治疗组（34例）和对照组（34例）,治疗组每日行一次管石复位术,连续复位治疗3天,对照组仅行管石复位术治疗一次,两组患者在手法复位的基础上配合服用甲磺酸倍他司汀片、盐酸氟桂利嗪治疗。1周及3个月后进行疗效评定。结果治疗1周后治疗组治愈率为82．4％,对照组治愈率为58．8％,两组差异有统计学意义（P＜0．05）;治疗3个月后,治疗组治愈率为91．2％,对照组治愈率为85．3％,两组差异无统计学意义（P＞0．05）。结论在准确判断 BPPV 分型的基础上,采用多次手法复位术治疗并配合药物治疗,可提高 BPPV 的短期治愈率,缩短治愈时间。     

Brandt-Daroff习服法联合倍他司汀治疗良性阵发性位置性眩晕复位后残余症状的疗效分析

目的　观察Brandt-Daroff习服法,以及联合倍他司汀治疗良性阵发性位置性眩晕（BPPV）复位后残余症状的疗效。方法　纳入2017年3月～2019年3月收治BPPV复位成功患者,将其中复位后仍存在残余头晕患者75例随机分3个组,对照组（倍他司汀治疗）、训练组（Brandt-Daroff习服法）和联合组（Brandt-Daroff习服法联合倍他司汀）,每组25例。对所有患者治疗后残余症状持续时间,治疗前后的眩晕残障量表（dizziness handicap inventory,DHI）进行评分比较。结果　治疗前各组患者的基线资料及DHI评分差异无统计学意义（P＞0.05）。治疗后,联合组残余症状持续时间低于对照组和训练组（P＜0.05）,对照组和训练组之间差异无统计学意义（P＞0.05）;治疗7天后,联合组DHI评分低于训练组及对照组（P 均＜0.05）,训练组和对照组比较差异无统计学意义（P＞0.05）;治疗28天后,联合组DHI评分均低于对照组和训练组（P 均＜0.001）,训练组评分低于对照组,差异具有统计学意义（P＜0.001）。结论  Brandt-Daroff习服法联合倍他司汀能显著减轻BPPV成功耳石复位后残余的头晕症状,单用Brandt-Daroff习服法和常规内科药物倍他司汀有相似疗效。     

前庭康复训练联合药物治疗对良性阵发性位置性眩晕复位后残余症状的疗效分析

目的分析前庭康复训练联合药物治疗对良性阵发性位置性眩晕（BPPV）患者复位后残余症状的改善情况。方法选取2013年6月—2016年2月确诊为BPPV且行手法复位成功患者66例,根据随机数字表法,将患者平均分为药物组、前庭康复组和联合组,每组各22例。比较患者治疗前后的眩晕残障程度量表（DHI）和医院焦虑抑郁量表（HADS）评分情况;治疗结束后随访6个月,并记录各组患者复发率。结果治疗2、4、6周时,联合组DHI评分均明显低于前庭康复组和药物组,差异具有统计学意义（P＜0.05）。治疗6周后,联合组HADS T评分明显低于前庭康复组和药物组,差异均具有统计学意义（P均＜0.05）;联合组复发率低于药物组（χ2=3.511,P<0.05）和前庭康复组（χ2=2.387,P<0.05）,差异均具有统计学意义（P均<0.05）。结论对BPPV且行手法复位成功患者在药物治疗的同时辅以前庭康复训练,可有效改善BPPV患者的残余症状,并且降低了眩晕复发率,改善患者焦虑和抑郁状态,疗效显著。     

应激事件影响下“耳石症”患者的临床调查与分析

目的　对应激事件时期以眩晕为主诉患者进行临床调查,分析疑似“耳石症”病例的临床特点。方法  纳入2020-01-24～2020-03-31在首都医科大学附属北京同仁医院耳鼻咽喉头颈外科就诊的眩晕患者183例作为研究组,以2019-01-24～2019-03-31同期就诊的眩晕患者508例作为对照组进行临床资料对比分析,包括良性阵发性位置性眩晕（BPPV）的筛查率、确诊率、头晕评价量表（Dizziness Handicap Inventory,DHI）、医院焦虑抑郁量表（Hospital Anxiety and Depression Scale,HADS）评分和 匹兹堡睡眠质量指数量表（Pittsburgh Sleepquality Index,PSQI）评价等数据。结果　①研究组中因眩晕与位置相关而进行BPPV筛查者占94.0%（172/183）,高于对照组65.4%（332/508）（P＜0.001）。②研究组中确诊为BPPV患者为16.4%（30/183）,高于对照组7.9%（40/508）（χ2=10.726,P =0.001）。③研究组中BPPV确诊患者DHI总分及各维度评分与对照组间差异无统计学意义（P＞0.05）;以焦虑情绪为主的患者占63.3%（19/30）较对照组35.0%（14/40）高,差异具有统计学意义（χ2=5.523,P =0.019）;出现睡眠质量下降者占60%（16/30）与对照组65%（26/40）差异无统计学意义（P＞0.05）。④对研究组中77例患者进行双温试验,其中 37.7%（29/77）正常,与对照组24.6%（52/211）差异有统计学意义（χ2=4.729,P =0.030）。结论　在应激事件影响下疑似“耳石症”患者增加,在临床诊治时应注意有效甄别眩晕患者伴随的情绪认知和睡眠质量问题。     

并发良性阵发性位置性眩晕的突发性聋患者预后相关性分析

目的　探讨并发良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的突发性聋病例特征及BPPV与突发性聋预后相关性。方法　对2007 年3月～2013年3月,278例突发性聋病例进行回顾性分析。对治疗前及治疗后的纯音听阈结果进行分析,并对其预后进行多因素回归分析。结果　36例突发性聋病例并发BPPV（12.95%）。并发BPPV的突发性聋患者治疗前及治疗后听力损失重,并发BPPV的突发性聋者预后更差,多因素结果分析显示老龄（＞60岁）、治疗前听力的损失程度、前庭功能异常与突发性聋预后密切相关。结论　并发BPPV的突发性聋者,显示前庭功能受损更重,预后更差。     

Association between bone mineral density and benign paroxysmal positional vertigo: a meta-analysis

European Archives of Oto-Rhino-Laryngology - The association between bone mineral density (BMD) and benign paroxysmal positional vertigo (BPPV) has been investigated by multiple studies, but the...     

Evaluation of bone mineral density and 25-(OH) vitamin D levels in middle-aged and elderly women with recurrent benign paroxysmal positional vertigo

Abstract

Background: Middle-aged and elderly perimenopausal women are prone to developing BPPV without definite cause. Objectives: This study aimed to investigate the correlation between bone mineral density (BMD), 25-(OH) vitamin D, and serum calcium levels in patients with benign paroxysmal positional vertigo (BPPV) in middle-aged and elderly women.

Material and methods: A total of 103 women with two or more recurrent BPPV episodes (group A) and 80 age-matched healthy controls (group B) were recruited. All subjects had BMD and serum 25-(OH) D levels measurements taken, and the results were compared.

Results: BMD was reduced in group A, and the proportion of osteoporosis was higher than in group B (p?=?.039). The BMD T-score and 25-(OH) vitamin D level were lower in group A than in group B (p?=?.004 and p?<?.0001, respectively). In group A, the BMD T-score was lower (p?=?.017) and serum 25-(OH) vitamin D level was higher (p?<?.0001) in premenopausal women than in menopausal women.

Conclusions and Significance: Our study found that middle-aged and elderly women with recurrent BPPV, especially postmenopausal women, may present decreased BMD and serum vitamin D levels.     

Postural control according to the age in patients with benign paroxysmal positional vertigo

OBJECTIVES: To study the relationship between age and postural control in patients with benign paroxysmal positional vertigo. MATERIAL AND METHODS: Prospective study performed in 65 diagnosed patients with benign paroxysmal positional vertigo (BPPV) in any of its variants. The results of the Sensory Organization Test are compared with their equivalent in a control group by means of scatterplot and regression lines. For the statistical study the Mann-Whitney's U test was used. RESULTS: In the NORMAL group, the regression line for composite has a 0.0934 slope; in the BPPV group, 0.4284. This difference is due to conditions 5 and 6 fundamentally, the results being statistically significant. CONCLUSIONS: The patients with BPPV have a worse postural control than the group control. This difference is much more pronounced the older the patient, and is of vestibular origin.     

Clinical evaluation of vertigo in menopausal women

Vertigo is one of the usual menopausal symptoms. We have often examined some women under the complaint of vertigo related with the menopause. We diagnosed each disease based on neuro-otological examinations and investigated the characteristics of menopausal-associated vertigo. We studied 413 women aged 40-59 years old who complained of vertigo. There were 73 women with menopause symptoms (14 women introduced from the gynecologist in our medical center, 18 women had undergone treatment at another female clinic, and 41 women visited an otorhinolaryngologist first) compared with 340 women without menopause symptoms. In the menopause group, 41 (56.2%) cases were diagnosed as having benign paroxysmal positional vertigo (BPPV), 13 (17.8%) cases had Meniere's disease, sudden deafness with vertigo accounted 2 cases, one was an acoustic tumor, and so on. The percentage of patients with BPPV was almost same ratio between the menopause group (56.2%) and the non-menopause group (52.9%). The percentage of patients with Meniere's disease was higher markedly in the menopausal group (17.8%). than the non-menopause group (9.7%). Menopausal symptoms are caused not only by hot flashes related to a lack of estrogen but also by psychological factors. The onset of Meniere's disease can also be influenced by psychological factors. As for the diagnosis of Meniere's disease, we supposed the reason for the higher percentage in the menopausal group was its relationship with psychological factors. We could diagnose and treat some menopausal women with vertigo. We believe that joint consultation with a gynecologist and otorhinolaryngologist would be necessary to ensure an optimum quality of life for such patients.     

耳石复位法治疗半规管良性阵发性位置性眩晕的临床研究

目的：评价耳石复位法治疗良性阵发性位置性眩晕（BPPV）疗效。方法：回顾分析2002年1月～2005年6月间治疗的230例BPPV患者的临床资料。根据半规管耳石假说,随机分成治疗组122例,对照组108例,分别接受耳石复位法和一般对症治疗。治疗结束后2周复查并评定疗效。结果：治疗组88例眩晕和眼震于治疗后立即或在2周内逐渐消失,18例改善,16例无效,治愈率72．1％,总有效率86．9％。对照组51例立即或在2周内逐渐消失,23例改善,34例无效,治愈率47．2％,总有效率68．5%。两组疗效相比差异有统计学意义。结论：鉴于耳石复位法治疗无明显禁忌证,方法简单,无痛苦和不良反应,一次性治疗疗效高,短期（1～3个月）随访无复发,因此认为该法可作为BPPV门诊治疗的首选方法。     

Bone mineral density and serum 25-hydroxyvitamin D in subtypes of idiopathic benign paroxysmal positional vertigo

Although the etiology of benign paroxysmal positional vertigo (BPPV) is idiopathic in most cases, the association of osteoporosis or vitamin D deficiency with BPPV has attracted much interest recently. While it is generally accepted that osteoporosis or vitamin D deficiency is related to the occurrence and/or recurrence of BPPV, the difference in serum vitamin D level and bone mineral density (BMD) among different subtypes of BPPV has not been investigated. We aimed to compare T-score of BMD score and serum 25-hydroxyvitamin D level among idiopathic BPPV patients with a different subtype. This study included 117 consecutive patients with idiopathic BPPV (26 men and 91 women; mean age, 55 ± 11 years; age range, 25 to 78 years) who underwent blood sampling for serum 25-hydroxyvitamin D level measurement and bone mineral densitometry of the anterior-posterior lumbar spine and femur between April 2018 and February 2019. Among 117 patients, 49 were diagnosed with posterior semicircular canal (PSCC) BPPV, 24 were diagnosed with lateral semicircular canal (LSCC) canalolithiasis, and 44 were diagnosed with LSCC cupulolithiasis. The mean T-score of BMD was −1.5 ± 0.9 in PSCC BPPV, −1.5 ± 1.3 in LSCC canalolithiasis, and −1.5 ± 1.1 in LSCC cupulolithiasis, which was not significantly different (p = 0.998, One-way ANOVA test). The mean level of 25-hydroxyvitamin D was 22.5 ± 10.6 ng/ml in PSCC BPPV, 26.8 ± 16.0 ng/ml in LSCC canalolithiasis, and 25.4 ± 9.6 ng/ml in LSCC cupulolithiasis, which was not significantly different (p = 0.262, One-way ANOVA test). The proportion of osteoporosis/osteopenia or vitamin D deficiency/insufficiency did not show significant difference among idiopathic BPPV patients with different subtypes, and findings of this study indicate that either serum level of vitamin D or T-score of BMD is not a distinguishable characteristic among different subtypes of BPPV.     

Benign paroxysmal positional vertigo in older women may be related to osteoporosis and osteopenia

Benign paroxysmal positional vertigo (BPPV), so-called canalolithiasis and cupulolithiasis, usually occurs after head trauma or viral vestibular neuritis. In many cases, the cause remains obscure, and it often affects women more than 50 years old. The goal of this work was to study a possible relationship between BPPV and osteopenia or osteoporosis. Thirty-two women, whose ages ranged from 50 to 85 years (median age, 69 years), who had BPPV and were free of any other otoneurologic history, were selected. The diagnosis of osteopenia or osteoporosis was confirmed by a bone mineral density measurement made with dual x-ray absorptiometry of spine and hip (T-score). The BPPV was unilateral in 26 patients and bilateral in 6 patients. Our results showed osteopenia or osteoporosis in 24 of the 32 patients (75%) with BPPV. The T-scores were compared in 3 age groups to those of 83 healthy women. The patients with BPPV had a significantly lower (p < .026) T-score in all groups. Possible pathophysiological mechanisms are discussed to explain the apparent correlation between BPPV and osteopenia or osteoporosis.     

耳石复位法治疗良性阵发性位置性眩晕32例

目的 探讨耳石复位法治疗良性阵发性位置性眩晕（BPPV）的的效果。方法 应用Epley管石复位法、Semont管石解脱法及Barbecue翻滚法对良性阵发性位置性眩晕32例予以治疗。结果 32例中经耳石复位法治愈27例(84.4%)，有效 3例(9.4%)，复位失败2例(6.3%)，后经前庭功能训练治愈。结论 耳石复位法是BPPV的首选治疗方法，对于复位失败的患者前庭功能训练可获得较好的疗效。     

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.     

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。