耳石手法复位治疗后半规管良性阵发性位置性眩晕

目的比较两种耳石手法复位治疗后半规管良性阵发性位置性眩晕(PC-BPPV)的疗效和安全性。方法 78例单侧PC-BPPV患者分为Ep ley手法治疗组和B randt手法治疗组。计算治疗后7 d、半个月的缓解率,观察治疗的不良反应。结果 Ep ley手法治疗组首次及2周的缓解率分别为61.9%、76.1%;B randt手法治疗组为66.6%、77.6%,两组比较差异无统计学意义。Ep ley手法治疗组出现不良反应7例,B randt手法治疗组出现不良反应3例。结论耳石手法复位治疗BPPV是一种非常有效的方法,B randt手法治疗操作更简单,容易被患者接受。     

青年良性阵发性位置性眩晕临床特征分析

目的 探讨青年良性阵发性位置性眩晕(BPPV)的临床特征.方法 回顾性分析2009年8月-2011年7月确诊的40例青年(≤40岁)BPPV患者的临床特征,并与同期诊治的286例中老年(＞40岁)患者的临床特点进行比较.结果 青年BPPV患者比例相对较高(12.3％),男女比例1∶3,年龄17～40(32.1±6.2)岁,潜伏时间1.2±1.3s,无明显潜伏期者10例(25％),眩晕发作持续时间中位值10s;半规管受累多见(27例,67.5％);40例患者中6例为壶腹嵴顶耳石症,且均为后半规管受累,其余34例为半规管耳石症.与中老年BPPV比较,青年BPPV患者无明显潜伏期者比例较高(25.0％vs11.5％,x2=5.554,P=0.018),而性别构成、病程、受累半规管比例、眩晕发作前潜伏时间、眩晕持续时间比较差异均无统计学意义(P＞0.05).结论 青年BPPV发病率相对较高,女性多见,后半规管受累常见.与中老年BPPV相比,青年BPPV中无明显潜伏期患者的比例较高,且壶腹嵴顶耳石症以累及后半规管者为多.     

高压氧治疗良性阵发性位置性眩晕33例

目的　探讨高压氧 (HBO)治疗良性阵发性位置性眩晕 (BPPV)的临床疗效。方法　 64例 ,随机分为两组 :HBO组 ,高压氧治疗 ,舱压 0 .2 MPa,每次舱内治疗时间 60 min,每日 1次 ,共 1 4次。对照组 ,血管扩张剂盐酸丁洛地尔治疗 1 4 d。结果　 HBO治疗 BPPV的总有效率 93 .94% ,与对照组比较差异有显著性 (P<0 .0 5)。 1～ 7d内强迫头位、恐惧感缓解较早 (P<0 .0 5)。结论　 HBO是治疗 BPPV的有效方法之一。     

良性阵发性位置性眩晕复位即时疗效不佳的影响因素

 目的 探讨良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)复位即时疗效不佳的影响因素。方法 选择2016-01至2017-12在医院经SRM-Ⅳ前庭功能治疗系统单次复位后即时疗效评估效果不佳的BPPV患者95例作为复位不良组,选择285例即时复位有效的患者作为复位有效组,通过比较两组临床特征,探讨引起即时疗效不佳的影响因素。结果 经Logistic回归多因素分析,头部外伤、前庭神经炎、突发性耳聋为BPPV即时疗效不佳的危险因素(OR分别为2.650、5.997、9.561;均有P<0.05)。多半规管BPPV较后半规管及水平半规管BPPV更易发生即时疗效不佳(P<0.05)。结论 完善基础检查及早期发现BPPV复位不良的危险因素,制定有针对性的复位和治疗方法,可减少患者的复位次数并缩短病程。     

SRM-Ⅳ前庭功能诊疗系统对无眼震性良性阵发性位置性眩晕的疗效分析

 目的 观察SRM-Ⅳ全自动前庭功能诊疗系统对无眼震性良性阵发性位置性眩晕的治疗效果。方法 选取64例可能为后半规管或水平半规管受累而位置试验无眼震的BPPV患者,按治疗方法分为3组:机器组(24例)、手法组(24例)和药物组(16例),分别通过诊疗系统行耳石复位、手法行耳石复位、口服甲磺酸倍他司汀及银杏叶提取物片,治疗7 d后比较各组间耳石复位效果,观察眼震和症状变化。结果 机器组痊愈率为70.83%,总有效率达91.6%;手法组痊愈率为50%,总有效率达66.67%;药物组痊愈率为18.75%,总有效率达50%。机器组与手法组比较,痊愈率和总有效率差异有统计学意义(P<0.05);与药物组比较,机器组痊愈率和总有效率明显高于药物组(P<0.05)。结论 SRM-Ⅳ前庭功能诊疗系统可有效地治疗无眼震BPPV,提高阴性眼震的检出率,有利于BPPV治疗的精准性和有效性。     

Benign paroxysmal positional vertigo in an airline pilot

Benign paroxysmal positional vertigo (BPPV) is one of the most common types of peripheral vertigo, characterized by violent whirling vertigo after a positional change. Although the condition is termed "benign," the clinical presentation can be incapacitating for pilots in certain maneuvers. We present a case of an airline transport pilot with the complaint of vertigo for 5 d. The vertigo was aggravated by head movements when looking up or rolling over, lasting for a few seconds. The patient was diagnosed with BPPV, and he was treated with physical therapy with the use of Epley maneuver. The airman applied for his First-Class medical examination after the treatment was successfully completed. The aviation medical examiner (AME) issued the airman medical certificate after contacting and receiving verbal approval from the Federal Aviation Administration's (FAA's) Aerospace Medical Certification Division (AMCD). While evaluating aviators who have had BPPV, AMEs should not issue medical certificates for any class until the condition is fully resolved. Although the AME Guide states that certification of pilots with other types of vertigo requires an FAA decision, once the patient is successfully treated and free of symptoms, approval for issuing the medical certificate can be obtained through contacting AMCD and by submitting all information and documentation pertaining to the diagnosis and treatment.     

Posterior semicircular canal dehiscence: a morphologic cause of vertigo similar to superior semicircular canal dehiscence

The aim of this study was to assess imaging findings of posterior semicircular dehiscence on computed tomography and to evaluate incidence of posterior and superior semicircular canal dehiscence in patients presenting with vertigo, sensorineuronal hearing loss or in a control group without symptoms related to the inner ear. Computed tomography was performed in 507 patients presenting either with vertigo (n=128; 23 of these patients suffered also from sensorineuronal hearing loss), other symptoms related to the inner ear, such as hearing loss or tinnitus (n=183) or symptoms unrelated to the labyrinth (n=196). All images were reviewed for presence of dehiscence of the bone, overlying the semicircular canals. Twenty-nine patients had superior semicircular canal dehiscence. Of these patients, 83% presented with vertigo, 10% with hearing loss or tinnitus and the remaining 7% with symptoms unrelated to the inner ear. In 23 patients dehiscence of the posterior semicircular canal was encountered. Of these patients, 86% presented with vertigo, 9% with hearing loss or tinnitus and 5% with symptoms unrelated to the inner ear. Defects of the bony overly are found at the posterior semicircular canal, in addition to the recently introduced superior canal dehiscence syndrome. Significant prevalence of vertigo in these patients suggests that posterior semicircular canal dehiscence can cause vertigo, similar to superior semicircular canal dehiscence. Electronic Publication     

良性阵发性位置性眩晕复位成功后残留症状特点及其影响因素

 目的 分析良性阵发性位置性眩晕(耳石症)患者复位成功后残留症状的临床特点及其可能的影响因素。方法 通过对本院收集的37例后半规管良性阵发性位置性眩晕患者、28例水平半规管良性阵发性位置性眩晕患者,12例混合半规管(同侧水平半规管合并后半规管)良性阵发性位置性眩晕患者采用SRM-IV型BPPV诊疗系统进行复位,收集复位成功后出现残留症状的临床特点及其相关影响因素。结果 77例良性阵发性位置性眩晕患者经明确诊断及成功复位后,残留症状的发生率为48.1%(37/77),其中头晕者占27%(10/37),不稳者占16.2%(6/37),颈部不适者占21.7%(8/37),合并两种残留症状者占32.4%(12/37),合并三种残留症状者占2.7%(1/37)。残留症状的发生与复位次数有关,而与发病前存在诱发因素(如劳累及睡眠欠佳)、受累半规管、性别、年龄、病程无关。结论 良性阵发性位置性眩晕复位成功后仍有残留症状,主要为头晕、不稳及颈部不适。残留症状的发生与患者所需复位次数有关。     

Sound- and pressure-induced vertigo associated with dehiscence of the roof of the superior semicircular canal

In many types of peripheral vertigo, imaging is not part of the initial evaluation. We present a patient with sound- and pressure-induced vertigo associated with bony dehiscence of the roof of the superior semicircular canal. The diagnosis of this new entity can only be made by high-resolution coronal CT imaging of the temporal bones. In patients with this symptom complex, CT should be performed early in the diagnostic workup.     

半卧位翻身训练治疗老年人良性阵发性位置性眩晕60例

目的：探讨半卧位翻身训练治疗老年人良性阵发性位置性眩晕的疗效。方法利用医院内双摇或三摇病床对60例阵发性位置性眩晕老年患者进行治疗,患者开始取仰卧位,每次先向病变侧侧卧,然后再向对侧侧卧,最后缓慢恢复到仰卧位,每个体位保持30 s,每次训练重复3次,3次/ d。结果治疗3 d 后,痊愈27例,有效32例,无效1例,3 d 痊愈率为45.0％,有效率为53.3％;有效32例中,19例治疗7 d 后痊愈,13例治疗14 d 后痊愈。无效1例通过外科手术治疗后症状缓解。整过治疗过程患者无一例基础疾病加重或出现并发症。结论半卧位翻身训练治疗老年人阵发性位置性眩晕依从性好,安全、有效、简便、经济。     

CT evaluation of bone dehiscence of the superior semicircular canal as a cause of sound- and/or pressure-induced vertigo

PURPOSE: To describe the computed tomographic (CT) findings at different collimation widths associated with superior semicircular canal (SSC) dehiscence syndrome and to determine the frequency of these findings in a control population. MATERIALS AND METHODS: Temporal bone CT scans with 1.0-mm and/or 0.5-mm collimation were obtained in 50 patients with sound- and/or pressure-induced vestibular symptoms. The control population consisted of 50 patients undergoing CT at 1.0-mm collimation and 57 patients undergoing CT at 0.5-mm collimation for other reasons. RESULTS: SSC dehiscence was documented on CT scans in all 36 patients with the clinical syndrome, with bilateral findings in six patients. Six other patients without specific clinical signs appeared to have dehiscence on 1.0-mm-collimated scans. Intact bone overlaying the SSC was subsequently identified with 0.5-mm-collimated CT in each case. On the 1.0-mm-collimated scans in 50 control patients, an area judged as possible or definite dehiscence was identified in 18 of 100 ears. The bone overlaying the SSC was intact in each of the 114 control ears evaluated with 0.5-mm-collimated CT. CT findings from the patients with vestibular symptoms combined with those in the control population indicated that the positive predictive value of an apparent dehiscence in the diagnosis of SSC dehiscence syndrome improved from 50% with 1.0-mm-collimated CT with transverse and coronal images to 93% with 0.5-mm-collimated CT with reformation in the plane of the SSC. CONCLUSION: The positive predictive value of CT in identification of SSC dehiscence syndrome improves with 0.5-mm-collimated helical CT and reformation in the SSC plane.     

天麻素联合丹红注射液治疗后循环缺血眩晕的疗效观察

目的评价天麻素联合丹红注射液治疗后循环缺血眩晕的有效性。方法后循环缺血眩晕患者315例,随机分为两组。治疗组168例,采用天麻素联合丹红注射液治疗10d;对照组147例只给予丹红注射液。结果治疗组总有效率为90.48%,对照组为79.59%。两者差异有统计学意义(P<0.05)。结论天麻素联合丹红注射液治疗后循环缺血眩晕优于单纯应用丹红注射液。     

歼击机飞行员垂直半规管功能的检测及其特征

目的　建立垂直半规管功能的测量方法 ,对我军部分战斗机飞行员和地面人员的垂直半规管功能进行检测 ,初步确定战斗机飞行员垂直半规管功能的特征。　方法　对 35名男性现役歼击机飞行员和 2 0名地面人员进行检测。在暗室中将受试者在转椅上通过特制头托头后仰 6 0° ,同时头左倾或右倾 4 5°,使两侧前、后垂直半规管分别位于水平面 ,采取 90°/s恒速旋转后急停刺激模式 ,记录旋转后眼震电图 ,分别对两侧前垂直半规管、两侧后垂直半规管受刺激引起的垂直眼震的持续时间、最大慢相速度、慢相速度衰减时间常数及各参数间的两侧不对称比进行计算分析 ,建立垂直半规管功能的测量方法。　结果　同地面人员相比 ,飞行员垂直眼震的最大慢相速度降低 (P <0 0 5 ) ,慢相速度衰减时间常数延长 (P <0 0 5 )。　结论　我军战斗机飞行员垂直眼震功能同地面人员存在一定差别 ,长期飞行对飞行员垂直半规管功能可能产生一定影响。     

体位排石与自然排石治疗肾下盏结石的疗效比较

目的观察体外冲击波碎石(ESWL)术后体位排石与自然排石治疗肾下盏结石的疗效。方法选择符合治疗标准的肾下盏结石患者208例。系从2008年6月前后分别抽取的自然排石、体位排石患者各104例。均为ESWL术后需继续治疗者。其治疗前结石长径在1.0～2.0 cm,治疗周期为30 d。观察结石排净率,排净时间及形成石街的概率。结果体位排石的104例中有80例肾下盏残留结石在行ESWL后其结石均全部排净,排净时间为(6.2±1.5)d;24例原位下盏结石行ESWL有16例排净,排净时间为(22.3±3.3)d,104例中有2例出现石街。自然排石的104例中,有68例为肾下盏残留结石,其中36例完全排净,排净时间为(24.5±4.6)d;36例原位肾下盏结石只有5例排净,排净时间为(23.7±3.7)d。104例石街发生18例,两组ESWL术后肾下盏残留结石的排净率和排净时间差异有统计学意义(P<0.01);原位肾下盏排净率差异有统计学意义(P<0.01),排净时间差异无统计学意义(P>0.05)。体位排石与自然排石发生石街的差异有统计学意义(P<0.05)。结论体位排石能有效提高ESWL术后残石的排净率,缩短排净时间,减少ESWL术后复发,同时也可以大大减少石街的发生率。并且对再次复发的小结石尽快排出有重要意义。     

垂直半规管功能检查研究进展及其在军事飞行员中的应用

目的对垂直半规管功能检查方法及在战斗机飞行员中的应用前景进行综述。资料来源与选择该领域的相关研究论文和综述。资料引用国内外公开发表的论文和综述25篇。资料综合对目前国内外常用的五项垂直半规管功能检查方法及其在军事飞行员中的应用进行分析和总结。结论旋转试验、甩头试验、冷热试验、旋转知觉测试、主动头旋转测试是5项常用的垂直半规管功能检查方法,在战斗机飞行员前庭功能的全面评估中必将发挥越来越重要的作用。