Home particle repositioning maneuver to prevent the recurrence of posterior canal BPPV

Objective

To check the value of home particle repositioning maneuver in the prevention of the recurrence of posterior canal benign paroxysmal positional vertigo (pc-BPPV).

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.     

The Epley manoeuvre for benign paroxysmal positional vertigo – a systematic review

Benign paroxysmal positional vertigo (BPPV) is a syndrome characterized by short‐lived episodes of vertigo in association with rapid changes in head position. Current treatment approaches include rehabilitative exercises and physical manoeuvres including the Epley manouevre. Randomized clinical trials of the Epley manoeuvre were identified. Outcome measures that were considered include: frequency and severity of attacks of vertigo; proportion of patients improved by each intervention; and conversion of a ‘positive’ Dix–Hallpike test to a ‘negative’ Dix–Hallpike test. Patients who received the Epley manoeuvre were more likely to have complete resolution of their symptoms [odds ratio 4.92 (95% C.I. 1.84–13.16)], and more likely to convert from a positive to negative Dix–Hallpike test [odds ratio 5.67 (95% C.I. 2.21–14.56)]. There were no serious adverse effects of treatment. There is some evidence that the Epley manouevre is a safe effective treatment for posterior canal BPPV.     

良性阵发性位置性眩晕的临床分析

目的探讨良性阵发性位置性眩晕的临床特征。方法回顾160例确诊BPPV患者,分析其临床资料。结果BPPV发病年龄为7-82岁,好发年龄段均为50—70岁,男女比例为0．68：1。发生于后半规管的BPPV为113例（70．6％）,水平半规管为21例（13．1％）,有26例（16．3％）为同时发生于后半规管和外侧半规管。47例水平半规管BPPV中,33例（70．2％）为半规管耳石,14例（29．8％）为壶腹嵴顶耳石。确诊患者中,有98例（61．3％）为首次发作,有49例（30．6％）为复发,或者有明确的类似发作病史。13例（8．1％）曾有眩晕发作,但具体发病特征不明确。对P—BPPV以Epley复位,1周后复查有效率为81．4％（92／113）。半规管型H—BPPV以Lempert法复位,有效率为72．7％（24／33）。壶腹嵴顶型H—BPPV采用强迫体位（健侧卧位）治疗,1周后复查有38．5％（5／13）转为半规管型,以Lempert法复位奏效。随访1月有12例复发（9例P—BPPV和3例H—BPPV）。结论BPPv在各年龄段均有发作,通过患者的发病特征和详细的神经耳科学检查可以做出诊断。根据不同类型进行复位治疗可以取得较好的疗效。     

良性阵发性位置性眩晕鉴别诊断及治疗进展

良性阵发性位置性眩晕作为周围性眩晕发病率最高的病种已为越来越多的临床医师所熟悉,本文将BPPV的发病率、发病机制、鉴别诊断及治疗手段等最新研究进展做一综述.     

眼震电图与动态姿势图在良性阵发性位置性眩晕中的临床应用

目的:探讨眼震电图(ENG)及动态姿势描记(DPG)2种前庭功能检查在良性阵发性位置性眩晕(BPPV)中的临床应用。方法:应用ENG与DPG对40例34～79岁的原发性BPPV患者(BPPV组)和20例正常者(对照组)进行检查,其中DPG评定参数选取感觉器官测试(SOT)中前庭感觉评分、本体感觉评分、视觉评分、Romber′s评分和综合评分。结果:40例BPPV患者的ENG检查中,温度试验异常者26例(65.0%);DPG异常者33例(82.5%),并且DPG中均表现为前庭觉评分低,其他几项评分均未见差别。温度试验和DPG两项结果均异常者24例(60.0%),温度试验正常患者中有9例(64.3%)出现前庭觉评分低,在SOT中除前庭觉评分低外其他几项评分均未见明显异常。此外,与对照组比较BPPV组ENG中温度试验和DPG的前庭评分明显异常(P<0.05),并且≥12个月患者上述检查异常程度更高(P<0.05)。结论:ENG与DPG是重要的前庭功能检查方法,二者联合应用能够全面分析BPPV患者前庭功能病变,且BPPV患者病程直接影响其前庭功能。     

良性阵发性位置性眩晕诊断治疗进展

良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)指头部运动到特殊位置诱发的短暂性眩晕,是最常见的外周性眩晕.近年来国内外对BPPV研究不断深入,临床医务工作者对该病也越来越熟悉.本文将从病理基础、治疗方式、复位后相关问题及最新进展做一综述.     

Vibration with the canalith repositioning maneuver: a prospective randomized study to determine efficacy

OBJECTIVES/HYPOTHESIS: The objective was to determine whether the inclusion of vibration and additional treatment cycles has an effect on short- and long-term success rates in the treatment of benign paroxysmal positional vertigo with the canalith repositioning maneuver. STUDY DESIGN: Prospective randomized study of patients treated at a tertiary vestibular rehabilitation center. METHODS: Variables identified for statistical analysis included patient age, gender, vibration used, and canalith repositioning cycles. Analysis using Student t test, chi2 test, Kaplan-Meier curves with log rank test, and Cox proportional hazards regression was performed. RESULTS: One hundred two patients with benign paroxysmal positional vertigo treated over a 1-year period (August 2001-August 2002) were randomly assigned to receive the canalith repositioning maneuver with or without vibration. Average duration of follow-up was 9.44 months. The single treatment success rate was 93.1%. To relieve symptoms, 29.4% of patients required more than one canalith repositioning cycle. The relapse rate was 30.5%. Thirty-nine patients were assigned to the canalith repositioning group with vibration, and 63 to the canalith repositioning group without vibration. There was no statistical difference in age, gender, initial success rates, or relapse rates between the canalith repositioning groups with and without vibration. On average, patients required 1.38 canalith repositioning cycles for successful treatment. Vibration did not affect the number of canalith repositioning cycles required to convert the Dix-Hallpike test result to normal. The need for additional canalith repositioning cycles had no statistical effect on initial treatment success or relapse rates. CONCLUSION: Vibration provided no additional benefit in initial treatment success or in reducing long-term relapse rates when included in the canalith repositioning maneuver. Many patients with benign paroxysmal positional vertigo require more than one canalith repositioning cycle at the time of initial treatment to relieve symptoms, but this does not indicate a higher likelihood for recurrence. No variable predicted a higher rate of recurrence.     

Dynamics of the vestibulo-ocular reflex in patients with the horizontal semicircular canal variant of benign paroxysmal positional vertigo

Objective Two types of direction-changing positional nystagmus, the geotropic and apogeotropic variants, are observed in patients with the horizontal semicircular canal (HSCC) type of benign paroxysmal positional vertigo (H-BPPV). In this study, we assessed the dynamics of the vestibulo-ocular reflex (VOR) of the HSCC in patients with H-BPPV.

Material and Methods Patients were rotated about the earth-vertical axis at frequencies of 0.1, 0.3, 0.5, 0.7 and 1.0 Hz with a maximum angular velocity of 50°/s. Eye movements were recorded on a video imaging system using an infrared charge-coupled device (CCD) camera, and our new technique for analyzing the rotation vector of eye movements in three dimensions was used.

Results In the patients with geotropic positional nystagmus, there were no differences in VOR gain between rotation to the affected and unaffected sides at frequencies of 0.1–1.0 Hz. Although no differences in VOR gain at frequencies of 0.3–1.0 Hz were noticed in patients with apogeotropic positional nystagmus, the VOR gain at 0.1 Hz was significantly smaller on rotation to the affected compared to the unaffected side.

Conclusion The results indicate that cupulolithiasis in the HSCC affected the dynamics of the HSCC-ocular reflex at 0.1 Hz, but not at higher frequencies, and that canalolithiasis in the HSCC does not change the VOR gain of the HSCC at any frequency. It is suggested that cupulolithiasis causes transient impairment of HSCC function by means of its mechanical restriction of movements of the cupula.     

良性阵发性位置性眩晕病因学分析

目的:分析良性阵发性位置性眩晕(BPPV)的发病情况及可能的致病因素.方法:对124例BPPV患者进行详细的病史调查、分组及合并疾病分析,并于复位治疗前行冷热试验检查,比较具有合并疾病和无合并疾病的BPPV患者的半规管受累情况.结果:124例BPPV患者中,有合并疾病者97例(78.2%)、无合并疾病者27例(21.8%);其中92例(74.2%)存在半规管反应减退(UW).比较有合并疾病和无合并疾病BPPV患者的正常和异常UW值、异常UW后半规管和外半规管累及情况、异常UW的单双侧别、异常UW与BPPV的侧别一致性,差异均无统计学意义(x<'2>值分别为0.000、0.000、0.306、0.027,P>0.05).结论:BPPV患者多数存在合并疾病,多发生于女性和中老年人;椭圆囊耳石脱落与半规管功能异常可能具有病理上的同源性;冷热试验可以为BPPV致病因素的分析提供帮助.     

Purely vertical upbeat nystagmus in bilateral posterior canal benign paroxysmal positional vertigo: A case report

Vertical nystagmus occurs in patients with central vestibular system pathology. Lesions of the pons, medulla, and cerebellum lead to vertical nystagmus. Given this association, vertical nystagmus is considered pathognomonic in nature. We present a case of benign paroxysmal positional vertigo (BPPV) with positive Dix‐Hallpike bilaterally, but also with upbeat purely vertical nystagmus in the straight back head hanging position. Computed tomography imaging of the typically pathologic structures in vertical nystagmus (brainstem/posterior fossa) revealed normal anatomy. We propose this case as an instance of peripheral‐associated purely vertical nystagmus without central pathology, while building on our previous understanding of BPPV physiology. Laryngoscope, 2010     

Office-based differential diagnosis of transient and persistent geotropic positional nystagmus in patients with horizontal canal type of benign paroxysmal positional vertigo

Conclusion: A 30?s observation of geotropic positional nystagmus is sufficient to distinguish persistent geotropic positional nystagmus (PGPN) from transient geotropic positional nystagmus (TGPN) in patients with horizontal canal type of benign paroxysmal positional vertigo (H-BPPV) in ENT office.

Objective: As a canalith repositioning procedure effectively treats H-BPPV with TGPN, but not PGPN, the differentiation between patients with PGPN and with TGPN is essential. The purpose of this study is to determine the observation period enough to distinguish TGPN from PGPN.

Methods: This study first analyzed positional nystagmus images recorded with an infrared CCD camera three-dimensionally in 47 patients with H-BPPV. PGPN is distinguished from TGPN in patients with H-BPPV precisely by means of time constant calculated form analysis of positional nystagmus. Ten-second and 30-s movies were made of positional nystagmus of the all 47 patients. Ten independent otolaryngologists were then asked to distinguish TGPN from PGPN after a 10?s or 30?s observation of the geotropic positional nystagmus images in 47 patients with H-BPPV.

Results: The sensitivity and specificity to distinguish TGPN from PGPN was 100% and 97% after 30?s observation, but 100% and 40% after 10?s observation, respectively.     

手法复位配合药物治疗良性阵发性位置性眩晕疗效分析

良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）是常见的前庭外周性疾病,本文研究手法复位配合药物治疗BPPV的疗效,以期为临床预防和治疗BPPV提供参考。     

耳石治疗仪诊断治疗良性阵发性位置性眩晕的临床分析

目的：分析机械辅助耳石检查复位治疗仪（TRV耳石治疗仪）对初诊为BPPV的病例进行耳石检查和复位的效果。方法：对我院前庭功能室2012—04—01—2012—07—01间使用TRV耳石治疗仪检查治疗的初诊为BPPV病例数据进行分析。所有病例随访时间为1～3个月。结果：504例初诊为BPPV的患者中,3例因为患者未完成检查排除,顺利完成检查治疗的有501例患者,其中男162例,女339例;年龄10-86岁（52．8±14．0岁）。其中检查阳性的169例（33．73％）,阴性332例（66．27％）。169例阳性患者中,单个半规管受累135例,占阳性患者的79．89％（左水平半规管17例,左上半规管4例,左后半规管29例,右水平半规管23例,右上半规管4例,右后半规管58例）;两个以上半规管受累25例（14．80%）。主观BPPV9例（5．33％）,其中右后半规管5例,左后半规管3例,右水平半规管1例。332例阴性病例中,病史不典型的163例,病史典型的169例检查阴性的患者中,之前做过手法复位的有14例,检查前症状已经好转的有33例。总的治疗有效率达到100％,其中因为症状缓解不满意而再次就诊的患者中检查结果阴性的10例,检查阳性10例患者中耳石症所涉半规管不同于初诊的为6例,耳石症所涉半规管与初诊相同的4例,复发率为2．37％。再次复位后均好转未复发。结论：对于初诊为良性阵发性位置性眩晕的患者,通过TRV耳石治疗仪检查确诊为BPPV的比率为34％,对确诊的BPPV治疗有效率高,复发率低,尤其适合诊断治疗复杂的多个半规管同时受累的BPPV。因其费用偏高,临床上易与手法复位相结合。     

Benign paroxysmal positional vertigo after stapedectomy

OBJECTIVE: To determine the incidence of benign paroxysmal positional vertigo (BPPV) following stapedectomy in a patient group and the efficacy of the Epley maneuver in this group. STUDY DESIGN: Prospective study in a university-based tertiary referral system. METHODS: The patient group comprised 63 patients who had undergone stapedectomy; a control group consisted of normal healthy individuals with no otolaryngological complaints. All individuals underwent the Dix-Hallpike maneuver for the diagnosis of BPPV. Patients who exhibited vertigo, torsional nystagmus (which reverses its direction on return to sitting position) preceded by a latent period, and the fatigability of these findings were considered to have BPPV. If the test result was positive, they underwent the Epley therapeutic maneuver. RESULTS: Four of the patients who had undergone a stapedectomy showed characteristic findings of BPPV. No individual in the control group had BPPV. All patients responded well to the Epley maneuver. CONCLUSIONS: Stapedectomy may be regarded as an etiological factor in BPPV. Because the fenestra is located in the posterior part of the stapes footplate, the pathophysiology appears to be related to utricular rather than saccular trauma. Correct measurement of the distance between the incus and stapes footplate is essential in stapedectomy. An Internet survey of the relevant literature in English shows a scarcity of publications on the incidence of BPPV following stapedectomy. In the present study, 63 patients who had undergone a stapedectomy were investigated for the presence of BPPV; all had Dix-Hallpike maneuvers performed for the diagnosis. Sixty-three individuals with no otolaryngological complaints made up the control group. Four of the patients who had undergone stapedectomy showed characteristic findings of BPPV, and no individual in the control group had BPPV; the difference between the two groups was statistically significant. All four of the patients diagnosed with BPPV responded well to the Epley maneuver. The pathophysiology appears to be related to utricular trauma. Correct measurement of the distance between the incus and stapes footplate is essential in stapedectomy.     

Causes and treatment of idiopathic benign paroxysmal positional vertigo based on endocrinological and other metabolic factors

The genesis of the Benign Paroxysmal Positional Vertigo (BPPV) seems to be related to some metabolic factors. These factors, such as vitamin D, glucocorticoids, and even thyroid and growth hormones, can affect bone metabolism and the mineralization of otoconia. It also seems to link to factors related to aging or nutritional habits. Besides, since the incidence of BPPV is quantitatively higher in women than in men, female sex steroids could be associated with this process. It could be useful to understand how these factors act in otoconial mineralization if we want to develop treatments aimed at preventing or delaying BPPV recurrences. In this review, we will analyze the role of these metabolic and hormonal factors in otoconial mineralization and in the treatment of BPPV.     

The canalith repositioning procedure for benign positional vertigo: a meta-analysis

OBJECTIVE: To review the effectiveness of the canalith repositioning procedure (CRP) in the treatment of benign paroxysmal positional vertigo (BPPV) with a critical review of the literature and meta-analysis. STUDY DESIGN: Meta-analysis. METHODS: Studies eligible for inclusion were randomized, controlled trials of the CRP performed on clearly defined cases of BPPV. A total of nine studies meeting inclusion criteria were identified by two independent literature searches of Medline. Treatment and control groups were compared for symptom resolution and elimination of a positive Dix-Hallpike test. RESULTS: Patients treated with CRP were more likely to demonstrate symptom resolution (odds ratio [OR] 4.6; 95% confidence interval [CI] 2.8-7.6) and negative Dix-Hallpike (OR 5.2; 95% CI 3.0-8.8) at the time of first follow-up. The effect of CRP for symptom improvement was strongest within the first month after treatment (OR 4.1; 95% CI 3.1-5.2) with some decline thereafter (OR 2.8; 95% CI 1.7-3.9). Conversely, the ability of CRP to produce a negative Dix-Hallpike strengthened between the first month after treatment (OR 3.0; 95% CI 1.8-4.0) and later follow-up times (OR 5.0; 95% CI 3.9-6.1). CONCLUSIONS: The CRP is more effective than control in resolving vertigo and positive Dix-Hallpike associated with BPPV. This finding was consistent among a variety of studies using different study designs. Untreated patients may demonstrate symptom improvement with time; however, many will continue to have a positive Dix-Hallpike when examined. Resolution of vertigo in untreated patients is therefore most likely because of avoidance of provocative positions.