耳石复位法治疗良性阵发性位置性眩晕的疗效观察

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2006年1月～2007年12月间治疗的112例后半规管和上半规管BPPV,随机分成治疗组（耳石复位治疗）57例,对照组（一般对症治疗）55例,治疗结束后2周复查并评定疗效,随访3个月。结果治疗组治疗后立即或2周内症状消失43例,其中30例症状立即消失,症状改善8例,无效6例,治愈率75.4%,总有效率89.5%。对照组治疗后立即或2周内症状消失23例,症状改善15例,无效17例,治愈率41.8%,总有效率69.1%。两组疗效比较差异有统计学意义。结论治疗组经过耳石复位治疗,半数以上（30例）症状立即消失,减轻了患者的痛苦,缩短了病程,无不良反应,近期疗效是肯定的,并且无明显禁忌症,无痛苦,方法简单易学,无需仪器,适合临床推广应用。     

无明显眼震的良性阵发性位置性眩晕患者手法复位疗效分析

目的 初步探讨无眼震良性阵发性位置性眩晕(BPPV)的治疗方法.方法 39例无明显眼震的BPPV患者(治疗组)和76例后半规管BPPV患者(对照组),采用Epley法分别进行1~3次手法复位治疗,两组均于治疗后2周复诊,比较其疗效.结果 治疗组症状立即消失21例,2周内症状消失6例,症状改善5例,7例无效,治愈率69.23%(27/39),总有效率84.62%(32/39);对照组症状立即消失36例,2周内症状消失23例,症状改善9例,8例无效,治愈率77.63%(59/76),总有效率89.47%(66/76).两组间治愈率和有效率比较差异均无统计学意义(P<0.05).结论 对不伴眼震的BPPV患者,Epley手法复位效果良好.     

耳石复位法治疗良性阵发性体位性眩晕

用Epley首创的耳石复位法(PRM)治疗后半规管性良性阵发性体位性眩晕(BPPV).2周后复查,结果显示,眩晕消失14例,无体位性眩晕,但有头昏2例,眩晕症状改善2例,无效1例.近期治愈率为73.7%(14/19),总有效率为94.7%(18/19),提示PRM是一种快捷,无损伤治疗后半规管性BPPV的方法.     

耳石复位法治疗良性阵发性位置性眩晕疗效观察

目的观察耳石复位法治疗良性阵发性位置性眩晕(BPPV)的疗效。方法对100例BPPV患者行耳石复位法治疗,其中后上半规管型患者80例采用Epley复位法治疗,水平半规管型患者20例采用Barbecue翻滚法治疗,治疗2周后复查,观察治疗效果。结果 80例一次性治愈,10例经2～3次治愈,5例改善,5例无效,总有效率为95%(95/100)。结论 Epley法和Barbecue翻滚法治疗BPPV效果好,操作简单,适于推广。     

不同类型位置性眩晕的诊断及耳石复位治疗

目的探讨不同类型位置性眩晕(benign paroxysmal positional vertigo,BPPV)的诊断方法和半规管耳石复位法对BPPV的治疗效果及存在的问题。方法从2005年1月～2007年12月对疑似BPPV患者行变位性眼震试验,并对确诊为BPPV的96例患者行耳石复位治疗。结果所有BPPV患者经1～2次耳石复位治疗,症状完全消失者84例(87.5%);眩晕消失但遗有与体位变换无关的头昏、头重脚轻感者12例(12.5%),其中10例头部症状于1周内消失,2例于2周内消失。结论不同类型BPPV在诊断方式上存在差异,耳石复位治疗BPPV安全有效,应作为首选。     

与头位改变相关眩晕患者的临床分析

目的探泔与头位改变相关的眩晕的诊断与治疗方法。方法对112例与头位改变相关的眩晕患者进行体位试验及影像学检查,对确诊和可疑为BPPV的患者进行复位治疗,对诊断为颈性眩晕的患者采用戴颈托和全身应用扩血管、营养神经类药物治疗。结果112例患者中,男45例,女67例,年龄12～75岁。确诊为良性阵发性位置性眩晕（BPPV）88例,其中后半规管BPPV76例,水平半规管BPPV9例,上半规管BPPV3例;可疑BPPV9例,这97例均用耳石复位法治疗,1周后痊愈90例,有效4例,近期总有效率96．9％。确诊为颈性眩晕15例,治疗2周后眩晕消失4例．明显好转11例。结论体位试验及影像学检查是诊断与头位改变相关的眩晕最简明的方法,物理疗法和药物治疗疗效好。     

药物与耳石复位治疗后半规管良性阵发性位置性眩晕的疗效分析

目的：比较药物治疗、手法复位和耳石复位仪复位治疗后半规管良性阵发性位置性眩晕（PC －BP_PV ）的疗效。方法将2012年8月～2013年4月收治的168例PC －BPPV患者随机分为三组,每组各56例,分别为药物治疗组、手法复位组和耳石复位仪复位组,其中药物治疗组予甲磺酸倍他司汀12 mg、甲钴胺500 ug、维生素B110 mg口服,3次／d ,银杏叶提取物注射液25 ml（87．5 mg）静脉滴注,每日2次,疗程7 d;手法复位组使用Epley复位法治疗;耳石复位仪复位组采用全自动SRM －IV型前庭功能诊断治疗系统治疗。三组均于治疗后7、28 d时复查,比较其疗效。随访半年,比较手法复位和耳石复位仪复位的复发率。结果治疗7天后药物治疗组、手法复位组及仪器复位组的总有效率分别为35．72％（20／56）、89．29％（50／56）、92．85％（52／56）,治疗28天后三组总有效率分别为46．42％（26／56）、94．64％（53／56）、96．43％（54／56）,药物治疗组疗效明显低于其他两组（ P＜0．05）,手法复位组与复位仪复位组疗效差异无统计学意义（P＞0．05）。半年后随访,手法复位组和仪器复位组复发率分别为15．79％及19．05％,差异无统计学意义（P＞0．05）。结论手法复位及耳石复位仪治疗PC－BPPV患者的疗效相当,总有效率高,均可作为治疗PC－BPPV的首选方法。     

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。     

颗粒复位法治疗后半规管良性阵发位置性眩晕

目的 评价颗粒复位法治疗良性阵发性位置性眩晕的效果。方法 对１９９６年７月－１９９８年６月间治疗的３１一半规管性良性性位置性眩晕患者进行回顾分析。地规管耳右症假说,患者接受１次颗粒复位法治疗。治疗结束２周后复查并评价疗效。结果 ２１例患者的眩晕和眼一立刻或在１－２周内逐渐消失。６例改善,４例无效。总有效率８７．１％。结论 颗粒复位法对大多数良性阵发性位置性眩晕患者有效,推荐作为治疗该的首选方法。     

良性阵发性位置性眩晕的急性期处理策略

目的　探讨良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）急性期临床特点、处理策略。方法　回顾性分析福建医科大学附属第一医院 耳鼻咽喉头颈外科2010年10月～2014年10月期间诊断为急性期BPPV患者46例,予口服抗眩晕治疗,分析急性期处理策略、手法复位的相关风险及并发症。结果　46例急性期BPPV患者予口服抗眩晕治疗,1周后复诊时症状消失痊愈18例,症状改善有效27例,无效者1例;对仍有眩晕的28例予手法复位,眼震、症状均消失。另外报道1例急性期BPPV在手法复位过程中,出现腰椎骨折,予对应处理;1例在耳石复位后出现耳石嵌顿现象并短暂性脑缺血发作。结论  BPPV因发病病程长短、自愈性、急性期BPPV手法复位可能存在的风险,应充分评估患者全身情况;对骨质疏松、围绝经期患者,复位过程中应充分告知手法复位风险并采取相应预防性措施,避免副损伤。     

A randomized trial of the canalith repositioning procedure

OBJECTIVE: To compare the effectiveness and complications of our adaptation of the canalith repositioning procedure (CRP) with the expectation treatment for benign paroxysmal positional vertigo. STUDY DESIGN: A randomized, controlled trial in the setting of a neurotological clinic in Thailand. METHODS: Fifty-eight patients with posterior benign paroxysmal positional vertigo were randomly assigned to treatment and control groups using a block of four. The treatment group was treated with the modified CRP technique until the nystagmus disappeared. A mastoid oscillator was not used, nor were any instructions given for patients after the maneuver. Both groups recorded the daily grading of symptoms and the amount of anti-vertiginous drugs (cinnarizine) taken. Objective and subjective assessments were made weekly until the nystagmus disappeared or until 4 weeks had passed since treatment began. RESULTS: The rates of effectiveness of CRP treatment and the control treatment for benign paroxysmal positional vertigo were 75.9% and 48.2%, respectively. There was a significant difference in the treatment outcomes of the CRP and control groups (P =.03). The CRP group used significantly fewer drugs than the control group (P =.001). Complications in the CRP group, such as lateral canalithiasis and fainting, were observed in 13.8% of the patients. CONCLUSIONS: The CRP was more effective than the expectation treatment for benign paroxysmal positional vertigo insofar as it provided faster recovery and required less dependence on medication. Complications of CRP were limited to 13.8% of patients.     

视频眼震图监视下的良性阵发性位置性眩晕手法复位临床分析

目的探讨良性阵发性位置性眩晕(benignparoxysmal positional vertigo,BPPV)手法复位的临床疗效及视频眼震图在复位中的作用。方法回顾性分析来我科就诊疑似BPPV患者200例,所有患者均分别在裸眼下和视频眼震图下通过变位试验共确诊159例并行手法复位治疗,统计裸眼下与视频眼震图下典型特征眼震的检出率及手法复位的临床治愈率及复发率。结果裸眼下特征眼震的检出率为68.50%,视频眼震图下典型眼震检出率为79.50%。手法复位第一次治愈率为77.99%,总有效率为98.11%,复发率为5.66%,复发患者经再次手法复位后均好转。结论视频眼震图在BPPV诊断及手法复位中起着重要作用,手法复位为治疗BPPV可靠而有效的方法。     

Benign paroxysmal positional vertigo due to a simultaneous involvement of both horizontal and posterior semicircular canals

From April 2001 to November 2003, we investigated 8 patients with benign paroxysmal positional vertigo (BPPV) that was suspected to simultaneously affect both the horizontal and posterior semicircular canals (HSCC and PSCC). These cases showed typical vertical-torsional nystagmus induced by the Dix-Hallpike maneuver, followed by a horizontal nystagmus. They also showed a direction-changing geotropic or apogeotropic positional nystagmus triggered by lateral head rotations in the supine position. Using the three-dimensional analysis of the positional nystagmus, the rotation axis of the positional nystagmus had a component perpendicular to the plane of PSCC and another component perpendicular to the plane of HSCC. All these findings suggest that BPPV in these patients was a combination of posterior and horizontal canal BPPV. The observation of a vertical-torsional positional nystagmus should prompt the specialist to perform not only the canalith repositioning procedure, but also to execute lateral head turns in the supine position.     

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.     

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。     

Canalith repositioning for benign paroxysmal positional vertigo.

OBJECTIVE: To evaluate the efficacy of canalith repositioning maneuvers (Semont, Epley, and modified maneuvers) in the treatment of posterior canal benign paroxysmal positional vertigo (BPPV) in comparison to the rate of resolution in the untreated control cohort. DATA SOURCES: Source articles were identified by a MEDLINE search of English language sources before 2004 plus manual crosschecks of bibliographies from identified articles, selected national meeting abstracts, review article references, and textbook chapters. STUDY SELECTION: Each controlled trial that compared canalith repositioning patients to untreated control subjects in posterior canal benign positional vertigo (blinded and unblinded) was reviewed for inclusion. DATA EXTRACTION: Data were abstracted systematically, scaled on validity and comparability, and cross-checked independently by another author. DATA SYNTHESIS: Studies were combined with fixed effects meta-analysis to estimate spontaneous resolution, 95% confidence intervals (CI) of effect size, and heterogeneity. CONCLUSION: Canalith repositioning is more effective than observation alone for the treatment of benign paroxysmal positional vertigo, despite spontaneous resolution rates of one in three at 3 weeks. Public health implications are discussed, based on the high frequency of unrecognized BPPV reported in elderly patients, and the improvements after canalith repositioning in postural control and health-related quality of life (SF 36 Health Survey) documented in the literature.     

Persistent Direction-Fixed Nystagmus Following Canalith Repositioning Maneuver for Horizontal Canal BPPV: A Case of Canalith Jam

The authors report a 64-year-old man who developed persistent direction fixed nystagmus after a canalith repositioning maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV). The patient was initially diagnosed with right HC-BPPV given that the Dix-Hallpike test showed geotropic horizontal nystagmus that was more pronounced on the right side, although the roll test did not show any positional nystagmus. The patient was treated with a canalith repositioning maneuver (Lempert maneuver). The next day, the patient experienced a different character of dizziness, and left-beating spontaneous nystagmus regardless of head position was observed. After a forced prolonged left decubitus and frequent head shaking, his symptoms and nystagmus resolved. This condition, referred to as canalith jam, can be a complication after the repositioning maneuver in patients with BPPV. Atypical positional tests suggest that abnormal canal anatomy could be the underlying cause of canalith jam.     

The effect of the canalith repositioning maneuver on resolving postural instability in patients with benign paroxysmal positional vertigo

OBJECTIVE: Patients with benign paroxysmal positional vertigo (BPPV) often experience postural instability as well as brief episodes of vertigo. The purpose of this study was to determine whether successful resolution of the episodic vertigo, through use of the canalith repositioning treatment, would be accompanied by improvement in postural stability. STUDY DESIGN: Prospective clinical study. SETTING: Outpatient tertiary care facility in a university. PATIENTS: Thirty-three patients with a diagnosis of the canalithiasis form of BPPV affecting the posterior canal unilaterally. All patients had complete remission of the positional vertigo after treatment. Patients with abnormal caloric or rotary chair test results were excluded from the study. INTERVENTION: The posterior canal BPPV was treated by the canalith repositioning treatment. MAIN OUTCOME MEASURES: Postural stability was assessed by computerized dynamic posturography before and 1 to 2 weeks after treatment. Six different subtests were used. RESULTS: A significant number of patients had abnormal stability, as measured with computerized dynamic posturography, before treatment. After treatment there was a significant increase in the number of subjects with normal results on the different subtests; however, not all patients had normal postural stability. Younger subjects were more likely to show improved stability. CONCLUSIONS: Treatment of BPPV using the canalith repositioning treatment results in improved postural stability in patients with BPPV. Not all patients have normal stability after treatment, however, and assessment and treatment of the balance problems may be necessary.