复位治疗对良性阵发性位置性眩晕患者姿势稳定性的影响

目的探讨耳石复位治疗（CanaIithrepositioningprocedure,CRP）对后半规管良性阵发性位置性眩晕（posterior semicircular canal benign paroxysmal positional vertigo, PSC-BPPV）患者姿势稳定性的影响。方法25例PSC—BPPV患者在CRP前、后进行4种站立条件下的姿势稳定性测试,①坚硬平板、睁眼（T1）;②坚硬平板、闭眼（T2）;③海绵垫、睁眼（T3）;④海绵垫、闭眼（T4）。以配对的25名正常人为健康对照组。采用身体直立时足底压力中心的平均晃动速度（swayvelocity,SV）为研究参数。结果①CRP前患者SV均较健康对照组增加,T1时有显著性差异（f=2．442,P=0．022）：T2NT4有极显著性差异（f值分别为3．529、5．799和4．312,P〈0．01）;②CRP后除T1外（f=1．808,P=0．083）,T2-T4时,患者身体晃动SV较治疗前降低,有显著性差异（f值分别为2．487、2．248和2．897,P〈0．05）：③CRP后患者姿势稳定性与健康对照组比较,T1gUT2时SV间比较,无显著性差异（f分别为1．388和2．022,P〉0．05）;T3和T4时SV间比较,有显著性差异（f分别为1．488和2．327,P〈0．05）。结论CRP可提高PSC—BPPV患者姿势稳定性,但与正常人仍有一定差异,提示PSC．BPPV患者可结合CRPgl前庭康复治疗提高姿势平衡能力。     

Postural stability in patients with different durations of benign paroxysmal positional vertigo

Postural stability maintenance was investigated in patients with idiopathic benign paroxysmal positional vertigo of the posterior semicircular canal (BPPV-PSC) and compared to healthy subjects. To measure the postural stability during a quiet upright stance, we used static posturography in two conditions: with open and with closed eyes. The effect of the repositioning Epleys maneuver on the recovery of postural stability in patients with different durations of BPPV-PSC less than 60 days after the first attack of positioning vertigo (group I) and more than 60 days (group II) was examined. The investigation was made 1 h after the positive Dix-Hallpike test and 7 days after treatment with the Epley maneuver. Sway velocity (SV) and relative power spectrum (RPS) of the stabilograms were calculated to evaluate the postural stability for each subject and each experimental condition. We found a pronounced spectral density peak in the frequency range of 1.0–2.0 Hz and smaller spectral density in the range of 0.15–0.5 Hz compared to that in healthy subjects. Our results showed that the postural maintenance in BPPV-PSC patients depended on the disease duration. Patients with a duration of BPPV symptoms less than 60 days after the first attack demonstrated a high dependence on the visual input for postural stability. One week after the Epley maneuver, differences in the recovery of postural control in both groups of patients were also found. We assume that the disturbed otolith function together with the impaired dynamics of the semicircular canal generate a particular pattern of postural maintenance. The different degree of restoration of postural stability 1 week after the EM treatment in BPPV-PSC patients with different durations of the disease gives us reason to believe that after removing the otoconia from the semicircular canal, some stimulation of other sensory subsystems and adaptation mechanisms occur that lead to a new pattern of postural maintenance.     

Long-term postural abnormalities in benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is a disorder in which patients suffer from acute rotatory vertigo due to the presence of free otoconial debris migrating into one or more semicircular canals during head movements and resulting in abnormal stimulation of the ampullary crest. A prolonged loss of equilibrium of unclear origin is also present. Static posturography is a useful tool for the study of postural control systems and their role in these abnormalities. The aim of the present study was to evaluate the frequency of body sway and long-term instability of BPPV patients by posturography frequency analysis. Twenty patients with canalithiasis of the posterior semicircular canal and 20 normal controls were subjected to static posturography. Informed consent was obtained from all subjects. Patients were tested 1 h after diagnosis, and 3 days and 12 weeks after the characteristic Epley repositioning maneuver. Patients with BPPV showed significantly increased body sway both on lateral (X) and anteroposterior (Y) planes compared to normal subjects. Corporal oscillation with a broad-frequency spectrum was observed in both closed and open eye tests. The repositioning maneuver decreased the X plane body sway, while the anteroposterior sway was unchanged. Twelve weeks after treatment, a normalization of the anteroposterior sway was observed. Results of this study suggest that the long-term postural disturbance associated with BPPV differs from the acute disequilibrium that subsides after canalith repositioning: the former is a sagittal plane/broad spectrum body sway, while the latter is primarily a frontal plane/low frequency sway. The Epley maneuver was shown to reduce frontal sway, a postural abnormality that might therefore be linked to posterior semicircular canal function. Conversely, the observed sagittal body sway was only partially relieved by the restoration of canal function, and therefore, may be more related to the chronic dizziness observed in these patients.     

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.     

Efficacy of postural restriction in treating benign paroxysmal positional vertigo

OBJECTIVE: To investigate the efficacy of postural restriction after canalith repositioning in treating benign paroxysmal positional vertigo (BPPV). DESIGN: Prospective trial of patients with postural restriction vs those without postural restriction after treatment. PATIENTS: Patients with classic BPPV and with BPPV without nystagmus were treated using the modified Epley canalith repositioning procedure. Patients were randomly separated into 2 groups. The first group was instructed to wear a cervical collar and to maintain an upright head position for 2 days. The second group had no motion restriction. After 5 days, the patients were followed up and evaluated using the Dix-Hallpike test. RESULTS: In the first group, 56 of 62 ears healed after the first maneuver, and the remaining ears healed after the second. In the second group, 45 of 57 ears healed after the first maneuver, 6 after the second, and 5 (with subsequent postural restriction) after the third (1 ear did not improve). Five patients in the first group and 3 patients in the second group had BPPV without nystagmus; all of these patients healed after a single maneuver. The difference between the 2 groups in the number of maneuvers required for treatment was statistically significant (P<.05). The number of patients who required a third maneuver was significantly higher in the second group (P<.05). CONCLUSIONS: Postural restriction enhances the therapeutic effect of canalith repositioning in the treatment of posterior semicircular canal BPPV. The long-term efficacy of postural restriction in preventing BPPV recurrence has not been demonstrated.     

Head-tilting stabilometry in patients with benign paroxysmal positional vertigo

OBJECTIVE: One of the pathologic conditions underlying benign paroxysmal positional vertigo (BPPV) is degeneration of the otolith organs. In this study, we examined changes in the parameters of stabilometry under an upright condition and head-tilt conditions in patients with BPPV. METHODS: We performed stabilometry on 21 patients with right BPPV, on 21 patients with left BPPV and on 21 controls. First, the subject stood barefoot in an upright position with both feet together on the platform with eyes closed. Next, tilting of the head about 30 degrees to the left was added. Then, tilting about 30 degrees to the right was performed. RESULTS: In right BPPV patients, the total length of velocity vectors in the right or left direction on right or left head-tilt were significantly smaller than those in an upright position. The enveloped area and total length of velocity vectors in the right or left direction were significantly larger than those in controls. In left BPPV patients, there were no parameters that showed any significant difference. CONCLUSIONS: In this study, lesions of right BPPV patients were coincidentally more severe than those in left BPPV patients, and velocity vectors with head-tilts were significantly smaller than in an upright position. Using the total length of the velocity vectors, head-tilting stabilometry has the potential to become a reliable otolith function examination method.     

Diagnostic problems in patients with benign paroxysmal positional vertigo

The steps of the examination procedure applied for a correct diagnosis of benign paroxysmal positional vertigo (BPPV) are reviewed. A precise diagnosis is important in view of treatment of this type of vertigo by rehabilitation therapy. Clinical experience supports the concept that the diagnosis has to be based not only on a typical history, but also on the presence of a reproducible vertigo and paroxysmal positioning nystagmus. In the procedure applied in the department, this nystagmus can be reproduced by the Dix-Hallpike maneuver under Frenzel's glasses, during electronystagmography (ENG) recording in the position tests, or it can be present in the vestibular habituation training test battery (a battery of 19 maneuvers applied for defining the adequate exercises in the rehabilitation treatment for BPPV). Analysis of the reviewed data in 95 patients showed that one third of the patients described the vertigo in a rather atypical way, while the further testing revealed a typical BPPV. This experience denies any absolute reliability to only history. In fact, only the finding of such a paroxysmal positioning nystagmus is conclusive for confirming BPPV. However, also the presence of such a nystagmus appeared not to be a constant datum, so that in some patients more than one examination was necessary to come to a reliable diagnosis. It is obvious that, for detecting a paroxysmal positioning nystagmus, ENG is less reliable than the Dix-Hallpike maneuver under Frenzel's glasses.     

良性阵发性位置性眩晕的听-前庭功能研究

目的了解良性阵发性位置性眩晕（benign paroxysmal positional veaigo，BPPV）在听和前庭功能检查方面的特点，进一步了解BPPV的可能发病机制，并提出防治策略。方法对86例BPPV患者行纯音测听、高刺激率听性脑干反应、前庭双温试验、前庭诱发的肌源性电位检查。分析BPPV患者几种耳功能检查的阳性率，以及在BPPV发病机制中的作用。结果86例BPPV患者中，原发性占82％（70／86）。纯音测听异常者占52％（45／86）；高刺激听性脑干反应异常者在原发性BPPV中60％（30／50）。前庭诱发的肌源性电位异常为34％（11／32）。前庭双温试验异常者25％（18／72），其中，与BPPV同侧者占67％（12／18）。水平半规管BPPV，双温试验异常者占11％（2／18），后半规管异常者占89％（16／18）。结论原发性BPPV发病率高于继发性BPPV（x^2=67．8140，P〈0．01），纯音测听结果正常与异常的例数几乎相同。高刺激听性脑干反应异常对于原发性BPPV有一定的贡献。水平半规管前庭双温试验异常率低，而后半规管异常率较高。前庭诱发的肌源性电位的异常率明显低于高刺激听性脑干反应和前庭双温试验，说明上迷路的病变与BPPV发病密切相关。鉴于内耳供血可能对BPPV的发病有一定的影响，对于异常的患者应给改善内耳供血的药物，以减少复发。     

Variables affecting treatment in benign paroxysmal positional vertigo

OBJECTIVE: To identify variables affecting outcome in patients with benign paroxysmal positional vertigo (BPPV) treated with canalith repositioning maneuvers. STUDY DESIGN: Retrospective review of patients at a tertiary vestibular rehabilitation center. METHODS: Variables identified for statistical analysis included method of diagnosis, age, sex, onset association with trauma, semicircular canal involvement, presence of bilateral disease, treatment visits, and cycles of canalith repositioning maneuvers per treatment visit. Multivariate statistical analysis using Pearson chi2, likelihood ratio, linear-by-linear association, and cross-tabulation tests were performed. RESULTS: Two hundred fifty-nine patients with BPPV who received treatment were identified from 1996 to 1998. Average follow-up time was 16.9 months. 74.8% required one treatment visit, 19.0% required a second treatment visit, and 98.4% were successfully treated after three treatment visits. The remainder required up to seven treatment visits for relief of symptoms. Variables affecting the number of treatment visits included bilateral disease or location of disease other than in the posterior semicircular canal. Patient age, sex, method of diagnosis, and onset association with trauma had no statistically significant impact. CONCLUSION: Patients with benign paroxysmal positional vertigo not located in a single posterior semicircular canal are more likely to require multiple visits for canalith repositioning.     

211例良性阵发性位置性眩晕临床分析

目的：探讨不同类型良性阵发性位置性眩晕（BPPV）的临床特征。方法：回顾性分析211例BPPV患者的临床特征,并对不同类型的BPPV作比较。结果：BPPV以女性多见,50～60岁为发病高峰段,潜伏期为（1．60±1．19）s,46例（21．8％）无明显潜伏期;眩晕发作持续时间中位数为10S,持续时间〈60s者177例（83．8％）,超过60s者34例（16．2％）;后半规管受累189例（89．6％）,水平半规管受累21例（10％）,后半规管加水平半规管受累1例（0．4％）。后半规管BPPV、水平半规管BPPV潜伏期分别为（1．89±1．33）s、（O．92±1．04）s,差异有统计学意义（P〈0．01）;汉族患者发病明显多于其他民族;而在性别构成、病程、眩晕持续时间上均无明显差异。结论：BPPV以后半规管受累常见,与水平半规管相比,后半规管BPPV潜伏期更长。     

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.     

Diagnosis and treatment of benign paroxysmal postural vertigo

The article describes pathogenetic aspects, clinical picture, principal diagnostic methods and treatment of patients with benign paroxysmal postural vertigo (BPPV). The evidence obtained at examination of 148 patients with complaints for vertigo episodes is provided. The group of 29 patients with a positive Dix-Holpike test was analysed. BPPV onset correlated with age, gender, prevalence of the pathological process location on the right, presence of labyrinthine hydropse.     

Utricular dysfunction in patients with benign paroxysmal positional vertigo.

OBJECTIVE: The objective of this study was to test the hypothesis that utricular function is impaired in patients with idiopathic benign paroxysmal positional vertigo. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary dizziness clinic and vestibular research laboratory. PATIENTS: Twelve patients with unilateral idiopathic benign paroxysmal positional vertigo were examined 1 week and 1 month after successful treatment with positioning maneuvers and compared with 24 healthy subjects. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Otolith function was assessed with estimation of the subjective visual vertical and analysis of the torsional otolith-ocular reflex. Unilateral stimulation of the utricle was performed on a rotator that allowed eccentric lateral displacement of the patient during earth-vertical rotation with constant velocity. The otolith-ocular reflex was recorded with three-dimensional video-oculography. RESULTS: There was no difference in the estimation of the subjective visual vertical between patients and controls. The peak-to-peak amplitude of the otolith-ocular reflex torsional eye position was smaller in patients than in the control group. The gain of the unilateral otolith-ocular reflex was reduced in patients on both sides on first testing. After several weeks, only the affected labyrinth showed a reduced otolith-ocular reflex gain. CONCLUSION: Our findings document otolith dysfunction in patients with idiopathic benign paroxysmal positional vertigo possibly secondary to degeneration of the utricular macula. This finding may account for the transient mild imbalance and dizziness that some patients with benign paroxysmal positional vertigo experience even after resolution of positional vertigo.     

Sensory interaction posturography in patients with benign paroxysmal positional vertigo

BPPV (benign paroxysmal positional vertigo) is a very common peripheral vestibular disturbance. The dysfunction becomes manifest mainly by vertigo and typical nystagmus. However, the vestibulospinal reflex (VSR) can also be disturbed. This can be shown by the SPGIII (static posturography type III), which is a platform technique evaluating ‘sensory interaction’ in a way comparable to that of the Equi-test. Half the patients with BPPV show disturbed posturographic results. By interfering with the sensory input of vision and/or proprioception, the separate contribution of each input can be evaluated. Different ‘formulae’ are seen, from complete normal results, through ‘overall’ formulae, i.e an undifferentiated influence in all test-conditions, to specific formulae, where we find ‘eye-closure’ and ‘head retroflexed'-effect and so-called ‘vestibular formulae'. These formulae are an expression of the different degrees of compensation achieved by the centres and especially of the ‘substituting’ compensation by vision and proprioception. These results confirm that posturography does not provide a typical results-pattern, thus the type of peripheral vestibular disorder cannot be diagnosed by it alone. The results give functional information on how the standing position is achieved in these patients with a disturbed VSR-input. The several formulae prove that indeed different compensatory patterns are possible, as has been shown by experiments on vestibular compensation.     

Oculographic findings in 145 patients with benign paroxysmal positional vertigo

ObjectiveBenign paroxysmal positional vertigo (BPPV) can be produced by specific manoeuvres and be studied by electrooculography (EOG). It allows an exhaustive study of features in the positional nystagmus. Although most of the patients with BPPV express typical nystagmus, there exists a group of them that exhibit a non typical form. In this work, a comparative study was carried out between two groups of patients.Material and methodsWe have studied retrospectively 145 patients with BPPV and Dix-Hallpicke (D-H) positive manoeuvre registered by EOG techniques. All patients were explored in a complete EOG tests. Two groups were identified: typical response/atypical response according to the features of nystagmus response. Possible alterations in other EOG tests in each group were investigated and differences between both types of response were analyzed.Results83.5% of cases showed typical nystagmus and atypical in the rest. Other EOG alterations observed in these patients, were (group typical response/atypical response): caloric hypofunction (17.3%/23%), positional nystagmus (12.4%/62.5%), alterations in visual-oculomotor function tests (10%/50%).ConclusionsFrequent alterations were observed in the classic manoeuvres and also in the rest of EOG tests. Probably atypical response in the first is due to or can explain the existence of the second.     

1240例良性阵发性位置性眩晕患者手法复位治疗

目的 总结分析1999年12月至2008年9月期间1240例良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者应用管石复位治疗后的短期和长期疗效.方法 对1240例BPPV患者应用改良Epley 手法和Barbecue 360°体位翻滚复位法进行手法复位治疗.并于一周后复查,随访一年.结果 1240名患者中,男500例,女740例,年龄5～92岁,平均(46.5±2.3)岁.其中单侧后半规管BPPV患者1149例,单侧水平半规管BPPV患者69例,同时性双侧后半规管BPPV患者17例,同时性双侧水平半规管BPPV患者2例,同时性后半规管与水平半规管BPPV患者3例;特发性BPPV 968例,继发性BPPV 472例,继发病因包括头部外伤、感染、各种耳部疾病、高血压、手术等.利用手法复位治疗后,首次治愈率85.6%(1062/1240),其中后半规管BPPV86.2%(991/1149),水平半规管BPPV 81.2%(56/69),混合性半规管BPPV 68.2%(15/22);观察随访1年后,总治愈率94.2%(1168/1240),复发率5.7%.结论 BPPV患者采用手法复位治疗,疗效肯定,见效快.方法 简单,短期复发率低,可作为治疗BPPV患者的首选治疗方法.     

Our experience with benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo has been considered a separate nosological entity. This status is explained by the theories of cupulolithiasis and canalolithiasis. The disorder is treated with training; success was achieved in 88% of our cases, which correlates with the literary data. Trauma and inflammation in the head and neck region may be regarded as possible etiological factors.     

三维滚轮耳石复位系统及其临床应用

目的 观察三维滚轮耳石复位系统治疗良性阵发性位置性眩晕的临床效果.方法 回顾性分析40例后半规管和水平半规管良性阵发性位置性眩晕患者的临床资料,其中20例采用三维滚轮耳石复位系统进行复位治疗,20例采用手法复位治疗,对其疗效进行比较.结果 采用三维滚轮耳石复位系统治疗的患者中第1次治疗后有17例(85%)治愈,3例经过第2次治疗痊愈;采用手法复位的患者中第1次治疗后有16例(80%)治愈,4例经过第2次治疗痊愈.应用x2检验二者的差异没有统计学意义.结论 应用三维滚轮耳石复位系统治疗良性阵发性位置性眩晕临床效果可靠,弥补了手法复位的缺陷,效果直观,可重复性强.