水平半规管良性阵发性位置性眩晕的诊断

目的探讨水平半规管良性阵发性位置性眩晕（BPPV）的诊断。方法自2003年1月至2006年9月，本眩晕中心共确诊为水平半规管BPPV（HSC BPPV）患者46例。诊断依据为典型的病史及用红外视频眼震电图仪记录患者在Dix—Hallpike试验和滚转试验中的眼震结果，并排除其他疾病。研究HSC BPPV的眼震特点。结果441例诊断为BPPV患者中，46例（10．43％）为水平半规管BPPV。其中38例（82．61％）为单侧病变，5例（10．87％）患者合并同侧后半规管病变，3例（6．52％）为双侧病变。35例患者通过两种试验诱发出水平眼震，11例患者仅通过滚转试验诱发出水平眼震。25例患者眼震方向向地，13例患者眼震方向背地，3例患者眼震方向不固定，5例患者各种手法诱发出同一方向的眼震。29例患者在双侧手法中出现眼震，17例患者在一侧手法中出现眼震。结论HSC BPPV眼震为完全水平性且多为快相向地。通常受累耳在双侧手法中均可出现眼震，以向患侧为重。一侧水平半规管和后半规管可同时受累。滚转试验在HSC BPPV检查中比Dix—Hallpike试验更加敏感。Dix—Hallpike试验结合滚转试验可使更多的HSCBPPV患者得到确诊．     

Spontaneous nystagmus in horizontal canal benign paroxysmal positional vertigo

Objective

Benign paroxysmal positional vertigo of horizontal semicircular canal (HSC-BPPV) is characterized by either geotropic or apogeotropic nystagmus induced by head roll test. Some patients also present with spontaneous nystagmus. The aim of this study is to examine the clinical manifestation of spontaneous nystagmus in HSC-BPPV and evaluate the effect on the treatment outcome.

Patients and methods

Electronystagmography and video eye movement recordings of 125 patients diagnosed as HSC-BPPV were reviewed retrospectively. Presence of spontaneous nystagmus was analyzed and treatment outcome after repositioning therapy was compared.

Results

Overall, spontaneous nystagmus was observed in 19 patients (15.2%) with HSC-BPPV at initial presentation. In canalolithiasis group (n = 64), the treatment outcome did not differ between patients with or without spontaneous nystagmus. However, in cupulolithiasis group (n = 61), patients presenting with spontaneous nystagmus (n = 10) required more repositioning therapy sessions.

Conclusion

The presence of spontaneous nystagmus at initial presentation may implicate poorer treatment outcome in cupulolithiasis HSC-BPPV patients.     

同时性后半规管与水平半规管性良性位置性眩晕

目的：探讨同时性后半规管与水平半规管性良性位置性眩晕（混合性良性位置性眩晕）的诊治方法。方法：联合应用Epley手法和Barbecue翻滚法对4例患者进行治疗，两次治疗间隔1d。结果：4例患者眩晕症状完全消失，随访至今无复发。结论：混合性良性位置性眩晕兼有后半规管与水平半规管性良性位置性眩晕的临床表现，联合采用Epley手法和Barbecue翻滚法治疗该病是可行的。     

水平半规管良性阵发位置性眩晕的诊治

目的探讨水平半规管良性阵发位置性眩晕（horizontalcanalbenignparoxysmalpositionalvertigo,HC-BPPV）的诊治方法。方法回顾分析1996年7月～2000年3月间南京医科大学第一附属医院耳鼻咽喉科诊治的9例HC-BPPV患者的临床资料。对所有患者全面采集病史,行纯音听阈测试和耳神经学检查,常规施行仰卧侧头位试验和Dix-Hallpike试验,并按Barbecue翻滚法行耳石复位治疗。结果本病以头位改变所诱发的短暂旋转性眩晕为特征,常见诱发体位为床上翻身（9/9例）和转头（5/9例）。仰卧侧头位试验可诱发水平向地性眼震,无潜伏期和疲劳性。采用Barbecue翻滚法治疗后全部患者症状立刻消失,随访4～15个月无复发。结论根据典型表现和体位试验结果,可明确区分水平半规管性和后半规管性BPPV以及其他原因引起的眩晕。Barbecue翻滚是治疗HC-BPPV有效的方法。     

水平半规管良性阵发性位置性眩晕的临床特点

目的 探讨水平半规管良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的临床特点.方法 回顾性分析2003年8月至2010年12月诊治的239例水平半规管BPPV患者的临床表现.结果 水平半规管BPPV占同期全部BPPV患者的25.7％(239/931).平卧侧头试验见水平向地性眼震者197例,眼震的平均潜伏期为(0.88±0.72)s,持续时间(26.36±19.71)s;水平离地性眼震者42例,平均潜伏期(2.69±1.83)s,持续时间(53.48±43.12)s;其中39例眼震表现为水平略带扭转向上而非纯水平,占16.3％(39/239).离地组眼震潜伏期明显长于向地组(t=-6.33,P＜0.001),眼震持续时间亦明显长于向地组(t=-3.99,P＜0.001).水平向地性眼震者予以Barbecue翻滚法治疗,192例经(1.6±0.8)个循环复位成功;水平离地性眼震者经左右侧头训练后,40例眼震转化为向地性,经(1.9±0.8)个循环后复位成功.结论 水平半规管BPPV占同期BPPV的比例较预期高.水平向地性眼震患者可直接给予Barbecue翻滚法治疗,水平离地性眼震患者应先行左右侧头训练,再给予Barbecue翻滚法复位.     

水平半规管良性阵发位置性眩晕的诊治

目的 探讨水平半规管良性阵发位置性眩晕（horizontal canal benign paroxymal positional vertigo ,HC- BPPV)的诊治 方法。方法 回顾分析1996年7月－2000年3年间南京医科大学第一附属医院耳鼻咽喉科诊治的9例HC－BPPV患者的临床资料。对所有患者全面采集病史,行纯音听阈测试和耳神经学检查,常规施行仰卧侧头位试验和Dix-Hallpike试验,并按Barbecue翻滚法行耳石复位治疗。结果 本病以头位改变所诱发的短暂旋转性眩晕为特征,常见诱发体位为床上翻身（9／9例）和转头（5／9例）。仰卧侧头位可诱发水平向地性眼震, 无潜伏期和疲劳性。采用Barbecue翻滚法治疗后全部患者症状立刻消失,随访4－15个月无复发。结论 根据典型表现和体位试验结果,可明确区分水平半规管性和后半规管性BPPV以 春他原因引起的 眩晕。Barbecue翻滚是治疗HC－BPPV有效的方法。     

水平半规管良性阵发性位置性眩晕

良性阵发性位置性眩晕(Benign Paroxysm Positional Vertigo,BPPV)是一种阵发性、由头位变动引起的伴有特征性眼震的短暂发作性眩晕,是最常见的前庭疾病。后半规管BPPV(Benign Paroxysmal Positional Vertigo ofPosterior Semicircular Canal,PSC-BPPV)是最常见的BPPV类型,临床上推荐Dix-Hallpike试验作为诊断PSC-BPPV的"金标准",Epley法是目前治疗PSC-BPPV最有效的复位方法。水平半规管BPPV(Benign Paroxysmal Positional Vertigoof Horizontal Semicircular Canal,HSC-BPPV)发病机制复杂,是仅次于PSC-BPPV的常见BPPV亚型,其实际发病率可能被低估。临床实践中,HSC-BPPV其诊断与复位治疗方法与PSC-BPPV均不相同。本文即围绕HSC-BPPV研究的发展史及流行病学、分类、病因、发病机制、诊断及治疗复位方法的相关进展做一综述。     

外半规管良性阵发性位置性眩晕的诊疗

良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)是最常见的周围性眩晕,主要表现为随头位变化出现的短暂性眩晕发作,该病分为后半规管型、外半规管型、上半规管型及多半规管.其中后半规管BPPV最常见,其次为外半规管BPPVo外半规管BPPV根据发病机制、原理、眼震方向等有多种分类方法.近年来外半规管BPPV的手法复位逐渐被熟悉,但一些患者复位后效果不佳,如外半规管嵴帽结石症,部分患者行常规手法复位后发作性眩晕仍然存在.我们将这部分手法复位后眩晕症状改善不明显的类型归结为难治型外半规管嵴帽结石症.本文主要围绕外半规管BPPV的概念及分类、流行病学、病因、发病机制、诊断及复位方法,尤其对于难治型外半规管嵴帽结石症的复位方法做一综述.     

水平半规管良性阵发性位置性眩晕患者眼震参数客观特征

目的 探讨水平半规管良性阵发性位置性眩晕(BPPV)眼震的方向、强度、时间等参数的客观特征及机制.方法 水平半规管BPPV患者233例,其中水平半规管管石症(horizontal semicircular canalithasis,HSC-Can) 179例,水平半规管壶腹嵴顶结石症(horizontal semicircular canal cupulolithiasis,HSC-Cup)54例.应用视频眼震图仪分别记录滚转试验诱发眼震,比较各个试验头位的眼震方向、强度、时间等参数特点.采用SPSS17.0统计软件进行数据处理.结果 水平半规管BPPV患者滚转试验在左侧、右侧转头位均可诱发出水平性眼震.HSC-Can诱发眼震方向与转头方向相同,向患侧和健侧转头位诱发眼震的潜伏期(-x±s,下同)为(1.922±1.501)s和(1.447±0.855)s,持续时间为(25.620±10.409)s和(22.110±10.931)s,强度为(56.441±33.168)°/s和(24.239±13.892)°/s,向患侧转头诱发眼震的潜伏期、持续时间及强度均大于健侧,差异均具有统计学意义(t值分别为3.715、15.219和4.070,P值均＜0.01),其中眼震强度之比约为2∶1.HSC-Cup诱发眼震方向与转头方向相反,向健侧转头诱发眼震的强度明显大于向患侧转头,其强度之比约为2∶1,差异具有统计学意义(t=-7.634,P＜0.01);而向健侧和向患侧转头诱发眼震的潜伏期,差异则无统计学意义(t=1.670,P=0.101).HSC-Can滚转试验中向患侧转头诱发眼震的潜伏期、强度均大于HSC-Cup向健侧转头,但差异无统计学意义(t值分别为1.554和0.305,P值均＞0.05).结论 水平半规管BPPV患者滚转试验向左右侧转头诱发眼震的强度均遵循Ewald定律,强弱之比约为2∶1;潜伏期、持续时间及强度等眼震图参数可作为BPPV的客观诊断指标.     

Natural course of positional vertigo in patients with apogeotropic variant of horizontal canal benign paroxysmal positional vertigo

Objective

The purpose of this study was to assess the natural course of positional vertigo in patients with the apogeotropic variant of horizontal canal type of benign paroxysmal positional vertigo (AH-BPPV), which is reported to be more refractory to physiotherapy than the geotropic variant of horizontal canal type of BPPV (GH-BPPV).

Methods

14 patients with AH-BPPV treated without physiotherapy were asked to visit the hospital every 2 weeks. At every follow-up visit, they were interviewed and positional nystagmus was assessed. After the disappearance of positional nystagmus, patients were asked about the time of cessation of the positional vertigo. Thus, the primary outcomes were evaluated by the self-reported onset and remission of positional vertigo. The time course of remission of positional vertigo was then calculated.

Results

The average and median period from the onset to natural remission of positional vertigo in patients with AH-BPPV was 13 and 7 days, respectively.

Conclusion

We have already reported that the average and median period from the onset to natural remission of positional vertigo in patients with GH-BPPV was 16 and 7 days, respectively (Imai et al., 2005 [8]). Thus, the natural course of AH-BPPV is not as refractory as that of GH-BPPV.     

Subjective visual horizontal in patients with posterior canal benign paroxysmal positional vertigo

CONCLUSION: Patients with posterior canal benign paroxysmal positional vertigo (p-BPPV) could have mild excitation in the vestibular system on the affected side. OBJECTIVE: p-BPPV is considered to be caused by small particles dislodged from the utricular macula. While subjective visual horizontal (SVH) mainly reflects utricular function, there is less documentation on SVH in patients with p-BPPV. The purpose of this study was to clarify whether p-BPPV could affect SVH. PATIENTS AND METHODS: Twenty-eight patients with unilateral idiopathic p-BPPV were enrolled. For comparison, 17 patients with vestibular neuritis and 45 patients with cerebello-pontine angle (CPA) tumor were also examined. For measurement of SVH, we used a device that has a red bar of light-emitting diodes (LEDs) in front of the patient. Subjects were asked to rotate the bar to the position that they felt was horizontal in a completely dark room. RESULTS: Deviation of SVH toward the unaffected side down was seen in 82.1% (23/28) of patients with p-BPPV. Mean+/-SD deviation of SVH from the true horizontal to the unaffected side down was 0.49+/-1.21 degrees. Conversely, deviation of SVH was toward the affected side down in 88.2% of patients with vestibular neuritis and in 75.6% of patients with CPA tumor.     

Benign paroxysmal positional vertigo of the horizontal canal

The benign positional vertigo of the horizontal canal seems to find its origins in a canalolithiasis. The diagnosis is usually easy when its characteristics are perfectly known. A horizontal nystagmus does not always mean that the vertigo is of a central origin. This canal is exclusively connected, via the brainstem, to the external and internal oculomotor muscles so that the movement obtained by its stimulation can only be horizontal! This is quite different from what is obtained for the posterior canal, which is connected to various oculomotor muscles. Specific therapeutic maneuvers have to be carried out to be efficient: if properly performed, the otoconias, heavy particles sensitive to gravity, are easily mobilized. This paper describes the pathophysiology of the positional vertigo of the horizontal canal, diagnosis of its two presentations, and therapeutic possibilities.     

以持续性眩晕为表现的水平半规管良性阵发性位置性眩晕的诊治

目的　探讨以持续性眩晕为表现的良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）患者的诊治。方法　回顾性分析2例以持续性眩晕为表现的BPPV患者的临床资料。结果　此2例患者在坐位及平躺位见方向向患侧的水平自发持续性眼震,甩头试验健侧阳性,平卧侧头试验双侧均诱发出水平离地性眼震,平躺后头部向患侧连续转360°时分别出现2个眼震消失点和2个眼震最强点,给予手法复位后患者眩晕症状缓解。结论　水平半规管BPPV患者偶可表现为持续性眩晕发作,其病因为壶腹嵴帽耳石症,临床表现与耳石重力因素和水平半规管空间位置相关。     

Differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV)

This article presents an approach to differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Such an approach is essential because of the difference in intervention between the two disorders in question. Results from evaluation of the case study presented here revealed a persistent ageotropic positional nystagmus consistent with MPV or a cupulolithiasis variant of HC-BPPV. The patient was treated with liberatory maneuvers to remove possible otoconial debris from the horizontal canal in an attempt, in turn, to provide further diagnostic information. There was no change in symptoms following treatment for HC-BPPV. This case was diagnosed subsequently as MPV, and the patient was referred for medical intervention. Treatment has been successful for 22 months. Incorporation of HC-BPPV treatment, therefore, may provide useful information in the differential diagnosis of MPV and the cupulolithiasis variant of HC-BPPV.     

Differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV)

This article presents an approach to differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Such an approach is essential because of the difference in intervention between the two disorders in question. Results from evaluation of the case study presented here revealed a persistent ageotropic positional nystagmus consistent with MPV or a cupulolithiasis variant of HC-BPPV. The patient was treated with liberatory maneuvers to remove possible otoconial debris from the horizontal canal in an attempt, in turn, to provide further diagnostic information. There was no change in symptoms following treatment for HC-BPPV. This case was diagnosed subsequently as MPV, and the patient was referred for medical intervention. Treatment has been successful for 22 months. Incorporation of HC-BPPV treatment, therefore, may provide useful information in the differential diagnosis of MPV and the cupulolithiasis variant of HC-BPPV.     

水平背地性眼震良性阵发性位置性眩晕的诊断和手法复位

目的：验证一种新的用于治疗水平背地性眼震良性阵发性位置性眩晕（apogeotropicHSC—BPPV）的手法复位方法。方法：该研究采取改良的SupineRollTest（M-RollTest）方法共诊断出l78例水平半规管良性阵发性位置性眩晕（HSC-BPPV）患者,其中37例apogeotropicHSC—BPPV纳入该研究样本,占发病数的20．79％。采用管石重置手法先将37例apogeotropicHSC—BPPV患者水平背地性眼震转变为水平向地性眼震;此后,施行传统barbecue法进行手法复位。管石重置手法如下：①患者取仰卧头垫高30°体位静卧;②10min后头快速向患侧转90°;③2min后头向中线回旋45°;④保持体位2min后患者恢复仰卧头高30°体位;静卧10min后,采用M—RollTest检查验证患者是否出现双侧水平向地性眼震。如管石重置失败,重复以上手法多次,直至出现双侧水平向地性眼震为止。结果：36例双侧水平背地性眼震经水平背地性眼震管石重置手法全部转变为双侧不同强度的水平向地性眼震,其中,18例经1次,11例经2次,4例经3次,3例经4～6次。1例经1次管石重置手法后自觉症状减轻,再次行M—RollTest检查证明水平眼震消失,但Dix-hallpike手法复位检查出现同侧上跳性扭转性眼震,确诊为同侧后半规管良性阵发性位置性眩晕（PSC-BPPV）。该组管石重置成功率为为97．3％。36例HSC—BPPV患者经barbecue法手法复位全部一次性获得成功,1例PSC—BPPV患者经Eptey管石复位法一次性获得成功。结论：该研究设计的水平背地性管石重置手法是治疗apogeotropicHSC—BPPV的必要手段,简便易学、成功率高,患者舒适度好,相对依从性高。     

水平半规管良性阵发性位置性眩晕的眼震特点和治疗

目的:探讨水平半规管良性阵发性位置性眩晕(HSC-BPPV)的眼震特点和治疗方法.方法:对43例HSC-BPPV患者应用红外线视频眼动记录仪分析其变位试验诱发的眼震特点,进行分型、定侧,并采用相应的耳石复位法治疗.结果:43例患者中:①水平向地性眼震患者27例,其中19例接受Barbecue翻滚疗法,或结合强迫侧卧体位疗法,8例不适于翻滚或体位维持困难者接受AspreUa法治疗;②水平背地性眼震16例,其中自行或采用Gufoni疗法后转变为水平向地性眼震12例,方向不能转换4例,采用Barbecue翻滚和(或)强迫侧卧体位疗法.1周后随访总有效率为72.1%,3个月后总有效率为81.4%.结论:HSC-BPPV的诊断和治疗应根据不同变位试验诱发的眼震特征判别耳石位于半规管的不同部位及不同发病机制类型,并选择合适的耳石复位技术治疗.     

Postural control in horizontal benign paroxysmal positional vertigo

Sixteen patients affected by benign paroxysmal positional vertigo of the horizontal semicircular canal (BPPV-HSC) were investigated by means of dynamic posturography (DP) and during bithermal caloric stimulation. Data were compared to data from 40 patients with benign paroxysmal positional vertigo of the posterior semicircular canal (BPPV-PSC) and 20 healthy controls. No postural deficit was observed before or after a liberative Lempert’s manoeuvre when patients were compared to control subjects. BPPV-PSC postural scores were significantly impaired compared to scores from the BPPV-HSC group. A residual significant postural impairment was also observed after a successful liberative manoeuvre in the BPPV-PSC group. Electronystagmographic recordings before recovery revealed significant hypoexcitability of the affected ear in 8/16 patients of the BPPV-HSC group. After the liberative manoeuvre, a symmetric bilateral response to caloric stimulation was recorded in all patients. Three main conclusions can be drawn from the present data. First, disorders of the horizontal semicircular canal do not change postural control. Second, dynamic posturography can detect the postural imbalance due to posterior semicircular canal dysfunction even after resolution of paroxysmal vertigo attacks. Third, utricular dysfunction can be ruled out as a cause of the residual postural deficit observed in BPPV-PSC patients. Therefore the recovery delay observed even 1 month after the liberative manoeuvre in the BPPV-PSC-group might be due to the persistence of small amounts of residual debris in the canal, to paralysis of ampullar receptors, or to the time needed for central vestibular re-adaptation. Received: 2 December 1999 / Accepted: 17 February 2000     

Insights into horizontal canal benign paroxysmal positional vertigo from a human case report

For horizontal canal benign paroxysmal positional vertigo, determination of the pathologic side is difficult and based on many physiological assumptions. This article reports findings on a patient who had one dysfunctional inner ear and who presented with horizontal canal benign paroxysmal positional vertigo, giving us a relatively pure model for observing nystagmus arising in a subject in whom the affected side is known a priori. It is an interesting human model corroborating theories of nystagmus generation in this pathology and also serves to validate Ewald's second law in a living human subject. Laryngoscope, 123:3197–3200, 2013