复发和非复发良性阵发性位置性眩晕患者温度试验结果比较

目的　比较复发和非复发良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）患者温度试验特点。方法　收集同期就诊79例BPPV患者,随 访后分为复发组26例和非复发组53例,均采用冷热温度试验检测一侧减弱（unilateral weakness,UW）发生率,并对结果进行比较分析。结果　复发组UW19例（73.08%）,非复发组UW26例（49.06%）,二者比较差异有统计学意义（χ 2=4.11,P＜0.05）。复发组温度试验UW正常或轻度减弱10例（38.46%）,非复发组37例（69.81%）,二者比较差异有统计学意义（χ 2=7.11,P＜0.01）。后半规管BPPV患者UW31例（56.36%）,外半规管BPPV患者UW14例（58.33%）,二者比较差异无统计学意义（χ 2=0.02,P＞0.05）。45例温度试验异常的BPPV患者中,减弱侧和病变侧不一致率高（57.78%）。两组优势偏向（directional preponderance,DP）异常率比较差异无统计学意义（χ 2=0.16,P＞0.05）。结论  复发组UW发生率高于非复发组,且复发组UW程度较非复发组严重。温度试验为BPPV患者的治疗及预后提供参考依据。     

Management of 210 patients with benign paroxysmal positional vertigo: AMC protocol and outcomes

Conclusion: Benign paroxysmal positional vertigo (BPPV) could be treated with specific maneuvers for the involved canals. Management on a daily basis gave earlier relief than weekly treatment, especially in apogeotropic BPPV. Apogeotropic and multi-canal BPPVs were related to the increased numbers of follow-ups and trauma was related to the increased recurrence. Objective: We aimed to report the short-term outcomes of our protocol for BPPV and evaluate the factors influencing the results and recurrence. Methods: In 210 BPPV patients, posterior semicircular canal (PSCC), geotropic and apogeotropic lateral canal BPPVs were treated with the Epley maneuver, barbecue maneuver, and barbecue maneuver after head-shaking. The total number of follow-ups needed to have no provoked nystagmus, success rates at 1 week and 1 month, and factors for repeated maneuvers or recurrence were identified. Results: Apogeotropic and multi-canal BPPV needed more follow-ups than PSCC BPPV. Multi-canal BPPV showed a significantly lower 1-week success rate than other types. Anterior and multi-canal BPPV showed significantly lower 1-month success rates than other types. The 1-week success rates for PSCC and geotropic and apogeotropic BPPV in patients followed up on a daily basis were higher than those in patients with weekly follow-up and the difference was significant only in apogeotropic BPPV. The overall 1-year recurrence rate was 16% and higher recurrence rate was related to trauma.     

Benign paroxysmal positional vertigo: 10-year experience in treating 592 patients with canalith repositioning procedure

OBJECTIVE: To assess the long-term efficacy of canalith repositioning procedure (CRP) in the treatment of patients with benign paroxysmal positional vertigo (BPPV). BACKGROUND: Alternative theories for the pathophysiology of BPPV have been redefined in the past few years. CRP is considered to be the standard technique for its management. However, long-term follow-up results have been minimally reported in the literature. PATIENTS/METHODS: Five hundred ninety-two patients, 290 (49%) men and 302 (51%) women, were enrolled in this prospective study; their ages ranged from 18 to 84 (mean 59) years. At the time of their first examination, patients reported the duration of symptoms varied from 1 day to 18 months. Inclusion criteria were patient history compatible with BPPV and positive provocative maneuver (either Dix-Hallpike or Roll test). A variant of Epley and Barbeque maneuver was used. The Epley maneuver was used for posterior and anterior canal involvement, and "Barbeque roll" was used for horizontal canal involvement. Short-term follow-up was obtained 48 hours and 7 days after initial treatment, whereas long-term follow-up was obtained at repeated 6 month intervals. RESULTS: The posterior semicircular canal was involved in 521 (88%) patients treated, whereas the horizontal and anterior semicircular canals were involved in 59 (10%) and 12 (2%) patients, respectively. Symptoms subsided immediately in 497 (84%) patients. In 77 (13%) patients, the Dix-Hallpike maneuver remained positive after 48 hours, and CRP was performed again. Patients' mean follow-up was 46 months; 544 (92%) of 592 patients treated reported no symptoms of vertigo. CONCLUSION: Our data, based on long-term follow-up, suggest that CRP remains an efficient and long-lasting noninvasive treatment for BPPV.