继发于突发性聋的良性阵发性位置性眩晕的临床治疗分析

目的　回顾性分析继发于突发性聋的良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）患者的临床表现,并探讨其可能的发病机制,探索合适的诊断与治疗方案。方法　观察218例突发性聋患者中BPPV的发病情况和临床治疗效果,另有37例同期原发性BPPV作为对照组。所有患者均经Dix-Hallpike实验和Barbecue滚转检查确定诊断,继发性BPPV患者的原发病（突发性聋）符合中华医学会耳鼻咽喉头颈外科学分会制定的诊断标准。按照BPPV类型,进行Epley手法复位或Barbecue翻滚手法治疗,并评价治疗效果。结果　218例突发性聋患者中有9l例出现BPPV,发生率41.7%,均为同侧患耳。BPPV经耳石复位,其中1次治愈62例（68.1%）,2次治愈16例（17.6%）,3次治愈13例（14.3%）。随访6～22个月,高频听力改善均不及低频,外半规管型BPPV复发2例,后半规管型复发5例,经过再次复位后治愈。继发性BPPV与原发性BPPV均经手法复位治愈,疗效相似。结论　BPPV可继发于突发性聋,且突发性聋继发BPPV可达41.7%,其中以后半规管BPPV常见,耳石复位治疗是最为有效的治疗方法,治愈率与原发性BPPV相似。     

内耳病变并发良性阵发性位置性眩晕

目的了解继发于几种内耳疾病的良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）的发病情况，进一步了解BPPV的可能发病机制。方法观察眩晕诊疗中心2004年1月至2006年11月53例前庭神经炎、90例突发性聋（包括伴眩晕的突发性聋）、381例梅尼埃病BPPV等的发病情况，并与同期183例原发性BPPV比较。结果4种内耳疾病后可以出现BPPV，分别是前庭神经炎、突发性聋、梅尼埃病和Bell麻痹。前庭神经炎后出现BPPV为9．4％（5／53）；突发性聋后出现BPPV为38．9％（35／90）；梅尼埃病后出现BPPV为0．3％（1／381）；1例Bell麻痹后出现BPPV。其中外半规管BPPV5例；后半规管37例，其中1例后半规管BPPV在复位过程中出现同侧前半规管BPPV。管结石症39例，外半规管嵴顶结石症3例。内耳病变后出现BPPV在发病后半年内出现者占75．0％（27／36）。继发性BPPV的手法复位效果与原发性BPPV相似，大多都可1、2次就诊后治愈。结论内耳病突发性聋、前庭神经炎和梅尼埃病后可以出现BPPV。这种类型的BPPV主要表现为后半规管管结石，偶见外半规管嵴帽结石。原发性BPPV与内耳病变后出现的BPPV手法复位疗效相似。     

突发性聋并发良性阵发性位置性眩晕的临床分析

目的研究突发性聋并发BPPV(benign paroxysmal positional vertigo,BPPV)的临床特点及预后,探讨其可能发病机制。方法回顾性研究198例突发性聋患者的临床资料,根据有无眩晕、眩晕特点和变位试验结果确诊是否并发BPPV,分析突发性聋并发的BPPV的临床特点及预后,并与同期59例原发性BPPV进行比较。结果 28例全聋型突发性聋并发BPPV,BPPV发病均在突聋后1周内,最常见类型是水平半规管BPPV,其次是后半规管BP-PV,而原发性BPPV最常见类型是后半规管BPPV,其次是水平半规管BPPV;突发性聋并发的BPPV手法复位的治愈率和复发率与原发性BPPV相似。结论突发性聋并发的BPPV最常见类型是水平半规管BPPV,其次是后半规管BPPV;其手法复位的治愈率和复发率与原发性BPPV相似。     

继发于突发性聋的良性阵发性位置性眩晕的疗效分析

目的:探讨突发性聋继发的良性阵发性位置性眩晕(BPPV)手法复位与原发性BPPV手法复位的疗效差异.方法:将392例BPPV患者分为突发性聋伴BPPV组(64例)和原发性BPPV组(328例),所有患者均经位置试验确诊为BPPV,行手法复位后1周,评估其疗效.结果:突发性聋伴BPPV组患者经手法复位治疗1周后评估,治愈...     

突发性聋伴发良性阵发性位置性眩晕的临床特点及疗效观察

目的　探讨突发性聋伴发良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的临床特点,观察其疗效。方法　观察2012年10月～2014年6月耳 鼻咽喉科收治的36例突发性聋伴发BPPV发病情况,并与同期原发性BPPV患者40例及突发性聋不伴眩晕患者40例进行疗效比较。结果　伴发BPPV的36例突发性聋患者,受累半规管均与突发性聋发病侧一致,其中水平半规管BPPV 6例,占16.7%（6/36）;后半规管BPPV 27例,占75.0%（27/36）;混合管BPPV 3例,占8.3%（3/36）。36例患者出现BPPV的时间均在突发性聋发病后数小时至数天（＜10天）发生。突发性聋伴发BPPV组1次治愈率明显低于原发性BPPV组,但两种治疗方法的总治愈率均为100%。不伴眩晕突发性聋组的痊愈率、显效率及有效率均高于伴发BPPV组。结论　伴发于突发性聋的BPPV以后半规管多见,与原发性BPPV经耳石复位治疗后均可取得较好疗效。而不伴眩晕的突发性聋其疗效优于伴发BPPV的突发性聋。     

继发于突发性聋的良性阵发性位置性眩晕的诊治分析

目的回顾性分析继发于突发性聋的良性阵发性位置性眩晕(BPPV)的临床特征与诊治效果。方法回顾性分析2011年1月~2017年1月在我科诊疗的30例继发于突发性聋的良性阵发性位置性眩晕病例资料。结果在30例突发性聋合并BPPV患者中,女19例,男11例;年龄16~83岁,平均52岁;听力曲线呈全聋型、平坦型和中频下降型者分别有23例、5例和2例;BPPV中后半规管BPPV占25例,水平半规管BPPV 4例,多半规管BPPV 1例;突聋与BPPV多发生于同一侧(29例)。手法复位治疗后2周和1个月其总有效率分别为60%和73%。结论突发性聋合并BPPV患者其耳聋多呈全聋型,BPPV多为累及后半规管者,突聋与BPPV多发生于同一侧,通过手法复位治疗多数BPPV可获缓解,但其疗效不及原发性BPPV。     

继发于突发性聋的良性阵发性位置性眩晕的临床特点

目的:回顾性分析继发于突发性聋的良性阵发性位置性眩晕(BPPV)患者的临床表现和治疗结果,并探讨其可能的发病机制。方法:观察178例突发性聋患者中继发BPPV的发病情况和治疗效果,所有患者均按照中华医学会耳鼻咽喉科学分会制订的诊治标准。结果:①突发性聋患者中有31例继发BPPV,后半规管BPPV26例,水平半规管BPPV 5例;均发生于突发性聋同侧的患耳,左耳16例,右耳15例。②突发性聋至继发BPPV的间隔在1周内27例,1周～1个月3例,1～3个月1例。③所有继发于突发性聋的BPPV均经手法复位治愈。结论:BPPV可继发于突发性聋,其中以后半规管BPPV常见,耳石复位是有效的治疗方法。     

继发突发性聋的良性阵发性位置性眩晕

目的 回顾性分析继发于突发性聋的良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的临床特点,并探讨该病的诊断与治疗特点.方法 突发性聋伴BPPV患者19例,全部进行了手法复位治疗,并评价其治疗效果.结果女性患者63.2％,男性36.8％;本组BPPV均继发于突发...     

突发性聋伴良性阵发性位置性眩晕的预后分析

目的探讨突发性聋伴良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者的预后。方法回顾性分析105例突发性聋患者的临床资料,根据有无伴眩晕以及体位试验的结果分为三组:突发性聋伴BPPV组(13例)、突发性聋伴非BPPV眩晕组(27例)、突发性聋不伴眩晕组(65例),比较三组患者治疗前后的听力情况。结果突发性聋伴BPPV组与突发性聋伴非BPPV眩晕组听力损失较突发性聋不伴眩晕组重,且预后相对较差。结论 BPPV是突发性聋的不良预后因素,耳石手法复位对BPPV治疗有效。     

突发性聋的针灸治疗

突发性聋又称突发性感音神经性聋，老年人多发。近年来临床接诊40例（44耳）60岁以上老年突发性聋患者，采用针灸治疗，并与40例（48耳）常规药物治疗的患者进行对比研究，现报告如下。     

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。     

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.     

手法复位治疗良性阵发性位置性眩晕36例

目的 评价体位治疗在良性阵发性位置性眩晕（BPPV）的应用价值。方法 回顾性分析36例原发性或继发性BPPV的临床资料,后半规管BPPV采用改良Epley手法或Semont手法复位,水平半规管采用Barbecue翻滚疗法复位治疗,评价其治疗效果。结果 33例后半规管BPPV患者应用改良Epley手法或Semont手法复位,有效率为93.9%。3例水平半规管BPPV患者采取Barbecue翻滚法复位后症状均明显改善。结论 手法复位治疗良性阵发性位置性眩晕方法简单,疗效可靠,治愈率高。     

突发性聋伴良性阵发性位置性眩晕患者的预后研究

目的：研究突发性聋（突聋）伴良性阵发性位置性眩晕（BPPV）患者的预后情况。方法：分析24例突聋伴BPPV患者的临床资料,并与同期125例突聋不伴BPPV患者进行比较。结果：突聋伴BPPV和突聋不伴BPPV患者治疗后3个月听力恢复的总有效率分别为41．67％和72．80％,差异有统计学意义（P〈O．05）。结论：突聋伴BPPV患者听力的预后比突聋不伴BPPV患者更差,BPPV是突聋患者听力预后不良的一个影响因素。     

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.     

Delayed diagnosis and treatment of benign paroxysmal positional vertigo associated with current practice

The purposes of this study were to demonstrate the current status of benign paroxysmal positional vertigo (BPPV) management and the advantages of repositioning maneuvers as well as to facilitate the accurate and efficient diagnosis and management of BPPV. Of 131 participants with severe dizziness/vertigo who were examined and treated, 31 (23.7 %) fulfilled the diagnostic criteria for BPPV. All patients in the study had a diagnosis of BPPV confirmed by their history, typical subjective symptom reports, and characteristic positional nystagmus during the Dix–Hallpike test and/or roll test. All participants were comprehensively interviewed regarding their medical history, characteristics of the first attack of vertigo, associated symptoms, previous financial costs, and number of hospital visits. The average duration from the appearance of the first symptoms until a final diagnostic positional maneuver was >70 months. On average, patients visited hospitals more than eight times before the final diagnosis due to initial visits to inappropriate departments, including neurology, emergency, orthopaedic surgery, and Traditional Chinese Medicine, with a corresponding average financial cost of more than 5,000 RMB. The canalith repositioning procedure (CRP) was effective in 80.65 % of patients after the first repositioning maneuver. Our data demonstrated that despite the significant prevalence of BPPV, delays in diagnosis and treatment frequently occur, which have both cost and quality-of-life impacts on both patients and their caregivers. The CRP is very effective for patients with BPPV. It is important for patients to pay more attention to the impact of BPPV on their lives and recognize its nature to ensure compliant follow-up in otolaryngology.     

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。