Epley法和Semont法治疗后半规管良性阵发性位置性眩晕的疗效比较

目的探讨采用Epley管石复位法和Semont管石解脱法治疗后半规管良性阵发性位置性眩晕的疗效。方法将100例确诊为原发性后半规管良性阵发性位置性眩晕的患者随机分为Epley法组和Semont法组,Epley法组给予Epley管石复位法治疗,Semont法组给予Semont管石解脱法治疗,统计治疗1周后的疗效,并随访6个月。结果 Epley法50例,治愈40例,有效3例,无效7例,6个月后复发6例;Semont法50例,治愈31例,有效13例,无效6例,6个月后复发7例。治愈率:Epley法为80%,Semont法为62%,两组比较差异有统计学意义(χ~2=3.93,P0.05);总有效率:Epley法为86%,Semont法为88%,两组比较差异无统计学意义(χ~2=0.019,P0.05);6个月后复发率:Epley法为12%,Semont法为14%,两组比较差异无统计学意义(χ~2=0.019,P0.05)。结论Epley法治疗后半规管BPPV的短期治愈率明显高于Semont法,Epley法应被视为后半规管BPPV的一线首选治疗方法。     

不同复位手法治疗后半规管良性阵发性位置性眩晕疗效及原因分析

目的　探讨不同复位手法治疗后半规管良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）疗效及原因。方法　回顾性分析我院2013年6月 ～2016年12月300例后半规管BPPV患者临床资料，按照患者治疗方法不同分为A组156例，施行Epley复位手法；B组144例，施行Semont管石解脱法。比较两组患者治疗效果、复发率并分析效果不佳的原因。结果　B组患者首次疗效、1周疗效及1个月疗效均明显好于A组（χ2=4.371、5.294及4.542，P 均＜0.05）；Semont管石解脱法治疗管结石症与嵴顶结石症疗效均较好，Epley管石复位法治疗嵴顶结石症疗效较差；两组复发率无明显差异（P＞0.05）。结论　Semont 管石解脱法治疗后半规管BPPV管结石症与嵴顶结石症疗效均较好，Epley管石复位法治疗嵴顶结石症疗效较差。两组BPPV复发率均较高。     

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。     

手法复位治疗良性阵发性位置性眩晕疗效观察

目的 探讨手法复位治疗良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的方法和效果.方法 根据受累半规管的不同,将对64 例明确诊断为BPPV的患者分为两组,后半规管BPPV(PC-BPPV)组61例,行改良Epley 方法治疗,水平半规管BPPV(HC-BPPV)组3例,行改良Semont方法治疗,7~10天后观察治疗效果.结果 61例PC- BBPV患者中,治愈56例(91.8%),有效3例(4.92%),无效2例(3.28%);3例HC-BPPV患者中治愈2例,有效1例.结论 应用Epley法和Semont法手法复位治疗PC-BPPV和HC-BPPV方法简单,安全可靠,疗效肯定.     

后半规管良性阵发性位置性眩晕三种自我治疗手法的疗效比较

目的 对后半规管良性阵发性位置性眩晕三种自我治疗手法(改良Epley法、改良Semont法和Brandt-Daroff法)进行临床疗效和复发率的对比研究.方法 168例患者随机抽签法分为四组,改良Epley组45例,改良Semont组43例,Brandt-Daroff组40例和对照组40例,对照组仅给予药物治疗不使用复位法.比较四组治疗1周和1个月时的疗效、不良反应发生率以及6个月时的复发率,并对四组达到治愈所需的时间进行比较.结果 改良Epley法治疗1周时疗效优于其他三组,差异具有统计学意义(x2=8.55、23.23及44.00,P值均＜0.01),1个月疗效优于Brandt-Daroff法(x2=8.42,P＜0.05).改良Semont法1周疗效优于对照组(x2=14.49,P＜0.01),1个月疗效与对照组比较差异无统计学意义(x2=0.01,P＞0.05).Brandt-Daroff法疗效较差,1周和1个月疗效与对照组比较,差异均无统计学意义(x2=3.35及0.18,P值均＞0.05).Kaplan-Meier生存曲线比较四组的治愈时间,经Log-rank检验分析,改良Epley组治愈时间短于其他三组,差异具有统计学意义(x2=10.850、25.779及35.085,P值均＜0.01).眩晕、恶心、呕吐、心悸等不良反应的发生率在三个物理治疗组间差异无统计学意义.治疗6个月时四组的复发率比较,差异无统计学意义(x2=4.076,P=0.253).Logistic回归分析显示,年龄和治疗前病程长短是复发的独立预测因素,而复位方法、性别、患侧、病因和发病次数等与复发无关.结论 改良Epley法在快速缓解后半规管良性阵发性位置性眩晕症状方面优于改良Semont法和Brandt-Daroff法,可作为反复发作患者的一线治疗选择,但该方法并不能降低复发率.     

2118例良性阵发性眩晕患者手法复位疗效观察

目的收集在2008年1月~2013年12月广西医科大学第一附属医院耳鼻咽喉-头颈外科确诊并治疗的2118例BPPV患者的资料进行疗效分析。方法对2118例BPPV患者分别应用改良三步快速手法复位法、Epley复位法和Barbecue复位法进行复位治疗,于诊治后随访6个月。结果 12118名患者中男971例(45.85%),女1147例(54.15%);年龄8~87岁,发病平均年龄(49.36±11.73)岁,后半规管BBPV 2005例(94.66%)、水平半规管BBPV 88例(4.16%)、上半规管BBPV 14例(0.66%)、混合半规管BBPV 11例(0.52%)。2有1366例后半规管BPPV行传统Epley法治疗,639例行改良三步快速手法复位法治疗,两组首次有效率分别为90.6%、89.8%,远期(半年)有效率93.8%、95.8%,两组远期效率无统计学差异(χ~2=3.293,P>0.05);水平半规管Barbecue和Gufoni治疗,首次有效率92.7%,远期(半年)有效率98.6%;上半规管Epley治疗,首次有效率78.6%,远期(半年)有效率85.7%;混合型半规管联合复位治疗,首次有效率78.6%,远期(半年)有效率85.7%;3传统Epley手法复位组复发率为19.39%,改良三步快速手法复位组复发率为18.3%,两组复发率比较无统计学差异(χ~2=1.865,P>0.005)。4复发患者回院治疗率,传统Epley手法复位组为100%,改良三步快速手法复位组为18.3%,两组比较统计学差异显著(χ~2=1.865,P>0.005)。5复发患者复发1~2次的所占比例传统Epley手法复位组及三步快速手法复位组分别为43.4%、71.2%,复发次数≥3次的比例两组分别为56.6%、27.9%。两组复发次数≥3次的比例进行比较,有统计学差异(χ~2=32.34,P<0.01)。结论 BPPV患者采用手法复位治疗疗效肯定,见效快,方法简单,远期疗效好,手法复位是BPPV患者的最佳的治疗方法。     

家庭式改良Epley法补充性治疗后半规管BPPV的疗效观察

目的观察家庭式改良Epley法补充性治疗后半规管BPPV的疗效。方法将2019年1月～2019年6月三甲医疗机构确诊的80例后半规管BPPV患者按随机数据表法分为对照组和治疗组,每组40例,对照组:在三甲医疗机构眩晕专科医师给予患者传统Epley法治疗,治疗组:在三甲医疗机构模拟家庭环境,以医患共同参与的医疗模式给予改良Epley法治疗,如患者仍有残余头晕或者位置性眩晕复发,予补充家庭式改良Epley法自我复位治疗。统计两组患者治愈率,记录两组患者治疗1天及1周后眩晕残障量表(DHI)评分。结果治疗1天后,治疗组治愈率85%,对照组治愈率60%,治疗组治愈率明显高于对照组(P<0.05);治疗1周后,治疗组治愈率92.5%,对照组治愈率87.5%,两组治愈率相当(P>0.05);治疗1天后、1周后治疗组的DHI得分均低于对照组(P<0.05),两组复位治疗过程均未出现严重不良反应。结论家庭式改良Epley法能有效、安全的补充性治疗后半规管BPPV,这一医患共同参与的医疗模式值得在临床上推广。     

良性阵发性位置性眩晕的简单治疗法

良性阵发性位置性眩晕（BPPV）是多种常见的外周性前庭紊乱中的一种，其发病机理有两种①半规管终须结石：砂粒粘着于后半规管的终顶引起的眩晕和服震；②半规管结石：砂粒游动于后半规管长臂中导致眩晕和眼震。其治疗方法已有多种，传统治疗了法为Brand－Daroff锻炼法。由于病人在锻炼过程中要耐受反复头位改变引起的眩晕而难以接受。本文对两种简单治疗方法即Semont法和EPley氏法进行研究比较。病人选取60例BPPV病人，平均年龄58土17岁，女44例，男16例，随机分为Semont法治疗组和改良Epley法治疗组，各30例。治疗方法：①Semont法…     

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.     

318例良性阵发性位置性眩晕的诊治分析

目的:研究不同类型良性阵发性位置性眩晕(BPPV)的诊断、治疗及疗效。方法:回顾性分析318例BPPV患者的资料,根据变位试验诱发的眼震特点进行分型,并采用相应的耳石复位技术治疗,对治疗1次无效者间隔7d重复治疗,重复3次无效者采用Brandt-Daroff习服练习;完成治疗后随访观察总有效率。结果:①后半规管BPPV患者221例(69.5%),采用Epley管石复位法;②水平半规管BPPV患者62例(19.5%),采用Bar-becue翻滚加强迫侧卧体位疗法;③前半规管BPPV患者23例(7.2%),采用Epley管石复位法;④混合型BPPV患者12例(3.8%),采用Epley加Barbecue翻滚联合治疗。1周后随访总有效率为82.1%(261/318),3个月后随访总有效率为91.8%(292/318)。结论:结合病史,根据不同变位试验诱发的眼震特征对BPPV患者进行诊断并采用相应手法复位治疗是一种非常有效的方法,能有效缩短病程,减轻患者痛苦,可在临床广泛应用。     

Success of the modified Epley maneuver in treating benign paroxysmal positional vertigo.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is a common condition seen by otolaryngologists. The purpose of this study is to determine the ability of the modified Epley maneuver to treat BPPV. STUDY DESIGN: Retrospective review. METHODS: A retrospective chart review of 107 patients diagnosed with BPPV at our institution between March of 1993 and June of 1995. Each patient was diagnosed with isolated BPPV by history and Hallpike-Dix maneuver. There were no other vestibular symptoms or electronystagmogram abnormalities. Patients diagnosed with BPPV received modified Epley maneuvers, were instructed to remain upright for 48 hours, and wore a soft collar for a week. Patients were followed up with repeat Hallpike-Dix maneuvers at 1 to 2 weeks. If symptoms persisted, the maneuver was repeated for up to a maximum of three times, at which point patients were considered to have failed treatment. RESULTS: The average age of patients was 57.8 years old. Thirty percent were male and the right ear was affected in 54%. The posterior semicircular canal was affected in 105 ears. The average patient received 1.23 Epley maneuvers, with a success rate of 93.4%. No successfully treated patients received mastoid vibration. Seven out of 107 patients failed after three Epley maneuvers. Two failure patients had a history of temporal bone fracture. Two failure patients were treated with posterior semicircular canal block surgery. CONCLUSION: The modified Epley maneuver is an excellent treatment for BPPV.     

改良Semont方法治疗后半规管良性阵发性位置性眩晕的短期疗效研究

目的　研究改良Semont方法治疗后半规管良性阵发性位置性眩晕（posterior semicircular canal benign paroxysmal positional vertigo,PSC-BPPV）的短期疗效。方法　2015年10月～2016年4月在耳鼻咽喉科门诊经Dix-Hallpike试验及Roll试验,确诊为单侧PSC-BPPV管结石症患者93例,应用改良Semont方法治疗,观察复位后3 d和7 d有效率。结果　治疗过程中部分患者出现不同程度眩晕、恶心症状,但所有患者均顺利完成复位治疗。93例应用改良Semont复位法复位,3 d随访,痊愈、有效和无效分别为72、16和5例,治愈率77.4%,总有效率94.6%;1周随访,痊愈、有效和无效分别为84、5和4例,治愈率90.3%,总有效率95.7%。结论　改良Semont复位法治疗PSC-BPPV可靠有效,可以作为治疗PSC-BPPV的有效补充。     

Effects of postural restriction after modified Epley maneuver on recurrence of benign paroxysmal positional vertigo

Objective

In the present study, we calculated the success rate of the modified Epley maneuver and determined the effectiveness of post-maneuver positional restriction in terms of the prevention of early and late recurrence.

Methods

The present study was conducted on 78 patients who had unilateral benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal (SCC) and who were treated in the Otorhinolaryngology Department of Susehri State Hospital. The Dix–Hallpike test was performed on all patients. After the involved canal was identified using this test, we guided patients through the modified Epley repositioning maneuver. A maximum of two maneuvers were performed in the same session. The patients were randomly divided into two groups. One group was not advised any positional restriction, while the second group was advised positional restriction for 10 days after the procedure. Recurrences during 1–90 days after the treatment were noted as early recurrences, while those that occurred after 90 days were noted as late recurrences.

Results

In the restriction group (n = 39), repositioning was successful after a single maneuver in 32 (82.05%) patients and after two maneuvers in 5 (12.8%) patients. Repositioning failed in two (5.1%) patients. In the non-restriction group (n = 39), repositioning was successful after a single maneuver in 31 (79.4%) patients and after two maneuvers in 6 (15.3%) patients. Repositioning failed in two (5.1%) patients. Thus, the success rate was 94.8% in each group. Early recurrence occurred in 3 (8.1%) of 37 patients in the restriction group and 2 (5.4%) of 37 patients in the non-restriction group (p > 0.05). Late recurrence occurred in 5 (13.5%) of 37 patients in both the restriction and non-restriction groups (p > 0.05).

Conclusion

Postural restriction after a canalith repositioning procedure does not improve procedural success or decrease early and late recurrence rates. However, the number of patients was too small to detect a difference between both treatment groups.     

Effect of applying head-shaking maneuver before Epley maneuver in BPPV

IntroductionThe Epley maneuver is applied in the treatment of benign paroxysmal positional vertigo, the BPPV. However, dizziness and balance problems do not improve immediately after the treatment.ObjectiveIn this study, the effectiveness of the head-shaking maneuver before the Epley maneuver was investigated in the treatment of BPPV.MethodsBetween March 2020 and August 2020, ninety-six patients with posterior semicircular canal BPPV were analyzed prospectively. The patients were divided into two groups: patients who underwent the Epley maneuver only in the treatment (Group 1) and patients who underwent the Epley maneuver after the head-shaking maneuver (Group 2). The results of the Berg balance scale and dizziness handicap index were evaluated before the treatment and at the first week after the treatment.ResultsThe improvement in functional, emotional, and physical dizziness handicap index and Berg balance scale values after the treatment was found to be statistically significant in both groups. It was determined that the change in functional and physical dizziness handicap index and Berg balance scale values of the patients in Group 2 was statistically higher than those in Group 1. Although, the change in emotional dizziness handicap index values in Group 2 was higher than those in Group 1, no statistical significance was found between the groups.ConclusionAs a result of our hypothesis, we think that in the treatment of posterior semicircular canal BPPV, the otoliths adhered to the canal can be mobilized by the head-shaking maneuver, and this will contribute to the increase of the effectiveness of the Epley maneuver.     

The aspiration-irrigation maneuver

OBJECTIVES/HYPOTHESIS: To compare cultures obtained from the aspiration-irrigation maneuver (AIM) with other reports and compare diagnostic and therapeutic value after AIM versus the Proetz maneuver and needle aspiration-irrigation. STUDY DESIGN: Patients with radiographic evidence (mucous membrane thickness greater than 6 mm, air-fluid levels, or complete opacification) and symptoms (nocturnal cough, fever, postnasal drainage [PND], otitis, mucopurulent discharge from the nose) of sinus disease who were referred from pediatrician and/or family physician and who otherwise would be candidates for surgery were selected to receive treatment with AIM. The study was divided into three separate groups (54 patients who were age 8 years and younger, 54 patients who were age 9 years and older, and 32 adult patients who were treated with both needle aspiration and AIM. METHODS: Using Bernoulli's principle and the Venturi effect, saline and a vacuum apparatus were used to capture the contents of the sinuses for culture, and results were compared with results of needle aspirate cultures. RESULTS: Children's cultures from group 1 compared favorably with the literature (Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae or a combination of these); cultures in patients age 9 years and older revealed a greater variety of bacteria, depending on chronicity of infection, and a high incidence of Staphylococcus aureus (beta-lactamase positive). There was a 66% correlation of AIM with needle aspiration. CONCLUSIONS: AIM was found to be a safe, simple, painless, and inexpensive adjunct to the diagnosis and treatment of sinus disease.     

改良Valsalva法(玩具式自家鼓气吹鸣器)治疗分泌性中耳炎临床观察

目的评估使用玩具式自家鼓气吹鸣器治疗分泌性中耳炎的疗效.方法24名分泌性中耳炎患儿采用改良Valsalva法行咽鼓管吹张,每日3次以上,持续2周后复查,行耳科检查及听力学评估,包括耳镜检查、声导抗及纯音测听,无效者继续3月;另23名同样患儿作为对照组.结果治疗组患儿68%骨气导差减至小于15 dB,对照组为26%,治疗组患儿有62%其声导抗鼓室峰压值恢复正常(大于-100dapa),对照组有29%,统计学分析两组差异有显著性.结论玩具式自家吹鸣器进行改良Valsalva吹张治疗分泌性中耳炎是有效的,儿童使用时有浓厚兴趣,可作为一种治疗分泌性中耳炎的辅助器械.     

Repositioning intervals in the modified Epley’s maneuver and their effect on benign paroxysmal positional vertigo treatment outcome

Introduction: This study showed that short and long interval treatments achieved comparable success rates. There was no statistically significant difference in the rate of early and late recurrences between the two groups. Modified Epley maneuver can be applied in a short interval time with comparable success and recurrence rates which are as effective as in a long interval time.

Objective: The Epley maneuver is called the particle repositioning or canalith repositioning procedure. If a short time interval in each position is effective, it will allow for reduced time and avoid unnecessary physical burden. How long of a stay in each position is not determined in the literature. There is an absence of comparative studies of the BPPV repositioning time. The aim of this study is to compare the treatment time in patients with benign paroxysmal positional vertigo (BPPV).

Study design: Longitudinal prospective study.

Setting: Outpatient practice in a tertiary care facility.

Subjects and methods: Sixty consecutive patients with BPPV were included in this study. These patients were sequentially allocated to one of two groups (A or B). The interval times between each position in group A and B were 15 and 120?s, respectively. Modified Epley maneuver was performed in all patients. The maneuvers in both groups were exactly the same sequence of movements, except interval times.

Results: The mean age of the patients was 49.25 years (range =19–76 years). Of the 60 patients, 48 (80%) were women and 12 (20%) were men. Successful outcome was achieved in 26 patients (86.7%) after the first modified Epley maneuver in both groups. Three patients from each group (total six patients) responded to the third modified Epley maneuver and the remaining two patients did not respond to any modified Epley maneuver. Therefore, the Semont maneuver was applied with a successful result.     

Reliability of the pharyngeal squeeze maneuver

OBJECTIVES: Fiberoptic endoscopic evaluation of swallowing with sensory testing has been used to assess the integrity of laryngopharyngeal sensory and motor components. The pharyngeal squeeze is a maneuver used during fiberoptic endoscopic evaluation of swallowing with sensory testing to assess pharyngeal motor function. Although the pharyngeal squeeze manuever has been used in numerous scientific publications, its reliability has not been critically evaluated. Therefore, we sought to evaluate the reliability of the pharyngeal squeeze maneuver. METHODS: Forty individuals who were undergoing fiberoptic laryngoscopy for various reasons were instructed to perform the pharyngeal squeeze maneuver. Three different clinicians reviewed the videotape on 4 separate occasions. The clinicians were first asked to rate each side of the pharynx as normal, diminished, or absent. They were then instructed to simply rate the maneuver as normal or abnormal. The interobserver and intraobserver reliability of the pharyngeal squeeze maneuver were assessed with the kappa coefficient. RESULTS: The mean age of the cohort was 58 years. Fifty-eight percent (23 of 40) were male. When the clinicians were instructed to rate each side of the pharynx as normal, diminished, or absent, the interobserver and intraobserver reliabilities were poor (63% to 68% agreement; kappa = 0.18 to 0.67). When the clinicians were asked to rate the pharyngeal squeeze maneuver as normal or abnormal, both interobserver and intraobserver reliabilities were excellent (85% to 98% agreement; kappa = 0.75 to 0.95). CONCLUSIONS: The pharyngeal squeeze maneuver displayed poor reliability when motor function was classified into unilateral or bilateral normal, diminished, and absent categories. The pharyngeal squeeze maneuver was very reliable when simply graded as normal or abnormal. Clinicians could not reliably distinguish between diminished and absent pharyngeal motor functions.