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。     

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.     

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.     

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.     

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．     

门诊复位加自我复位治疗后半规管良性阵发性位置性眩晕

目的：比较首次治疗时单纯门诊复位法（改良Epley法）与门诊复位加自我复位法（自我改良Epley法）治疗单侧原发性后半规管良性阵发性位置性眩晕（PC-BPPV）的疗效。方法：我科眩晕门诊确诊为原发性单侧PC-BPPV的150例患者中,147例符合条件并配合随访。将其随机分为单纯门诊复位组（73例）和门诊复位加自我复位组（74例）,前者在门诊采用改良Epley法治疗,后者采用门诊改良Epley法复位加自我复位法（自我改良Epley法）治疗。结果：1周时,单纯门诊复位组治愈率为53．4％,门诊复位加自我复位组治愈率为83．8％（P〈O．01）。单纯门诊复位组中,手法复位与复位椅复位成功率分别为45．9％和61．1％（P〉0．05）,风险比为0．752,95％CI为0．486～1．163;门诊复位加自我复位组中,手法复位与复位椅复位成功率分别为87．5％和81．O％（P〉0．05）,风险比为1．081,95％CI为0．8881．316。两组严重不良反应发生率：单纯门诊复位组0,门诊复位加自我复位组为1．3％（P〉O．05）。结论：门诊复位配合自我复位比单纯门诊复位法能更快、更有效地治愈后半规管BPPV,能有效地减少患者的就诊次数;两组患者严重不良反应发生率无明显差异。单纯复位椅比手法复位效果更好,但自我复位可减少两种复位方法的效果差距,可用于配合程度较好的后半规管BPPV患者。     

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。     

Mechanism of posterior semicircular canal stimulation in patients with benign paroxysmal positional vertigo

A quantitative study of the stimuli and vestibulo-ocular response associated with benign paroxysmal positional vertigo (BPPV) was made to test and further develop the canalithiasis theory of BPPV. The angular velocities of the head in the planes of the semicircular canals during the Dix-Hallpike test were measured in four healthy subjects using electromagnetic sensors to record the position of the head in a six degrees of freedom paradigm. Next, the nystagmus reactions in seven patients diagnosed with idiopathic BPPV were recorded with video-oculography. The characteristics of the vestibulo-ocular reflex (VOR) response were analyzed using three-dimensional vector techniques. The angular velocity of the head was primarily, but not exclusively, in the plane of the posterior semicircular canal (PSC) in question. Both the anterior and horizontal canals were also stimulated by a lesser degree. The duration of the motion stimulus in the PSC was < 1.3 s with peak angular velocities of 150 deg/s. The eye response in BPPV patients began 4 s after the test and had a duration of 15-20 s. Peak slow-component eye velocities of about 42 deg/s were reached 3-5 s after onset of nystagmus. The motion of the eye, as predicted by the cupulolithiasis theory, is disconjugated and has torsional, vertical, and horizontal components. In the eye ipsilateral to the tested ear it is primarily torsional (0.80, 0.54, 0.16) and in the contralateral eye it is mainly vertical (0.57, 0.73, 0.08). These results suggest that particles, initially resting on the floor of the cupula dome in the PSC, are perturbed by the Dix-Hallpike test and disperse freely into the endolymph where they are propelled by gravity into the canal lumen. This creates abnormal pressure on the cupula and the specific VOR activation of the ipsilateral superior oblique and the contralateral inferior rectus muscles, whose force vectors are indistinguishable from the measured eye motion vectors. The estimated pressure exerted on the crista is approximately 10(-2) dyn/cm2.     

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。     

Efficacy of treatments for posterior canal benign paroxysmal positional vertigo

OBJECTIVE: This study was performed to determine the relative effectiveness of several passive head maneuvers for treating benign paroxysmal positional vertigo. STUDY DESIGN: This prospective study used 87 subjects diagnosed by their physicians with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal. METHODS: Subjects were randomly assigned to three treatment groups: modified Epley maneuver, modified Epley maneuver with augmented head rotations, and modified Semont maneuver. They were interviewed 1 week after receiving one maneuver. If subjects desired further treatment, they were treated again with the same maneuver, a methodology repeated until subjects desired no further treatment; they were telephoned 3 and 6 months after the last treatment. RESULTS: The groups did not differ significantly, but subjects decreased significantly on vertigo intensity and frequency and improved significantly on independence in activities of daily living. Before treatment, tasks requiring pitch rotations of the head induced vertigo; common comorbid conditions were osteoporosis, cervical spine problems, and head trauma. CONCLUSIONS: These data suggest that augmented head rotations are unnecessary and that the modified Epley and Semont maneuvers are equally effective in the remediation of vertigo in this population.     

后半规管良性阵发性位置性眩晕发作与头部睡眠姿势相关性分析

目的　研究睡眠姿势与后半规管良性阵发性位置性眩晕（posterior semicircular canal benign paroxysmal positional vertigo,PSC-BPPV）发病的关系,为临床BPPV的预防和治疗提供指导。方法　采用Dix-Hallpike试验,对208例确诊为PSC-BPPV患者进行问卷调查,内容包括眩晕的诱发体位、伴随症状、与睡眠姿势的关系及眩晕持续时间等。重点对PSC-BPPV病变耳和睡眠时头部姿势进行调查,分析两者相关性。结果　PSC-BPPV诱发体位主要是卧位坐起和躺下,伴随症状主要为恶心、呕吐,耳鸣很少,无听力下降,眩晕持续时间很少超过60 s。208例PSC-BPPV患者中125例睡眠时总采取同一姿势（右侧卧85例,左侧卧40例）,83例患者睡眠姿势不定。PSC-BPPV病变耳与患者头部睡眠姿势侧别具有较好一致性（Kappa系数=0.401＞0）。Spearman相关性分析发现PSC-BPPV病变耳与头部睡眠姿势侧别比较（r =0.203,P＜0.05）,与年龄比较（r =-0.179,P＜0.05）,差异具有统计学意义,与性别比较差异无统计学意义。结论　习惯性头部睡眠姿势促使耳石沉积在低位耳的后半规管,是导致同侧PSC-BPPV的主要因素之一。     

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.     

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.     

上半规管良性阵发性位置性眩晕41例

目的 探讨上半规管良性阵发性位置性眩晕(BPPV)诊断和治疗的最佳方案。方法 回顾性分析41例上半规管BPPV患者的病历资料,并对所有患者的诊断及复位进行评估分析。结果 SRM-Ⅳ模拟Dix-Hallpike试验诱发出典型垂直向下眼震28例(68.3%),其中眼震伴有向地扭转的成分19例,不伴有扭转成分9例;SRM-Ⅳ上半规管BPPV诱发试验诱发出典型垂直向下眼震35例(84.6%),其中眼震伴有向地扭转的成分30例,不伴有扭转成分5例。在所有41例患者中有38例能通过两种诱发试验对受累侧别做出判断,其中因诱发眼震伴有扭转成分而判断侧别30例,单侧诱发诱发出垂直向下眼震且不伴有扭转成分3例,双侧诱发出垂直向下眼震5例,且不伴有扭转成分,但因眩晕及眼震的强度有明显差别而判断出侧别,患者对受累侧别不能判断3例。在能判断出侧别的38例患者中有左侧上半规管受累25例,右侧上半规管受累13例。对41例采用SRM-Ⅳ上半规管BPPV复位法进行治疗,通过一次治疗痊愈28例,有效12例,无效1例。结论 上半规管BPPV 临床上被越来越重视,应用SRM-ⅣBPPV诊疗系统对上半规管BPPV进行诊治效果好,应该在临床得到推广。