良性阵发性位置性眩晕52例治疗经验总结

目的回顾性总结我科对BPPV患者的诊疗情况,探讨在基层医院开展BPPV诊疗的可行性。方法回顾2006年7月-2007年12月间在我科确诊的BPPV患者52例,后半规管及上半规管BPPV按照Epley所描述的CRP方法进行复位治疗,水平半规管BPPV患者按照Barbecue翻滚法进行复位治疗,并于治疗结束后3个月内复查和评价疗效。结果52例患者中,46例为后半规管BPPV,5例为水平半规管BPPV,1例为上半规管BPPV,手法复位后,50例痊愈,治愈率为96.2%。结论手法复位治疗BPPV患者是一种非常有效的方法,其方法简单、易行,无需特殊贵重器械,可以在基层医院推广。     

Anterior Canal benign paroxysmal positional Vertigo following surgical Management of superior canal dehiscence

Objective

Benign paroxysmal positional vertigo (BPPV) is a common post-surgical finding in patients managed for superior semicircular canal dehiscence (SSCD). The posterior semicircular canal has been reported as the involved canal in the majority of cases of post-surgical BPPV, with only two cases reported of lateral canal involvement. The objective of this report is to present a case in which an anterior semicircular canal BPPV response was identified in a patient following surgical management for SSCD.

Benign paroxysmal positional vertigo following closed sinus floor elevation procedure: mallet osteotomes vs. screwable osteotomes. A triple blind randomized controlled trial

Objective: To compare mallet osteotomes with screwable osteotomes determining benign paroxysmal positional vertigo (BPPV) following the osteotome closed sinus floor elevation procedure. Materials and Methods: This triple‐blind randomized controlled trial involved 196 patients affected by edentulous atrophic ridges (107 males and 89 females; mean age 62.05±7.10; age range 49–79 years), requiring an osteotome closed sinus floor elevation procedure. Patients were randomly allocated to either a mallet‐osteotomes group (Group 1, n=98) or a screwable osteotomes group (Group 2, n=98). Two different surgeons, blind to the study, performed the closed sinus lift procedure according to the blocks allocation. A complete post‐surgical examination, including the Dix–Hallpike maneuver, was performed on 196 patients before and after surgery. The diagnosis of BPPV was supported by the existence of ageotropic nystagmus concurrent with vertigo. Results: Three patients of Group 1 (3/98–3.06%) showed a BPPV of the posterior semicircular canal omo‐lateral to the implanted side 1 or 2 days after the surgical procedure, which was promptly solved using the Epley re‐positioning maneuver. Conclusions: Preparation of implant beds with osteotome and mallet transmits percussive and vibratory forces capable of detaching the otoliths from their normal location; moreover, the patient's surgical head position favors the displacement of otoliths into the posterior semicircular canal. Implant surgeons should be aware of this possible complication following closed sinus lift procedure and patients should always be informed before undergoing surgery. To cite this article:
Sammartino G, Mariniello M, Scaravilli MS. Benign paroxysmal positional vertigo following closed sinus floor elevation procedure: mallet osteotomes vs. screwable osteotomes. A triple blind randomized controlled trial.
Clin. Oral Impl. Res. 22 , 2011; 669–672
doi: 10.1111/j.1600‐0501.2010.01998.x     

感觉门控P50在特发性BPPV成功复位后残余头晕中的应用

目的 探讨特发性良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）成功复位后出现残余头晕的患者感觉门控P50特点。方法 选择2018年6月至2019年11月就诊于大连市第三人民医院符合入组条件的确诊为BPPV并成功行手法复位后的患者60例,根据治疗7天后有无残余头晕（residual dizziness,RD）分为RD组和无RD组,行感觉门控电位P50检测,记录S1-P50及S2-P50的潜伏期、波幅及S2-P50/S1-P50波幅比值,进行统计学分析。结果 与无RD组相比,RD组S1-P50波幅减低,潜伏期延长,S2-P50波幅增高,潜伏期延长（P<0.05）;RD组S2/S1比值高于无RD组,差异具有统计学意义（P<0.05）。结论 感觉门控P50可以客观评价BPPV成功复位后残余头晕患者感觉门控功能缺损情况,提示患者可能存在情绪障碍,为临床治疗提供方向。     

管石复位法治疗良性阵发性位置性眩晕的影响因素分析

目的观察管石复位法治疗良性阵发性位置性眩晕的长期效果，探讨影响治疗预后的相关因素。方法回顾性分析59例后半规管良性阵发性位置性眩晕患者治疗和随访结果．并对管石复位法治疗成功的良性阵发性位置性眩晕患者进行多因素COX回归分析。结果59例患者中有54例（91．5％）治愈。治愈的54例患者在随访中有21例（38．9％）复发，其中有10例患者伴有半规管轻瘫。对患者的性别、年龄、发病时间、病因、半规管功能等指标进行多因素分析，只有半规管轻瘫一项指标进入COX模型，说明半规管轻瘫是影响治疗预后的因素。结论半规管轻瘫是影响BPPV患者管石复位法治疗预后的影响因素。     

In whom does horizontal canal BPPV recur?

Purpose

The objective of this study is to examine the rate of horizontal canal BPPV recurrence of the same type and search for predisposing factors.     

The use of mastoid vibration with canalith repositioning procedure to treat persistent benign paroxysmal positional vertigo: A case report

The Canalith Repositioning Procedure (CRP) was originally described as a non-invasive treatment for Benign Paroxysmal Positional Vertigo (BPPV) by Epley. Since its inception, the maneuver has undergone several modifications; and currently is performed in the absence of induced mastoid vibration (oscillation). Clinically, mastoid vibration may be used to assist in treatment of persistent cases of BPPV, where a simple CRP may fail to improve symptoms. This case describes a patient with a three-month history of BPPV (right posterior canalithiasis), who was previously treated unsuccessfully with standard CRP. Mastoid vibration was introduced as part of the treatment due to persistent BPPV. After one treatment utilizing CRP with mastoid vibration, the patient had complete resolution of symptoms, and remained symptom free at a six-month follow-up. It can be concluded that introducing mastoid oscillation via vibration to the CRP in persistent cases of semicircular canalithiasis BPPV may produce positive patient outcomes.     

Horizontal Direction‐Changing Positional Nystagmus and Vertigo: A Case of Vestibular Migraine Masquerading as Horizontal Canal BPPV

Episodic positional vertigo is typically due to benign paroxysmal positional vertigo (BPPV) but may also be a manifestation of vestibular migraine. Distinguishing vestibular migraine from BPPV is essential since the treatment of each disorder is markedly different. The 31‐month clinical course of a 41‐year‐old woman with vestibular migraine causing recurrent positional vertigo is described. During vestibular migraine attacks, she developed left‐beating nystagmus in the upright position with removal of fixation, and geotropic horizontal nystagmus during the supine roll test. Interictally, her exam demonstrated positional apogeotropic horizontal nystagmus with the supine roll test, more intense in the supine head left position. Her vestibular migraine was successfully controlled with topiramate and eletriptan.     

难治性眩晕的初步临床分析

目的当患者被诊断为难治性眩晕需要接受手术治疗或破坏性治疗时,医生应该对患者的诊断和治疗再次进行慎重的、充分的评估。方法对2006年12月至2011年6月在本科就诊诊断为难治性眩晕的病例进行回顾性分析,患者资料包括病史、听力学、前庭学和影像学检查。结果 78例患者拟诊为难治性良性阵发性位置性眩晕23例和拟诊为难治性梅尼埃病55例。其原因包括诱因未除17例(21.8%);诊断有误8例(10.2%)后被确诊为桥小脑角病变、第四脑室肿瘤、鼻窦炎、精神神经疾病;病情复杂合并其它疾病42例(54%),包括梅尼埃病合并BPPV、颈椎病、心血管疾病、脑血管疾病、先天畸形和精神神经科学疾病等;药物治疗不当2例(2.5%),手术治疗不当9例(11.5%)。结论诊断难治性眩晕需谨慎,避免误诊误治。