倍他司汀联合手法复位治疗良性阵发性位置性眩晕患者的临床效果分析

目的 探讨倍他司汀联合手法复位治疗良性阵发性位置性眩晕(BPPV)的临床效果.方法 92例BPPV患者随机分为两组各46例,对照组给予倍他司汀治疗,实验组给予倍他司汀联合手法复位治疗,比较两组的治疗效果.结果 实验组的治疗总有效率为89.13％,显著高于对照组的71.74％(P＜0.05).治疗2周后,实验组的VSI评...     

Lateral semicircular canal-BPPV: Prospective randomized study on the efficacy of four repositioning maneuvers

IntroductionMultiple repositioning maneuvers have been described to treat lateral semi-circular canal Benign Paroxysmal Positional Vertigo (LC-BPPV) patients. In this study, we compare efficacy of four therapeutic repositioning maneuvers for LC-BPPV patients and aim to identify clinical variables associated with persistent disease.Material and methodsA prospective study was conducted at a tertiary center, between January 2017 and September 2019. Patients diagnosed with LC-BPPV were randomly treated with Gufoni or barbecue-roll maneuvers (for the geotropic variant) and Gufoni-Appiani, barbecue-roll or Zuma-e-Maia maneuvers (for the apogeotropic form). Efficacy was compared and statistical analysis was performed to find clinical factors associated with no response.ResultsForty-eight patients and 82 maneuvers were included. Female patients and right side were more commonly affected. The mean age was 67 years. Seven cases (14.6%) resulted from a canal-switch. One single maneuver resolved 23 cases (47.9%) and the success rate rose to 75% at the end of the first visit (after up to 4 maneuvers) and to 93.8% after a-week of follow-up. Success rates were significantly better with Gufoni (68%) than with barbecue roll (34.8%; p = 0.021) in geotropic LC-BPPV and better with Gufoni-Appiani (71.4%) than barbecue roll and Zuma-e-Maia maneuvers (33.3%; p = 0.239) in apogeotropic LC-BPPV. Higher rates of persistent disease after first visit were found with older patients, left side and apogeotropic LC-BPPV and with longer latency and duration diagnostic nystagmus.ConclusionOur study suggests that Gufoni and Gufoni-Appiani maneuvers may be the most efficacious treatment for geotropic and apogeotropic LC-BPPV, respectively, compared to barbecue-roll and Zuma-e-Maia maneuvers.     

A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo

Objective

Primary objective of this study was to find a statistical link between the most worldwide comorbidities affecting the elderly population (hypertension, diabetes, osteoarthrosis, osteoporosis and depression) and recurrent episodes of BPPV. Secondary objective was defining possible “groups of risk” for people suffering recurrent positional vertigo related to the presence of a well documented comorbidity.

Methods

This was an observational, cross-sectional, multicenter, spontaneous, non-pharmacological study. The data of 1092 patients suffering BPPV evaluated in 11 different Departments of Otolaryngology, Otoneurology and Neurology, referring Centers for positional vertigo evaluation, were retrospectively collected.

Results

Regarding evaluated comorbidities (hypertension, diabetes, osteoarthrosis, osteoporosis and depression), data analysis showed the presence of at least one comorbid disorder in 216 subjects (19.8%) and 2 or more in 408 subjects (37.4%). Moreover there was a statistical significant difference between the number of comorbidities and the number of recurrences, otherwise said as comorbidity disorders increased the number of relapses increased too.

Conclusion

The presence of a systemic disease may worsen the status of the posterior labyrinth causing a more frequent otolith detachment. This condition increases the risk for patients suffering BPPV to have recurrent episodes, even if correctly managed by repositioning maneuvers. The combination of two or more of aforementioned comorbidities further increases the risk of relapsing BPPV, worsened by the presence of osteoporosis. On the basis of this results it was possible to define “groups of risk” useful for predicting BPPV recurrence in patients with one or more comorbidity.     

Differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV)

This article presents an approach to differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Such an approach is essential because of the difference in intervention between the two disorders in question. Results from evaluation of the case study presented here revealed a persistent ageotropic positional nystagmus consistent with MPV or a cupulolithiasis variant of HC-BPPV. The patient was treated with liberatory maneuvers to remove possible otoconial debris from the horizontal canal in an attempt, in turn, to provide further diagnostic information. There was no change in symptoms following treatment for HC-BPPV. This case was diagnosed subsequently as MPV, and the patient was referred for medical intervention. Treatment has been successful for 22 months. Incorporation of HC-BPPV treatment, therefore, may provide useful information in the differential diagnosis of MPV and the cupulolithiasis variant of HC-BPPV.     

顽固性良性阵发性位置性眩晕的发病机制及治疗

目的 回顾性分析我科门诊及住院患者中顽固性良性阵发性位置性眩晕的患者,分析发病因素及治疗手段,为顽固性良性阵发性位置性眩晕的发病机理及治疗提供新思路.方法 收集2010年1月-2010年12月我科门诊诊断为顽固性良性阵发性位置性眩晕的患者16人,分析发病因素、治疗手段及预后.结果 16例患者经手法复位、体位训练及药物辅助治疗后,眩晕症状基本消失,随访半年未再发作.结论 顽固性良性阵发性位置性眩晕发病机制可能与内耳缺血、运动及活动减少有关,我们采用保守治疗的方法,疗效满意.     

The canalith repositioning procedure for benign positional vertigo: a meta-analysis

OBJECTIVE: To review the effectiveness of the canalith repositioning procedure (CRP) in the treatment of benign paroxysmal positional vertigo (BPPV) with a critical review of the literature and meta-analysis. STUDY DESIGN: Meta-analysis. METHODS: Studies eligible for inclusion were randomized, controlled trials of the CRP performed on clearly defined cases of BPPV. A total of nine studies meeting inclusion criteria were identified by two independent literature searches of Medline. Treatment and control groups were compared for symptom resolution and elimination of a positive Dix-Hallpike test. RESULTS: Patients treated with CRP were more likely to demonstrate symptom resolution (odds ratio [OR] 4.6; 95% confidence interval [CI] 2.8-7.6) and negative Dix-Hallpike (OR 5.2; 95% CI 3.0-8.8) at the time of first follow-up. The effect of CRP for symptom improvement was strongest within the first month after treatment (OR 4.1; 95% CI 3.1-5.2) with some decline thereafter (OR 2.8; 95% CI 1.7-3.9). Conversely, the ability of CRP to produce a negative Dix-Hallpike strengthened between the first month after treatment (OR 3.0; 95% CI 1.8-4.0) and later follow-up times (OR 5.0; 95% CI 3.9-6.1). CONCLUSIONS: The CRP is more effective than control in resolving vertigo and positive Dix-Hallpike associated with BPPV. This finding was consistent among a variety of studies using different study designs. Untreated patients may demonstrate symptom improvement with time; however, many will continue to have a positive Dix-Hallpike when examined. Resolution of vertigo in untreated patients is therefore most likely because of avoidance of provocative positions.     

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.     

良性阵发性位置性眩晕病因学研究

目的 研究良性阵发性位置性眩晕病的可能病因,并分析其临床特点.方法 收集2014年3月至2017年3月我院收治的256例BPPV患者的临床资料.采用多因素Logistic回归分析BPPV发生与各临床参数之间的相关性.结果 BPPV患者多见于50岁以上的女性,以后半规管BPPV为主.约1/3的患者存在耳科疾病史,常合并高血压、糖尿病、骨质疏松、动脉粥样硬化及血脂异常等代谢性疾病;约50％的患者存在负性的心理状态,多吸烟、饮酒.多因素Logistic回归分析显示,头外伤、耳科疾病、高血压、糖尿病、血脂异常、动脉粥样硬化、骨质疏松、吸烟及焦虑是BPPV患病的危险因素(P＜ 0.05或P＜0.01).结论 BPPV以≥50岁的女性患者居多,以后半规管BPPV为主,约1/3的患者有耳科疾病史,半数患者存在负性的心理状态,头外伤、耳科疾病、高血压、糖尿病、血脂异常、动脉粥样硬化、骨质疏松、吸烟及焦虑可能是BPPV患病的危险因素.     

Measurement of ocular countertorsion reflex with fundoscopic camera in normal subjects and in patients with inner ear lesions

Summary To record the ocular countertorsion reflex (OCR), we devised a new technique using an ophthalmo-fundoscope camera. OCR was measured in twenty two healthy subjects and in eighty three patients with inner ear lesions as benign paroxysmal positional vertigo (BPPV), sudden deafness, Menière's disease, vestibular neuronopathy, acoustic neuroma and cases given ototoxic drugs. The mean values and the standard deviations of OCR for healthy subjects were obtained, but a wide range of the values in each eye in each direction was evident.Considering the wide range of OCR values, judgement should based not only on OCR value itself, but on differences in OCR values between clockwise (CW) and counter-clockwise (CCW) tilt or on the percentage of OCR values in CW or CCW tilt to the total countertorsion of that eye.In this report OCR values below 2 in either tilt (CW or CCW) were regarded as abnormal and 5 differences at 30 tilt and 4 differences at 45 tilt between CW and CCW tilt were regarded as suspicious of otolith dysfunction.Abnormal OCR values in most unilateral inner ear lesions excluding acoustic neuromas were seen in 14% according to our criteria.The incidence of abnormal OCR values was high in BPPV with caloric abnormalities, acoustic neuromas and in cases given ototoxic drugs, while it was less in BPPV without caloric abnormalities and vestibular neuronopathy.From the results obtained by this test, a hypothesis was drawn as to the relation of the tilt to the lesion of the otolith organ.With the development of the otolith function test, it could be applied to many disorders of the inner ear and internal auditory canals and to reevaluate the hitherto known diagnosis as Meniere's disease, sudden deafness etc.Presented at the Eleventh World Congress of Oto-rhino-laryngology, March 13–19, 1977. Buenos Aires, Republica Argentina     

半夏白术天麻汤配合耳石复位法治疗良性阵发性位置性眩晕的临床疗效及对血脂代谢影响

目的:观察半夏白术天麻汤配合改良耳石复位法治疗良性阵发性位置性眩晕的临床疗效及探讨血脂代谢异常对本病发病机制的相关性;方法:将我院中医内科2013年1月至2015年1月门诊就诊符合诊断标准的BPPV患者53例,采用PEMS 3.0 for Windows"完全随机(2组或多组)设计,将入选标准的患者按先后顺序随机分为治疗组(23例)和对照组(30例);2组患者在发作期均先卧床休息,持续低流量吸氧,对照组给予改良Epley复位法,治疗组在对照组基础上给予半夏白术天麻汤辨证加减,分别观察2组在治疗后第2天、2周、3个月临床疗效及治疗前后血脂水平变化并进行分析。结果:治疗后第2天总有效率相比较,治疗组总有效率为73.91%,对照组总有效率为60.00%,总有效率相比较,差异有统计学意义(χ~2=6.782,P=0.0020.05);治疗后2周总有效率相比较,治疗组总有效率为86.96%,对照组总有效率为73.33%,总有效率相比较,差异有统计学意义(χ~2=7.540,P=0.0000.05);3个月后总有效率相比,治疗组总有效率为95.65%,对照组总有效率为83.33%,总有效率相比较,差异有统计学意义(χ~2=8.351,P=0.0000.05);血脂水平变化方面,治疗后3个月治疗组在TG、TC、LDL、Apo-A1与对照组相比较,差异有统计学意义(P0.05),在HDL、Apo-B方面与对照组相比较,差异无明显统计学意义(P0.05)。结论:半夏白术天麻汤配合耳石复位法治疗良性阵发性位置性眩晕的临床疗效确切,血脂代谢的异常与良性阵发性位置性眩晕关系密切,该治疗方法科学,患者依存性高,值得临床推广应用。