340例眩晕患者的病因分析

目的分析眩晕患者的常见病因,减少临床误诊和漏诊。方法收集340例以眩晕为主诉的耳鼻咽喉头颈外科就诊患者,根据病史、临床症状和体征、相应的辅助检查结果,分析确定病因。结果眩晕发生于各个年龄段,成人多见,亦可见于儿童,周围性眩晕占77.05%,其中BPPV占28.23%,中枢性眩晕占8.82%,非前庭系统性眩晕占10.30%,其中精神性眩晕占5.59%,原因不明者占3.82%。结论眩晕常见病因是周围性眩晕,BPPV最为常见,但随着年龄的增加,中枢性眩晕在病因所占的比例逐渐增加,而中青年患者精神性眩晕发病率亦较高。临床医师应提高对BPPV和精神性眩晕的认识,同时也不可忽视发生率低的一些疾病的存在。     

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.     

Surgical management for benign paroxysmal positional vertigo of the superior semicircular canal

Benign paroxysmal positional vertigo of the superior semicircular canal is a rare form of BPPV. It accounts for 1% to 3% of cases. The characteristic nystagmus is positional, down‐beating, with a torsional component elicited by the Dix‐Hallpike maneuver. Symptoms of superior semicircular canal BPPV often resolve spontaneously; however, it can be refractory to repositioning maneuvers. Surgical management is described for posterior semicircular canal BPPV. To date, however, there is only one reported case of surgical management for superior semicircular canal BPPV. Here we show video documentation of positional, down‐beating nystagmus and describe a case of superior semicircular canal BPPV requiring canal occlusion with successful resolution of symptoms. Laryngoscope, 125:1965–1967, 2015     

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。     

不同耳石复位法应用于良性阵发性位置性眩晕的临床效果分析

目的：分析不同耳石复位法治疗良性阵发性位置性眩晕（BPPV）的临床效果。方法资料随机选自2012年1月～2014年1月本院诊治的BPPV患者126例,按照完全随机法1∶1分成研究组和对照组各63例,63例对照组患者统一行Epley耳石复位法,45例研究组PC-BPPV患者行改良Epley耳石复位法,18例研究组HC-BPPV患者行Barbecue翻滚法,分析两组患者治疗后的临床效果、症状改善时间与复发次数。结果研究组患者复发率7.94%、PC-BPPV复发率6.67%与PC-BPPV复发率5.56%均比对照组23.81%、23.91%与23.53%低,差异有统计学意义（P＜0.05）;研究组的治疗次数（1.27±0.23）次、治疗1月的发作次数（1.28±0.31）次与治疗时间（5.06±3.12）d,均比对照组（2.34±0.46）次、（3.24±4.26）次与（8.87±3.29）d少,差异有统计学意义（P＜0.05）;研究组患者的眩晕、恐惧感、恶心呕吐、强迫体位改善时间比对照组低,治疗1月的前庭功能比治疗前与对照组均低,差异有统计学意义（P＜0.05）。结论改良Epley耳石复位法是PC-BPPV患者的临床有效治愈手段,Barbecue翻滚法是治疗HC-BPPV的可靠有效治疗方案,分型治疗可以有效改善BPPV临床疗效。     

管石复位法结合中药治疗良性阵发性位置性眩晕23例疗效观察

目的：探讨管石复位法结合助气消痰汤治疗良性阵发性位置性眩晕（BPPV）的疗效。方法：根据（Epley）1993所描述的管石复位法,将脱落的耳石复位后结合助气消痰汤治疗,观察疗效。结果：治疗1-2个疗程后,23例病例,治愈率73．9％,总有效率91．3％。结论：准确的手法复位与助气消痰汤结合治疗BPPV有显著的疗效。     

良性阵发性位置性眩晕患者焦虑状况调查及药物干预效果

目的：观察良性阵发性位置性眩晕（BPPV ）患者焦虑障碍的发生率、特点及药物干预效果。方法采用汉密尔顿焦虑量表（HAMA）对78例BPPV患者进行测评分析,并将其中51例伴有焦虑的患者分为常规治疗组（常规组）及抗焦虑药物干预组（干预组）,1月后再进行HAMA评分。结果78例BPPV患者中51例（65·38％）存在不同程度的焦虑;女性、老年、文化程度较高的BPPV患者焦虑程度分别高于男性、中青年及文化程度较低的BPPV患者（ P＜0·01）;51例伴焦虑的BPPV患者接受治疗1月后其焦虑程度均有明显减轻（P＜0·01）,但干预组焦虑缓解更为明显（P＜0·05）。结论多数BPPV患者存在不同程度的焦虑情绪,合理的药物干预能有效改善BPPV患者的焦虑状态。     

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。