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。

Diagnosis and treatment of horizontal canal benign paroxysmal positional vertigo

Objective　To explore effective methods for the diagnosis and treatment of horizontal-canal benign paroxysmal positional vertigo (HC-BPPV). Methods　Medical records from nine patients with HC-BPPV, treated between July 1996 and March 2000, were retrospectively analyzed. Data of complete history, audiograms, positional tests and neuro-otological examinations were collected. All patients were treated with a particle repositioning maneuver called the “barbecue rotation” which starts with the patient in the supine position and consists of three 90-degree head rotations towards the unaffected ear. Results　HC-BPPV was characterized by brief attacks of intense vertigo that were induced mainly by rolling over in bed (9/9) and turning the head to either side while upright (5/9). In most cases, rotation to the pathological side from supine position caused a very intense horizontal nystagmus beating towards the undermost ear. Findings such as latency and fatigability, which are common features of posterior-canal BPPV (PC-BPPV), were not present. After the barbecue rotation, all patients had immediate and sustained relief of their attacks during the 4 to 15 months' follow up. ConclusionsHC-BPPV is different from PC-BPPV and other vertiginous diseases in typical presentations and positional testing results. The barbecue rotation is a successful method for curing the disorder.