难治性良性阵发性位置性眩晕的临床分析

doi:10.6040/j.issn.1673-3770.0.2017.384

摘要/Abstract

摘要： 目的探讨难治性良性阵发性位置性眩晕(BPPV)的临床特点及治疗。方法回顾分析2014年8月至2016年1月诊断为难治性BPPV的13例患者的临床资料,分析其病因相关因素、类型、临床特点及治疗效果。结果 13例难治性BPPV中,头部外伤为最常见因素,离地性水平半规管BPPV为最常见类型。根据病因积极治疗伴随疾病,正确手法复位治疗,联合Brandt-Daroff康复训练,11例治愈,随访1年无复发;2例无效;1例后半规管、1例水平半规管BPPV,至他院行半规管堵塞术手术治疗,术后效果好。结论难治性BPPV可能与头部外伤及突发性聋等疾病相关,首先需根据病因积极治疗伴随疾病,同时采用正确的手法复位治疗,并联合康复训练。治疗后大部分患者疗效好,无效者行半规管堵塞术效果好。

关键词: 良性阵发性位置性眩晕, 病因, 手法复位, 康复训练, 难治性

Abstract: Objective To investigate the clinical characteristics and treatment of intractable benign paroxysmal positional vertigo(BPPV). Methods A retrospective analysis was performed on 13 patients diagnosed as having intractable BPPV,and etiological factors, types, clinical features, and therapeutic effects were analyzed. Results Depending on the cause, concomitant illness was actively treated. Through correct manipulation and Brandt-Daroff treatment, 11 patients were cured, and none of the patients had any recurrence after 1 year of follow-up. The treatment was ineffective in 2 patients, one had a posterior semicircular canal, and one had horizontal semicircular canal BPPV and went to another hospital to undergo semicircular canal blockage surgery with good outcome. Conclusion Refractory BPPV may be associated with head trauma, sudden sensorineuraI hearing loss, and so on. First of all, we must actively treat the accompanying diseases according to the cause. Meanwhile, we should rehabilitate the patients with the correct method and combine Brandt-Daroff exercises. Most patients have good efficacy after treatment, and semicircular canal occlusion is effective for those with invalid refractory BPPV.

Key words: Benign paroxysmal positional vertigo, intractable, Rehabilitation training, Manipulation reduction, Etiology

中图分类号:

R764

鄢慧琴,王豪. 难治性良性阵发性位置性眩晕的临床分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 86-88.

YAN Huiqin, WANG Hao. Clinical analysis of intractable benign paroxysmal positional vertigo[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2018, 32(3): 86-88.

参考文献

[1] 王英歌,潘黎静,顾晰,等. 顽固性良性阵发性位置性眩晕的发病机制及治疗[J]. 中华耳科学杂志, 2011, 9(4):372-375. WANG Yingge, PAN Lijing, GU Xi, et al. Pathogenesis and treatment of intractable benign paroxysmal positional vertigo[J]. Chin J Otol, 2011, 9(4):372-375.
[2] Gross EM, Ress BD, Viirre ES, et al. Intractable benign paroxysmal positional vertigo in patients with Menieres disease[J]. Laryngoscope, 2000, 110(4):655-659.
[3] 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉科学分会.良性阵发性位置性眩晕的诊断依据和疗效评估[J].中华耳鼻咽喉头颈外科杂志,2007,42(3):163-164.
[4] Hilton M, Pinder D. The Epley(canalith repositioning)manoeuvre for benign paroxysmal positional vertigo[J]. Cochrane Database Syst Rev, 2002(1):CD003162.
[5] Hilton MP, Pinder DK. The Epley(canalith repositioning)manoeuvre for benign paroxysmal positional vertigo[J]. Cochrane Database Syst Rev, 2004(2):CD003162.
[6] Hilton M, Pinder D. The Epley(canalith repositioning)manoeuvre for benign paroxysmal positional vertigo[J]. Cochrane Database Syst Rev,2014(2):CD003162.
[7] Bhattacharyya N, Baugh RF, Orvidas L, et al. Clinical practice guideline: benign paroxysmal positional vertigo[J]. Otolaryngol Head Neck Surg, 2008, 139(5Suppl 4):S47-81.
[8] Fife TD, Iverson DJ, Lempert T, et al. Practice parameter: therapies for benign paroxysmal positionalvertigo(an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology[J]. Neurology, 2008, 70(22):2067-2074.
[9] Mandalà M, Pepponi E, Santoro GP, et al. Double-blind randomized trial on the efficacy of the Gufoni maneuver for treatment of lateral canal BPPV[J]. Laryngoscope, 2013, 123(7):1782-1786.
[10] Anagnostou E, Kouzi I, Spengos K. Diagnosis and treatment of anterior-canal benign paroxysmal positional vertigo: a systematic review[J]. J Clin Neurol, 2015, 11(3):262-267.
[11] Brandt T, Daroff RB. Physical therapy for benign paroxysmal posi-tional vertigo[J].Arch Otolaryngol, 1980, 106(8):484-485.
[12] Vibert D, Kompis M, Häusler R. Benign paroxysmal positionalvertigo in older women may be related to osteoporosis and osteopenia[J].Ann Otol Rhinol Laryngol, 2003, 112(10):885-889.
[13] Cohen HS, Kimball KT, Stewart MG. Benign paroxysmal positional vertigo and comorbid conditions[J]. ORL, 2004, 66(1):11-15.
[14] Otsuka K, Suzuki M. Mechanisms of intractable BPPV [inJapanese]. Equilibrium Res, 2006, 65:156-160.
[15] Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo(BPPV)[J]. CMAJ, 2003, 169(7):681-693.
[16] Horii A, Kitahara T, Osaki Y, et al. Intractable benign paroxysmal positioning vertigo: long-term follow-up and inner ear abnormality detected by three-dimensional magnetic resonance imaging[J].Otol Neurotol, 2010, 31(2):250-255.
[17] Ahmed RM, Pohl DV, MacDougall HG, et al. Posterior semicircular canal occlusion for intractable benign positional vertigo: outcome in 55 ears in 53 patients operated upon over 20 years[J]. J Laryngol Otol, 2012, 126(7):677-682.
[18] Zhu Q, Liu C, Lin C, et al. Efficacy and safety of semicircular canal occlusion for intractable horizontal semicircular benign paroxysmal positional vertigo[J]. Ann Otol Rhinol Laryngol, 2014, 124(4):257-260.
[19] 曹效平, 顾东胜, 袁洵易,等. Brandt-Daroff康复练习治疗水平半规管良性阵发性位置性眩晕[J].中华耳科学杂志,2015, 13(2):293-296. CAO Xiaoping, GU Dongsheng, YUAN Xunyi, et al. The effect of brandt-daroff exercises on horizontal semicircular canal benign paroxysmal positional vertigo[J]. Chin J Otol, 2015, 13(2):293-296.
[20] 孙利兵,郑智英,王斌全,等. 前庭康复训练对良性阵发性位置性眩晕复位后残余症状的疗效分析[J].临床耳鼻咽喉头颈外科杂志, 2017, 31(12):897-900. SUN Libing, ZHENG Zhiying, WANG Binquan, et al. Curative effect analysis of the vestibular rehabilitation training on residual dizziness after successful canalith repositioning maneuvers in patients with benign paroxysmal positional vertigo[J]. J Clin Otorhinolaryngol Head Neck Surg, 2017, 31(12):897-900.
[21] 马鑫,张翔,静媛媛, 等. Brandt-Daroff康复练习治疗不典型眼震良性阵发性位置性眩晕[J].中国耳鼻咽喉头颈外科杂志,2009,16(8):420-422. MA Xin, ZHANG Xiang, JING Yuanyuan, et al. The effect of Brandt-Daroff exercises on positional vertigo with atypical positioning nystagmus[J]. Chin Archi Otolaryngol Head Neck Surg, 2009, 16(8):420-422.
[22] 蒋子栋,高帆,温彦华. 难治性眩晕的初步临床分析[J]. 中华耳科学杂志,2012,10(2):155-159. JIANG Zidong, GAO Fan, WEN Yanhua. Clinical analysis of intractable vertigo syndrome[J]. Chin J Otol, 2012, 10(2):155-159.
[23] 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科分会. 良性阵发性位置性眩晕诊断和治疗指南(2017)[J].中华耳鼻咽喉头颈外科杂志, 2017, 52(3):173-177.

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