耳石治疗仪诊断治疗良性阵发性位置性眩晕的临床分析

韩朝; 田亮; 迟放鲁

doi:10.13201/j.issn.1001-1781.2013.22.011

耳石治疗仪诊断治疗良性阵发性位置性眩晕的临床分析

- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科耳神经颅底外科(上海, 200031)

详细信息

通讯作者: 迟放鲁, E-mail:chifanglu@126.com

中图分类号: R255.3

收稿日期: 2013-06-04

Clinical analysis of the diagnosis and treatment of benign paroxysmal positional vertigo by TRV-CRP

- Department of Otolaryngology and Ear Nerve Skull Base Surgery, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, 200031, China

More Information

Corresponding author: CHI Fanglu, E-mail: chifanglu@126.com

Received Date: 04 June 2013

摘要

摘要: 目的:分析机械辅助耳石检查复位治疗仪(TRV耳石治疗仪)对初诊为BPPV的病例进行耳石检查和复位的效果。方法:对我院前庭功能室2012-04-01-2012-07-01间使用TRV耳石治疗仪检查治疗的初诊为BPPV病例数据进行分析。所有病例随访时间为1~3个月。结果:504例初诊为BPPV的患者中,3例因为患者未完成检查排除,顺利完成检查治疗的有501例患者,其中男162例,女339例;年龄10~86岁(52.8±14.0岁)。其中检查阳性的169例(33.73%),阴性332例(66.27%)。169例阳性患者中,单个半规管受累135例,占阳性患者的79.89%(左水平半规管17例,左上半规管4例,左后半规管29例,右水平半规管23例,右上半规管4例,右后半规管58例);两个以上半规管受累25例(14.80%)。主观BPPV 9例(5.33%),其中右后半规管5例,左后半规管3例,右水平半规管1例。332例阴性病例中,病史不典型的163例,病史典型的169例检查阴性的患者中,之前做过手法复位的有14例,检查前症状已经好转的有33例。总的治疗有效率达到100%,其中因为症状缓解不满意而再次就诊的患者中检查结果阴性的10例,检查阳性10例患者中耳石症所涉半规管不同于初诊的为6例,耳石症所涉半规管与初诊相同的4例,复发率为2.37%。再次复位后均好转未复发。结论:对于初诊为良性阵发性位置性眩晕的患者,通过TRV耳石治疗仪检查确诊为BPPV的比率为34%,对确诊的BPPV治疗有效率高,复发率低,尤其适合诊断治疗复杂的多个半规管同时受累的BPPV。因其费用偏高,临床上易与手法复位相结合。
- 耳石复位 /
- 机械辅助 /
- 良性阵发性位置性眩晕 /
- 治疗 /
- 效果
Abstract: Objective: To explore the effective of the new mechanical assistant canalith repositioning procedure(TRV-CRP) to the diagnosis and treatment of the benign paroxysmal positional vertigo(BPPV).Method: The data of the cases with suspected diagnosis of BPPV from April to June of 2012 checked and treated by TRV-CRP in our vestibular function checking room were collected and analyzed. All of the cases were followed up to one to three months.Result: Total 504 cases of suspected diagnosis of BPPV were collected. Three cases were rejected for uncompleted procedure. All of the 501 completed procedure cases included 162 male and 339 female with age ranging from 10 years old to 86 years old(52.8±14 years old). 169 cases(33.73%) were positive diagnosis and 332 cases were negative diagnosis(66.27%). 135 cases enrolled only one semicircular canal(SC) account for 79.89% of all the positive diagnosis that included 17 cases of left horizontal SC, 4 cases of left superior SC, 29 cases of left posterior SC, 23 cases of right horizontal SC, 4 cases of superior SC and 58 cases of right posterior SC. 25 cases enrolled more than two SC(14.80%). 9 cases of objective BPPV(5.33%) included 5 cases of right posterior SC,3 cases of left posterior SC and one cases of right horizontal SC. Exception of 163 cases without classic BPPV history in the 332 negative diagnosis cases, 169 cases had classic BPPV history including 14 cases treated by manual canalith repositioning procedure and 33 cases which had released from the vertigo. The rate of treatment effective by TRV-CRP was 100%. There were 20 cases returned for retreatment because their unsatisfied about the release of their symptom but proved to be negative diagnosis again in 10 cases and positive diagnosis in 10 cases, however, only 4 cases proved to be the same SC disease were considered as relapse(2.37%) and others enrolled different SC. After retreated, all cases got release without relapse.Conclusion: TRV-CRP could diagnosis 34% of the primary diagnosis cases of BPPV. TRV-CRP had high rate of effective and lower relapse which especially fitted to patients suffered from complex BPPV or difficult to finish the manual repositioning procedure. However, due to the expensive of TRV-CRP, it is reasonable to combine TRV-CRP and manual repositioning procedure in clinical.
- canalith repositioning /
- mechanical assistance /
- benign paroxysmal positional vertigo /
- treatment /
- effect

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参考文献(13)

[1]	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(2006年,贵阳)[J]. 中华耳鼻咽喉头颈外科杂志, 2007,42(3):163-164.
[2]	单希征, 孙勍, 龙顺波, 等. 三维滚轮耳石复位系统及其临床应用[J]. 中华耳鼻咽喉头颈外科杂志, 2008, 43(10):786-788.
[3]	PARNES L S, AGRAWAL S K, ATLAS J. Diagnosis and management of benign paroxysmal positional vertigo(BPPV)[J]. CMAJ, 2003, 169:681-693.
[4]	NUTI D, NATI C, PASSALI D. Treatment of benign paroxysmal positional vertigo:no need for postmaneuver restrictions[J]. Otolaryngol Head Neck Surg,2000,122:440-444.
[5]	HAIN T C, HELMINSKI JO, REIS IL, et al. Vibration does not improve results of the canalithrepositioning procedure[J]. Arch Otolaryngol Head Neck Surg, 2000, 126:617-622.
[6]	RICHARD-VITTON T, VIIRRE E. Unsteadiness and drunkenness sensations as a new sub-type of BPPV[J]. Rev Laryngol Otol Rhinol(Bord),2011,132:75-80.
[7]	RICHARD-VITTON T, SEIDERMANN L, FRAGET P, et al.Benign positional vertigo, an armchair for diagnosis and for treatment:description and significance[J]. Rev Laryngol Otol Rhinol(Bord), 2005, 126:249-251.
[8]	TIAN Y, ZHANG T, JIANG X.Diagnosis and treatment of 318 benign paroxysmal positional vertigo cases[J].J Clin Otorhinol, 2012, 26:13-15.
[9]	SALVINELLI F, TRIVELLI M, CASALE M, et al. Treatment of benign positional vertigo in the elderly:a randomized trial[J]. Laryngoscope, 2004, 114:827-831.
[10]	STEENERSON R L, CRONIN G W, MARBACH P M. Effectiveness of treatment techniques in 923 cases of benign paroxysmal positional vertigo[J]. Laryngoscope,2005,115:226-231.
[11]	HONRUBIA V, BALOH R W, HARRIS M R,et al. Paroxysmal positional vertigo syndrome[J]. Am J Otol, 1999, 20:465-470.
[12]	KORRES S, RIGA M G, XENELLIS J, et al. Treatment of the horizontal semicircular canal canalithiasis:pros and cons of the repositioning maneuvers in a clinical study and critical review of the literature[J]. Otol Neurotol, 2011,32:1302-1308.
[13]	BHATTACHARYYA N, BAUGH R F, ORVIDAS L, et al. Clinical practice guideline:benign paroxysmal positional vertigo[J]. Otolaryngol Head Neck Surg, 2008,139:S47-81.