Asprella Libonati G, Gagliardi G, Cifarelli D, Larotonda G
Department of Otorhinolaryngology and Head-Neck Surgery, Hospital of Matera, Italy.
Acta Otorhinolaryngol Ital. 2003 Feb;23(1):10-5.
Aim of the work was to describe a new physical therapeutic approach for benign paroxysmal positional vertigo determined by canalolithiasis of the lateral semicircular canal. A review is made of the literature, and personal experience is reported. A total of 55 cases were observed, 40 geotropic forms, 15 apogeotropic forms. Liberatory manoeuvres were carried out observing the nystagmus during videonystagmoscopic examination, thus attempting to solve the problem in the first treatment session. Monitoring the patient under videonystagmoscopic examination, progression of the otolithic mass towards the non-ampullary segment is documented by the appearance of a nystagmus directed towards the healthy side (and, therefore, inhibitory, due to ampullofugal deflection of the ampullary cupula) during the individual steps of the rehabilitation treatment. Of the 40 geotropic forms, 30 were successfully treated with the Vannucchi-Asprella technique, and the other 10 with the Vannucchi-Asprella manoeuvre followed by a Lempert barbecue rotation. Of the 15 apogeotropic forms, 6 were solved with the Vannucchi-Asprella manoeuvre, 2 with the Vannucchi-Asprella technique followed by Lempert, 6 with the inverted Gufoni technique, followed by Lempert, 1 transformed into geotropic with inverted Gufoni plus Lempert and then resolved by means of a Vannucchi-Asprella manoeuvre. In all cases, therapeutic success was achieved in the first session. Treatment of benign paroxysmal positional vertigo of the lateral semicircular canal does not allow every case to be fully solved at the first attempt with any technique proposed up to now, in particular, for the apogeotropic forms. Being aware of the different techniques, choosing that most appropriate for the patient's "physical" needs, and, above all, verifying under videonystagmoscopic examination the progression in an ampullofugal direction of the otolithic mass during treatment enable excellent therapeutic results to be obtained in the treatment of benign paroxysmal positional vertigo of the lateral semicircular canal, by modifying the rehabilitation strategy while it is being carried out. Videonystagmoscopic examination monitoring of the nystagmus during treatment of benign paroxysmal positional vertigo of the lateral semicircular canal, is taking the place of the rigid schematism of the manoeuvres proposed, so far, allowing the treatment programme to be adapted to the individual case, thus enabling a solution to be reached in the first rehabilitation session by means of tailored therapy.
这项工作的目的是描述一种针对由外侧半规管管石症引起的良性阵发性位置性眩晕的新物理治疗方法。对相关文献进行了综述，并报告了个人经验。共观察了55例患者，其中40例为地向性形式，15例为背地向性形式。在视频眼震电图检查过程中进行解脱手法并观察眼震，从而试图在首次治疗时解决问题。在视频眼震电图检查下监测患者，在康复治疗的各个步骤中，通过出现朝向健康侧的眼震（因此，由于壶腹嵴帽的离壶腹偏斜，该眼震具有抑制性）记录耳石团块向非壶腹段的进展。在40例地向性形式中，30例采用Vannucchi - Asprella技术成功治疗，另外10例采用Vannucchi - Asprella手法后进行Lempert烧烤旋转治疗。在15例背地向性形式中，6例通过Vannucchi - Asprella手法解决，2例采用Vannucchi - Asprella技术后进行Lempert治疗，6例采用反向Gufoni技术后进行Lempert治疗，1例通过反向Gufoni加Lempert转变为地向性，然后通过Vannucchi - Asprella手法解决。在所有病例中，首次治疗即取得了治疗成功。对于外侧半规管良性阵发性位置性眩晕的治疗，目前所提出的任何技术都无法使每个病例在首次尝试时得到完全解决，尤其是对于背地向性形式。了解不同的技术，选择最适合患者“身体”需求的技术，最重要的是，在视频眼震电图检查下验证治疗过程中耳石团块向离壶腹方向的进展，通过在实施康复策略时对其进行调整，能够在外侧半规管良性阵发性位置性眩晕的治疗中获得优异的治疗效果。在外侧半规管良性阵发性位置性眩晕治疗过程中，通过视频眼震电图检查监测眼震，正在取代迄今为止所提出的手法的严格模式，使治疗方案能够适应个体情况，从而通过量身定制的治疗在首次康复治疗时找到解决方案。
