Leopardi G, Chiarella G, Serafini G, Pennacchi A, Bruschini L, Brizi S, Tasca I, Simoncelli C, Cassandro E
Clinic of Audiology, Magna Graecia University, Catanzaro, Italy.
Acta Otorhinolaryngol Ital. 2003 Jun;23(3):155-60.
Between 1995 and 2001, eight Italian clinical centres used the same diagnostic and therapeutic protocol in order to assess the clinical progress of paroxysmal positional vertigo and the benefits of an appropriate follow-up in prevention of relapse. The study population comprises 794 patients affected by paroxysmal positional vertigo. The study protocol comprised diagnostic staging including a complete otoneurological test, an anamnestic questionnaire aimed at identifying any possible risk factor, a blood test in basal conditions and monitoring of blood pressure. If necessary, more specific instrumental tests have been carried out. Appropriate rehabilitative manoeuvres were performed from 1 to 3 times within the same session. The patient was checked 3-5 days later: in the presence of a positive result, the treatment was repeated; if negative, patients were seen at clinical follow-up 7, 30, 180 and 365 days after recovery. Wherever possible, patients have been contacted 2 years after the first treatment and asked to answer a questionnaire and to attend for a clinical check-up. The incidence of paroxysmal positional vertigo appeared to be higher in females and in patients aged 50-70 years, being low in patients under 30. In 88.8% of cases posterior semicircular canals showed a significant involvement; in 6.8% of cases, only involvement of lateral semicircular canals; monolateral (2.7%) and bilateral (1.7%) multicanalar forms were rare. Paroxysmal positional vertigo forms involving posterior semicircular canals have been treated with Semont (simplified by Toupet), Epley, Parnes Price-Jones manoeuvres; those, involving lateral semicircular canals with Vannucchi-Vicini forced position and "barbecue" or Gufoni manoeuvre. Whilst all these manoeuvres were equally effective, longer recovery times have been observed in paroxysmal positional vertigo forms involving lateral semicircular canals when the Vannucchi-Vicini forced position was ineffective. Any relapses have been evaluated at least 15 days after a negative clinical pattern. Possible involvement of other semicircular canals (recurrence) some time after the first onset has been considered separately. Follow-up at 6 months showed recurrence in 12.4% of cases, while being chronic in 1.5% of cases. Only 9.3% of cases showed recurrence at 6 months, no statistically significant difference being observed between vertical (8.9%) and lateral canal (9.6%), forms. Relapses occurred in 3.1% of cases, in one third of which at least two risk factors were detected.
1995年至2001年间，意大利的八个临床中心采用相同的诊断和治疗方案，以评估阵发性位置性眩晕的临床进展以及适当随访对预防复发的益处。研究对象包括794例阵发性位置性眩晕患者。研究方案包括诊断分期，其中有全面的耳神经学检查、旨在识别任何可能危险因素的问诊问卷、基础状态下的血液检查以及血压监测。如有必要，还进行了更具体的仪器检查。在同一会诊期间进行1至3次适当的康复手法操作。3至5天后对患者进行检查：如果结果为阳性，则重复治疗；如果为阴性，则在恢复后7天、30天、180天和365天进行临床随访。尽可能在首次治疗后2年联系患者，要求他们回答问卷并参加临床检查。阵发性位置性眩晕的发病率在女性和50至70岁的患者中似乎较高，在30岁以下的患者中较低。在88.8%的病例中，后半规管有明显受累；在6.8%的病例中，仅水平半规管受累；单侧（2.7%）和双侧（1.7%）多管型很少见。涉及后半规管的阵发性位置性眩晕形式采用Semont（经Toupet简化）、Epley、Parnes Price-Jones手法治疗；涉及水平半规管的采用Vannucchi-Vicini强迫体位和“烧烤”或Gufoni手法治疗。虽然所有这些手法同样有效，但当Vannucchi-Vicini强迫体位无效时，涉及水平半规管的阵发性位置性眩晕形式的恢复时间更长。在临床症状为阴性后至少15天评估任何复发情况。首次发作一段时间后其他半规管可能的受累（复发）情况已单独考虑。6个月的随访显示，12.4%的病例复发，1.5%的病例为慢性。仅9.3%的病例在6个月时复发，垂直（8.9%）和水平半规管（9.6%）形式之间未观察到统计学上的显著差异。3.1%的病例出现复发，其中三分之一至少检测到两个危险因素。
