Otolaryngology Division, University Hospital Lucus Augusti, University Hospital Lucus Augusti, Lugo, Spain.
Otol Neurotol. 2012 Oct;33(8):1401-7. doi: 10.1097/MAO.0b013e318268d50a.
To compare the outcome and probability of recurrence in a series of patients with unilateral idiopathic benign paroxysmal positional vertigo of the posterior canal (PC-BPPV) that were randomly treated by Brandt-Daroff exercise (B-D exercise) or by particle repositioning maneuver (PRM).
Randomized prospective clinical trial.
Tertiary referral center.
Patients were included in this study if they complained of vertigo and had been diagnosed as having unilateral idiopathic PC-BPPV for at least 1 week before Dix-Hallpike maneuver (DHM), remained for 30 days in the randomly assigned treatment, and had at least 48 months' follow-up.
Forty-one patients were treated with a single PRM and 40 patients by B-D exercise.
Resolution of benign paroxysmal positional nystagmus on the DHM. The probability of recurrence was also studied.
At Day 7, DHM was negative in 80.5% of the PRM-treated patients and in 25% of those treated by B-D exercise (p < 0.001). At Month 1, the differences between both treatment groups remained statistically significant (92.7% in PRM versus 42.5% in the B-D exercise had a negative DHM; p < 0.001). The variable that influenced that DHM became negative was the PRM (RR = 4.8; 95% confidence interval, 2.5-9.2; p < 0.001). The number of recurrences in PRM and B-D exercise were 0.56 ± 0.8 and 0.48 ± 0.8, respectively (p = 0.48). The recurrence rate at 48 months was 35.5% (15/41) in B-D exercise and 36.6% (9/31) in the PRM group (p = 0.62). Although the time interval until the first recurrence was similar (p = 0.44), patients included in the PRM group showed a significantly longer time interval between the first and second recurrence (p = 0.04).
PRM is more effective treatment and as safe as B-D exercise in the short term for unilateral and idiopathic PC-BPPV, and although it does not reduce the probability of recurrence in the 4-year follow-up period compared with B-D exercise, it may delay the second recurrence's onset in those patients who had already experienced a single recurrence. Our study supports the use of PRM as the treatment of choice in unilateral and idiopathic PC-BPPV, although exercise may be also considered as an alternative treatment in selected cases.
比较 Brandt-Daroff 锻炼（B-D 锻炼）与颗粒重定位手法（PRM）治疗单侧特发性后半规管良性阵发性位置性眩晕（PC-BPPV）患者的结果和复发概率。
随机前瞻性临床试验。
三级转诊中心。
如果患者在 Dix-Hallpike 手法（DHM）前至少有 1 周被诊断为单侧特发性 PC-BPPV，并且在随机分配的治疗中至少停留 30 天，且随访至少 48 个月，则将患者纳入本研究。
41 例患者接受单次 PRM 治疗，40 例患者接受 B-D 锻炼。
DHM 上良性阵发性位置性眼球震颤的缓解情况。还研究了复发的概率。
第 7 天，PRM 治疗组的 DHM 阴性率为 80.5%，B-D 锻炼组为 25%（p<0.001）。第 1 个月，两组之间的差异仍具有统计学意义（PRM 组 92.7%，B-D 锻炼组 42.5%的 DHM 阴性；p<0.001）。影响 DHM 阴性的变量是 PRM（RR=4.8；95%置信区间，2.5-9.2；p<0.001）。PRM 和 B-D 锻炼的复发率分别为 0.56±0.8 和 0.48±0.8（p=0.48）。48 个月时，B-D 锻炼组的复发率为 35.5%（15/41），PRM 组为 36.6%（9/31）（p=0.62）。尽管首次复发的时间间隔相似（p=0.44），但 PRM 组的患者首次和第二次复发之间的时间间隔明显更长（p=0.04）。
在单侧和特发性 PC-BPPV 的短期治疗中，PRM 比 B-D 锻炼更有效且安全，尽管与 B-D 锻炼相比，在 4 年的随访期间它并未降低复发的概率，但对于已经经历过单次复发的患者，它可能会延迟第二次复发的发生。我们的研究支持将 PRM 作为单侧和特发性 PC-BPPV 的首选治疗方法，尽管在某些情况下也可以考虑锻炼作为替代治疗方法。
