Centre d'Explorations Fonctionnelles Otoneurologiques, 10, rue Falguière, 75015 Paris, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2013 Dec;130(6):303-7. doi: 10.1016/j.anorl.2012.01.007. Epub 2013 Jul 9.
The purpose of this study is to define the diagnostic criteria for anterior semicircular canal benign paroxysmal positional vertigo (BPPV) based on clinical data and the available anatomical and pathophysiological data.
Between July 2006 and June 2007, 4320 patients consulting for otoneurological disease were investigated by otological examination, videonystagmography and neurological examination.
BPPV was diagnosed in 1430 patients, involving the posterior semicircular canal in 1325 patients, the horizontal semicircular canal in 85 patients, the posterior semicircular canal and ipsilateral anterior (superior) semicircular canal in 19 patients and the anterior semicircular canal only in one patient. In the 20 patients with anterior semicircular canal BPPV, the Dix-Hallpike (DH) test induced ageotropic horizontal torsional nystagmus beating towards the uppermost ear in the lateral supine position with reversal on standing. The modified Epley manoeuvre was effective in 94.1% of cases on the 8th day and in 97.5% of cases at 1 month.
DISCUSSION/CONCLUSION: Nystagmus beating towards the uppermost ear on the DH test is consistent with BPPV involving the anterior semicircular canal of the uppermost ear. The torsional component of nystagmus and not just the vertical component must be taken into account to facilitate the diagnosis with videonystagmoscopy glasses and identify the affected side. The anterior semicircular canal is rarely affected due to its anatomical position. Settling of otoconia in this canal requires hyperextension of the head. Treatment is simple, consisting of the modified Epley particle repositioning manoeuvre.
本研究旨在根据临床资料及现有解剖学和生理学数据，确定前半规管良性阵发性位置性眩晕（BPPV）的诊断标准。
2006 年 7 月至 2007 年 6 月，对 4320 例因耳科疾病就诊的患者进行了耳科学检查、视频眼震图和神经系统检查。
诊断为 BPPV 的患者 1430 例，其中后半规管 1325 例，水平半规管 85 例，后半规管和同侧前（上）半规管 19 例，仅前半规管 1 例。在前半规管 BPPV 的 20 例患者中，Dix-Hallpike（DH）试验诱发头向患侧上极耳的位置性水平扭转性眼震，站立时眼震反向。改良 Epley 手法在第 8 天有效率为 94.1%，1 个月时有效率为 97.5%。
讨论/结论：DH 试验时眼震向患侧上极耳提示上极耳前半规管 BPPV。视频眼震图检查时，不仅要考虑垂直成分，还要考虑扭转成分，以便诊断和确定受累侧。由于解剖位置的原因，前半规管很少受累。该管内耳石的沉降需要头部过度伸展。治疗方法简单，包括改良 Epley 颗粒复位手法。
