Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, #7 Keunjaebong-gil, Hwaseong, Gyeonggi-do, 18450, South Korea.
Eur Arch Otorhinolaryngol. 2018 Jul;275(7):1731-1736. doi: 10.1007/s00405-018-5006-4. Epub 2018 May 26.
Clinicians sometimes see patients with relatively persistent geotropic direction-changing positional nystagmus (DCPN) as a variant of lateral semicircular canal-benign paroxysmal positional vertigo (LSCC-BPPV). Recently, the concept of a "light cupula" in the lateral semicircular canal, exhibiting persistent geotropic DCPN, has been introduced. However, the underlying pathogenesis of light cupula is not known. We investigated the efficacy of a modified cupulopathy repositioning maneuver (mCuRM), designed to reduce light debris attached to the cupula in patients with persistent geotropic DCPN.
Retrospective cohort study.
Participants included 65 patients with a persistent geotropic DCPN: 35 underwent treatment (mCuRM group), and 30 were followed-up but received no treatment (No CuRM group). We compared the therapeutic and survival rate of persistent geotropic DCPN between two groups.
On Day 1, the persistent geotropic DCPN did not resolve in either group. On the first and second follow-up days, persistent geotropic DCPN was observed in 28 (80%) and 21 (60%) of patients, respectively, in the mCuRM group, and in 28 (93.3%) and 24 (80%) patients, respectively, in the no mCuRM group. The differences between groups were not statistically significant. Furthermore, no between-group differences were found in the time from diagnosis to resolution of nystagmus, or the time from symptom onset to resolution of nystagmus. Kaplan-Meier analysis of the time course of persistent geotropic DCPN resolution from the day of diagnosis and day of symptom onset revealed no significant differences between the groups.
Our findings indicate that mCuRM had no therapeutic benefit for a persistent geotropic DCPN and suggest that the pathophysiology of persistent geotropic DCPN is less likely to be a light debris attached to the cupula.
临床医生有时会看到一些具有相对持久的向地性位置性变向眼球震颤（DCPN）的患者，将其视为水平半规管良性阵发性位置性眩晕（LSCC-BPPV）的一种变异。最近，人们提出了水平半规管中存在“轻嵴帽”的概念，这种轻嵴帽会导致持续的向地性 DCPN。然而，轻嵴帽的潜在发病机制尚不清楚。我们研究了改良嵴帽变位复位手法（mCuRM）对持续性向地性 DCPN 患者的疗效，该手法旨在减少附着在嵴帽上的轻碎片。
回顾性队列研究。
纳入 65 例持续性向地性 DCPN 患者：35 例接受治疗（mCuRM 组），30 例随访但未接受治疗（无 CuRM 组）。我们比较了两组患者持续性向地性 DCPN 的治疗效果和存活率。
第 1 天，两组患者的持续性向地性 DCPN 均未缓解。在第 1 天和第 2 天的随访中，mCuRM 组分别有 28（80%）和 21（60%）例患者持续性向地性 DCPN 缓解，无 mCuRM 组分别有 28（93.3%）和 24（80%）例患者持续性向地性 DCPN 缓解。两组间差异无统计学意义。此外，两组从诊断到眼球震颤缓解的时间、从症状出现到眼球震颤缓解的时间也无差异。从诊断日和症状出现日开始，对持续性向地性 DCPN 缓解时间的 Kaplan-Meier 分析显示，两组间无显著差异。
我们的研究结果表明，mCuRM 对持续性向地性 DCPN 无治疗作用，提示持续性向地性 DCPN 的病理生理学机制不太可能是附着在嵴帽上的轻碎片。
