Kitahara Tadashi, Ota Ichiro, Horinaka Akira, Ohyama Hiroki, Sakagami Masaharu, Ito Taeko, Shiozaki Tomoyuki, Wada Yoshiro, Yamanaka Toshiaki
Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara-city, Nara, Japan.
Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara-city, Nara, Japan.
Auris Nasus Larynx. 2019 Feb;46(1):27-33. doi: 10.1016/j.anl.2018.05.010. Epub 2018 Jul 2.
The aim of the present study was to examine the association of neuro-otological examination, blood test, and scoring questionnaire data with treatment-resistant intractability in idiopathic benign paroxysmal positional vertigo (BPPV) patients.
We experienced 1520 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University during May 2014 to April 2018. Six hundred and eleven patients were diagnosed as BPPV (611/1520; 40.2%) according to the diagnostic guideline of the International Classification of Vestibular Disorder in 2015. Among BPPV patients, there were 201 intractable patients (201/611; 32.9%), 66 of whom were idiopathic and enrolled to be hospitalized and receive neuro-otological examinations, including the caloric test (C-test), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV), glycerol test (G-test), electrocochleogram (ECoG), inner ear magnetic resonance imaging (ieMRI), blood tests including anti-diuretic hormone (ADH) and bone alkaline phosphatase (BAP), and self-rating questionnaires of depression score (SDS). Sixty-six patients were diagnosed as horizontal type cupula (hBPPVcu; n=30), horizontal type canal (hBPPVca; n=10), posterior type (n=20), and probable and/or atypical BPPV (n=6). Data are presented as ratios (+) of the number of idiopathic BPPV patients with examination and questionnaire data outside of the normal range.
The ratio (+) data were as follows: C-test=21.2% (14/66), cVEMP=24.2% (16/66), SVV=48.5% (32/66), G-test=18.2% (12/66), ECoG=18.2% (12/66), ieMRI=12.1% (8/66), ADH=9.1% (6/66), BAP=13.6% (9/66), and SDS=37.9% (25/66). Multivariate regression analysis revealed that the periods of persistent vertigo/dizziness were significantly longer in BPPV patients with hBPPVcu, C-test (+), endolymphatic hydrops (+), and BAP (+) compared with those with negative findings.
Although patients with idiopathic BPPV are usually treatable and curable within 1 month, the presence of hBPPVcu, canal paresis, endolymphatic hydrops, and elevated BAP may make the disease intractable, and thus require additional treatments.
本研究旨在探讨神经耳科学检查、血液检查及评分问卷数据与特发性良性阵发性位置性眩晕（BPPV）患者难治性顽固性的相关性。
2014年5月至2018年4月期间，我们在奈良医科大学眩晕/头晕中心接待了1520例连续的眩晕/头晕患者。根据2015年国际前庭疾病分类诊断指南，611例患者被诊断为BPPV（611/1520；40.2%）。在BPPV患者中，有201例顽固性患者（201/611；32.9%），其中66例为特发性患者，被纳入住院治疗并接受神经耳科学检查，包括冷热试验（C试验）、前庭诱发肌源性电位（cVEMP）、主观视觉垂直线（SVV）、甘油试验（G试验）、耳蜗电图（ECoG）、内耳磁共振成像（ieMRI）、血液检查，包括抗利尿激素（ADH）和骨碱性磷酸酶（BAP），以及抑郁评分自评问卷（SDS）。66例患者被诊断为水平半规管嵴顶结石症（hBPPVcu；n = 30）、水平半规管管结石症（hBPPVca；n = 10）、后半规管BPPV（n = 20）以及可能和/或不典型BPPV（n = 6）。数据以检查和问卷数据超出正常范围的特发性BPPV患者数量的比例（+）表示。
比例（+）数据如下：C试验=21.2%（14/66），cVEMP = 24.2%（16/66），SVV = 48.5%（32/66），G试验=18.2%（12/66），ECoG = 18.2%（12/66），ieMRI = 12.1%（8/66），ADH = 9.1%（6/66），BAP = 13.6%（9/66），SDS = 37.9%（25/66）。多因素回归分析显示，与检查结果为阴性的BPPV患者相比，hBPPVcu、C试验（+）、内淋巴积水（+）和BAP（+）的BPPV患者持续眩晕/头晕时间明显更长。
虽然特发性BPPV患者通常在1个月内可治疗且可治愈，但hBPPVcu、半规管轻瘫内淋巴积水和BAP升高可能使疾病变得难治，因此需要额外治疗。
