Zhao P P, Xu X R, Jin Z G, Zhang Y, Li Y J
Center of Vertigo Clinic Research of Aerospace, General Hospital of PLA Air Force, Beijing, 100142, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 Mar;33(3):220-224. doi: 10.13201/j.issn.1001-1781.2019.03.009.
To analyze the clinical features of secondary benign paroxysmal positional vertigo (BPPV) and provide evidence for its precise diagnosis and treatment. There were 942 patients with vertigo related to BPPV, including 204 patients with primary BPPV, 592 patients with vestibular migraine (VM), 83 patients with Meniere's disease (MD), 48 patients with vestibular neuronitis (VN), and 15 patients with sudden sensorineural hearing loss (SSNHL) accompanied by vertigo.There were 127 patients with BPPV secondary to vertigo in MD, VN, VM, and SSNHL. All patients received otolith repositioning treatment by hand or instrument based on detailed medical history. Secondary BPPV patients are treated according to the principle of diagnosis and treatment of primary BPPV. The incidence of secondary BPPV in each related disease was counted, and the difference between primary and secondary BPPV in gender, age, affected semicircular canal, number of reductions, and vertigo control rate was compared. ①The incidence of MD, VN, sudden vertigo, and VM secondary BPPV were 36.1% (30/83), 35.4%(17/48), 33.3% (5/15), and 12.7% (75/592). ②In patients with BPPV secondary to MD, the proportion of multi-semicircular canals involved was higher than that of primary BPPV, the difference was statistically significant (<0.05), and there was no significant difference in the distribution of semicircular canals involved among the remaining diseases. ③The vertigo control rate of BPPV secondary to MD and VM was lower than that of primary BPPV, and the difference was statistically significant (<0.05). ④The repositioning time of BPPV secondary to VM (2.88±2.32) and MD (2.53±1.14) was higher than that of primary BPPV (2.37±1.77). The difference was statistically significant (<0.05). There was no significant difference in the repositioning time between other secondary BPPV and primary BPPV. Common causes of secondary BPPV include MD, VN, SSNHL, and VM. Same as primary BPPV, the secondary BPPV was more common in women and the posterior semicircular canal was most affected. BPPV secondary to MD is more susceptible to multi-semicircular canals involvement than primary BPPV. Detailed medical history combined with targeted examination is conducive to the accurate diagnosis of BPPV. Secondary BPPV can also be treated by manipulation or instrument, however, the effect is worse than primary BPPV. Secondary BPPV should be treated according to the treatment principle of primary disease besides otolith repositioning.
分析继发性良性阵发性位置性眩晕(BPPV)的临床特征,为其精准诊断和治疗提供依据。942例与BPPV相关的眩晕患者,其中原发性BPPV患者204例,前庭性偏头痛(VM)患者592例,梅尼埃病(MD)患者83例,前庭神经炎(VN)患者48例,伴眩晕的突发性聋(SSNHL)患者15例。MD、VN、VM及SSNHL继发BPPV患者127例。所有患者均根据详细病史接受手法或仪器耳石复位治疗。继发性BPPV患者按原发性BPPV的诊治原则进行治疗。统计各相关疾病中继发性BPPV的发生率,比较原发性和继发性BPPV在性别、年龄、患侧半规管、复位次数及眩晕控制率方面的差异。①MD、VN、突发性眩晕及VM继发BPPV的发生率分别为36.1%(30/83)、35.4%(17/48)、33.3%(5/15)和12.7%(75/592)。②MD继发BPPV患者中多半规管受累比例高于原发性BPPV,差异有统计学意义(<0.05),其余疾病中受累半规管分布差异无统计学意义。③MD和VM继发BPPV的眩晕控制率低于原发性BPPV,差异有统计学意义(<0.05)。④VM(2.88±2.32)和MD(2.53±1.14)继发BPPV的复位时间高于原发性BPPV(2.37±1.77),差异有统计学意义(<0.05)。其他继发性BPPV与原发性BPPV的复位时间差异无统计学意义。继发性BPPV的常见病因包括MD、VN、SSNHL及VM。与原发性BPPV相同,继发性BPPV在女性中更常见,后半规管受累最为多见。MD继发BPPV比原发性BPPV更易多半规管受累。详细病史结合针对性检查有助于BPPV的准确诊断。继发性BPPV也可通过手法或仪器治疗,然而,效果比原发性BPPV差。继发性BPPV除耳石复位外,应按原发病的治疗原则进行治疗。