Kaplan Daniel Michael, Kraus Mordechai, El-Saeid Sabri, Slovik Youval
Department of Otolaryngology- Head and Neck Surgery, Soroka University Medical Center and the Faculty of Health Sciences, Ben Gurion University in the Negev, Beer Sheva, Israel.
Harefuah. 2020 Feb;159(1):103-106.
To characterize a subgroup of patients that were diagnosed with benign paroxysmal positional vertigo of the posterior semicircular canal pBPPV, with findings of geotropic-torsional nystagmus on the roll rest (RT) that intensified on the Dix-Hallpike exam (DH).
The study population consisted of patients with the diagnosis of pBPPV. First, the roll test (RT) and then the DH test were performed. Characteristics were compared between group 1 - patients with a negative RT and positive DH (in keeping with pBPPV), and group 2- patients with a torsional-geotropic nystagmus on the RT, that intensified on DH. Patients from both groups were treated with the Epley maneuver. If the nystagmus continued, further Epley maneuvers were performed until it subsided. Patients continued follow-up visits until they were asymptomatic and the exam was normal.
Ninety-one consecutive patients were diagnosed with pBPPV. Sixty nine patients belonged to group 1 and 22 to group 2. The average age was just under 60 and the percentage of males was 22 in group 1 and 45 in group 2, which was significantly different. Additional significant differences included: 1. Symptom duration, in days, until diagnosis (43.2 in group 1 and 22.3 in group 2). 2. The fraction of patients requiring only one Epley maneuver in the first treatment session was 77.4% in group 1 and 23.4% in group 2.
The appearance of a torsional-geotropic nystagmus during RT is most probably due to pBPPV, with a more severe clinical presentation, requiring more Epley maneuvers than in patients with a negative RT. These patients had increased symptoms and were diagnosed earlier. However, the response to treatment was similar in both groups. It is most important to differentiate these patients in group 2 from patients with BPPV arising from the horizontal semicircular canal, which has different clinical features and is treated differently.
对一组被诊断为后半规管良性阵发性位置性眩晕（pBPPV）的患者进行特征描述，这些患者在翻滚试验（RT）中出现地向扭转性眼震，且在 Dix-Hallpike 检查（DH）时加重。
研究人群包括诊断为 pBPPV 的患者。首先进行翻滚试验（RT），然后进行 DH 试验。比较第 1 组（RT 阴性且 DH 阳性的患者，符合 pBPPV）和第 2 组（RT 时出现扭转地向性眼震且在 DH 时加重的患者）之间的特征。两组患者均采用 Epley 手法治疗。如果眼震持续，则进一步进行 Epley 手法，直到眼震消失。患者持续随访，直到无症状且检查正常。
91 例连续患者被诊断为 pBPPV。69 例患者属于第 1 组，22 例属于第 2 组。平均年龄略低于 60 岁，第 1 组男性比例为 22%，第 2 组为 45%，差异有统计学意义。其他显著差异包括：1. 诊断前症状持续天数（第 1 组为 43.2 天，第 2 组为 22.3 天）。2. 在首次治疗 session 中仅需一次 Epley 手法的患者比例，第 1 组为 77.4%，第 2 组为 23.4%。
RT 期间出现扭转地向性眼震很可能是由于 pBPPV 所致，其临床表现更严重，与 RT 阴性的患者相比需要更多的 Epley 手法。这些患者症状更严重且诊断更早。然而，两组对治疗的反应相似。将第 2 组患者与水平半规管引起的 BPPV 患者区分开来非常重要，因为后者具有不同的临床特征且治疗方法不同。
