Correia Filipe, Castelhano Luís, Cavilhas Pedro, Escada Pedro
Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
Acta Otorrinolaringol Esp (Engl Ed). 2021 Jan 22. doi: 10.1016/j.otorri.2020.11.003.
Multiple repositioning maneuvers have been described to treat lateral semi-circular canal Benign Paroxysmal Positional Vertigo (LC-BPPV) patients. In this study, we compare efficacy of four therapeutic repositioning maneuvers for LC-BPPV patients and aim to identify clinical variables associated with persistent disease.
A prospective study was conducted at a tertiary center, between January 2017 and September 2019. Patients diagnosed with LC-BPPV were randomly treated with Gufoni or barbecue-roll maneuvers (for the geotropic variant) and Gufoni-Appiani, barbecue-roll or Zuma-e-Maia maneuvers (for the apogeotropic form). Efficacy was compared and statistical analysis was performed to find clinical factors associated with no response.
Forty-eight patients and 82 maneuvers were included. Female patients and right side were more commonly affected. The mean age was 67 years. Seven cases (14.6%) resulted from a canal-switch. One single maneuver resolved 23 cases (47.9%) and the success rate rose to 75% at the end of the first visit (after up to 4 maneuvers) and to 93.8% after a-week of follow-up. Success rates were significantly better with Gufoni (68%) than with barbecue roll (34.8%; p=0.021) in geotropic LC-BPPV and better with Gufoni-Appiani (71.4%) than barbecue roll and Zuma-e-Maia maneuvers (33.3%; p=0.239) in apogeotropic LC-BPPV. Higher rates of persistent disease after first visit were found with older patients, left side and apogeotropic LC-BPPV and with longer latency and duration diagnostic nystagmus.
Our study suggests that Gufoni and Gufoni-Appiani maneuvers may be the most efficacious treatment for geotropic and apogeotropic LC-BPPV, respectively, compared to barbecue-roll and Zuma-e-Maia maneuvers.
已经描述了多种复位手法来治疗后半规管良性阵发性位置性眩晕（LC-BPPV）患者。在本研究中，我们比较了四种治疗性复位手法对LC-BPPV患者的疗效，并旨在确定与持续性疾病相关的临床变量。
2017年1月至2019年9月在一家三级中心进行了一项前瞻性研究。诊断为LC-BPPV的患者被随机采用Gufoni手法或翻滚试验（用于地向性变异型）以及Gufoni-Appiani手法、翻滚试验或祖马-马亚手法（用于背地性类型）进行治疗。比较疗效并进行统计分析以找出与无反应相关的临床因素。
纳入了48例患者和82次手法治疗。女性患者和右侧更常受累。平均年龄为67岁。7例（14.6%）是由半规管转换引起的。单次手法治疗使23例（47.9%）患者康复，首次就诊结束时（最多4次手法治疗后）成功率升至75%，随访一周后升至93.8%。在地向性LC-BPPV中，Gufoni手法的成功率（68%）显著高于翻滚试验（34.8%；p=0.021）；在背地性LC-BPPV中，Gufoni-Appiani手法的成功率（71.4%）高于翻滚试验和祖马-马亚手法（33.3%；p=0.239）。首次就诊后持续性疾病发生率较高的情况见于老年患者、左侧和背地性LC-BPPV患者，以及潜伏期和诊断性眼球震颤持续时间较长的患者。
我们的研究表明，与翻滚试验和祖马-马亚手法相比，Gufoni手法和Gufoni-Appiani手法可能分别是治疗地向性和背地性LC-BPPV最有效的方法。
