Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China.
Eur Arch Otorhinolaryngol. 2022 Jul;279(7):3237-3256. doi: 10.1007/s00405-022-07288-9. Epub 2022 Feb 26.
To investigate the risk factors for residual dizziness (RD) in patients with benign paroxysmal positional vertigo (BPPV) after successful repositioning.
Searches were performed in PubMed, Embase, Cochrane library, Web of Science, Chinese National Knowledge Infrastructure, and Sino Med up to March 7, 2021 and references of relevant articles were screened. Data from eligible studies were meta-analyzed using Stata version 16.0 and Review Manager 5.4.
In this systematic review and meta-analysis of 4487 patients from 31 studies, the prevalence of RD was 43.0% (95% CI 39.0-48.0%). Age (MD 4.17; 95% CI 2.13-6.21, P = 0.000), female gender (OR = 1.28, 95% CI 1.11-1.47, P = 0.001), secondary BPPV (OR 1.88; 95% CI 1.27-2.77, P = 0.001), a longer duration of BPPV before treatment (MD 3.45; 95% CI 1.87-5.02, P = 0.000), abnormal ocular vestibular evoked myogenic potential (OVEMP, OR 4.34; 95% CI 2.78-6.78, P = 0.000), abnormal cervical vestibular evoked myogenic potential (CVEMP, OR 2.48; 95% CI 1.54-3.99, P = 0.000), higher Dizziness Handicap Index (DHI) score before treatment (MD 10.88; 95% CI 5.96-15.80, P = 0.000), anxiety (OR 9.58; 95% CI 6.32-14.52, P = 0.000), osteopenia (OR = 4.40, 95% CI 2.17-8.96, P = 0.000), onset in winter (OR 7.27; 95% CI 2.38-22.24, P = 0.001) and with a history of BPPV (OR 1.79; 95% CI 1.06-3.04, P = 0.03) are the risk factors for RD in patients with BPPV after successful repositioning. The affected side, location or type of semicircular involvement, hyperlipidemia, diabetes, hypertension, heart disease, migraine, sleep disorders, canalolithiasis/cupulolithiasis, the number of times the canalith repositioning procedures (CRPs) were performed and number of vertigo attacks did not correlate with the occurrence of RD.
Despite successful treatment, nearly half of the BPPV patients developed RD. RD seems to be a syndrome caused by multiple factors. The pathogenesis of most factors can be explained by psychological and/or physical disorders. Early recognition of these risk factors contributes to the prevention and treatment of RD.
研究良性阵发性位置性眩晕（BPPV）患者成功复位后残留头晕（RD）的危险因素。
检索 PubMed、Embase、Cochrane 图书馆、Web of Science、中国知网和 Sino Med 数据库，截至 2021 年 3 月 7 日，筛选相关文章的参考文献。使用 Stata 版本 16.0 和 Review Manager 5.4 对符合条件的研究数据进行荟萃分析。
在这项对 31 项研究中的 4487 名患者的系统评价和荟萃分析中，RD 的患病率为 43.0%（95%CI 39.0-48.0%）。年龄（MD 4.17；95%CI 2.13-6.21，P=0.000）、女性（OR=1.28，95%CI 1.11-1.47，P=0.001）、继发性 BPPV（OR 1.88；95%CI 1.27-2.77，P=0.001）、BPPV 治疗前持续时间较长（MD 3.45；95%CI 1.87-5.02，P=0.000）、眼性前庭诱发肌源性电位（OVEMP）异常（OR 4.34；95%CI 2.78-6.78，P=0.000）、颈性前庭诱发肌源性电位（CVEMP）异常（OR 2.48；95%CI 1.54-3.99，P=0.000）、治疗前眩晕障碍指数（DHI）评分较高（MD 10.88；95%CI 5.96-15.80，P=0.000）、焦虑（OR 9.58；95%CI 6.32-14.52，P=0.000）、骨质疏松症（OR=4.40，95%CI 2.17-8.96，P=0.000）、冬季发病（OR 7.27；95%CI 2.38-22.24，P=0.001）和 BPPV 病史（OR 1.79；95%CI 1.06-3.04，P=0.03）是 BPPV 患者成功复位后发生 RD 的危险因素。患侧、半规管受累部位或类型、高脂血症、糖尿病、高血压、心脏病、偏头痛、睡眠障碍、耳石症/壶腹嵴结石症、管石复位治疗（CRP）次数和眩晕发作次数与 RD 的发生无关。
尽管治疗成功，但近一半的 BPPV 患者出现 RD。RD 似乎是由多种因素引起的综合征。大多数因素的发病机制可以用心理和/或身体障碍来解释。早期识别这些危险因素有助于预防和治疗 RD。
