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良性阵发性位置性眩晕的最小刺激策略:其在资源有限环境中的应用

Minimal Stimulus Strategy in Benign Paroxysmal Positional Vertigo: Its Application in a Resource Limited Setting.

作者信息

Varghese Sunil Sam, Varghese Ashish, Kumar Navneet

机构信息

Department of E.N.T,, Chrisitan Medical College, Brown Road, Ludhiana, Punjab 141008 India.

Department of E.N.T Bangalore Baptist Hospital, Bellary Road, Hebbal, Bengaluru, Karnataka India.

出版信息

Indian J Otolaryngol Head Neck Surg. 2024 Dec;76(6):5740-5745. doi: 10.1007/s12070-024-05081-0. Epub 2024 Sep 24.


DOI:10.1007/s12070-024-05081-0
PMID:39559098
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11569047/
Abstract

Benign paroxysmal positional vertigo (BPPV) is the most common cause for vertigo. It is diagnosed by the characteristic nystagmus induced by provocative positional tests. During these positional tests the patient experiences spinning vertigo and neurovegetative symptoms such as nausea and vomiting. This can cause severe discomfort to the patient during treatment and in some cases reduced compliance. Minimal stimulation strategy reduced the episodes of induced vertigo, nausea and vomiting thereby making the treatment maneuvers more tolerable. This study aims to evaluate the utility of minimum stimulus strategy for managing BPPV in a resource limited center. The present study also evaluated the utility of 3rd step vertigo as an alternative marker for recovery nystagmus in predicting the efficacy of Epley's maneuver in treating posterior canal BPPV. All patients diagnosed with canalolithiasis of posterior semicircular canal (pc-BPPV), horizontal semicircular canal (hc-BPPV), anterior semicircular canal (ac-BPPV) and multiple semicircular canal (mc-BPPV) were included in the study. The side on which the maximum symptoms were experienced was asked to the patients and noted. The first positional test done in all patients was the Dix-Hallpike maneuver and minimum stimulation strategy was used for treating BPPV. Appropriate canalolith repositioning maneuvers (CRM) were used to treat BPPV. Positional maneuvers were repeated after the CRM in the same sitting and the treatment was considered successful if nystagmus had disappeared on repeat positional tests. The presence of 3rd step vertigo during Epley's maneuver was documented. A total of 71 patients were enrolled in the study. Patients correctly identified the side of BPPV in 76.31% of cases. 3rd step vertigo was able to predict a successful Epley's maneuver in pc-BPPV with a sensitivity and specificity of 41.67% and 60% respectively. Incidence of 3rd step vertigo was seen in 41.37% of patients with pc-BPPV and in 90.9% of patients with mc-BPPV. Minimal stimulation strategy is useful in reducing the discomfort experienced by the patients with BPPV during treatment and thereby improve the compliance to treatment maneuvers. Patients were able to identify the correct side of BPPV in 76.31% of cases. Third step vertigo could predict successful Epley's reposition maneuver with a sensitivity of 41.67% and specificity of 60% in our cohort. However, more studies with larger sample size are required to ascertain its role as an alternative marker for 'recovery nystagmus'.

摘要

良性阵发性位置性眩晕(BPPV)是眩晕最常见的病因。通过激发性位置试验诱发的特征性眼球震颤来进行诊断。在这些位置试验中,患者会经历旋转性眩晕以及恶心、呕吐等自主神经症状。这会在治疗期间给患者带来严重不适,在某些情况下还会导致依从性降低。最小刺激策略减少了诱发的眩晕、恶心和呕吐发作次数,从而使治疗手法更易于耐受。本研究旨在评估在资源有限的中心采用最小刺激策略管理BPPV的效用。本研究还评估了第三步眩晕作为恢复性眼球震颤的替代标志物在预测Epley手法治疗后半规管BPPV疗效方面的效用。所有被诊断为后半规管管结石症(pc - BPPV)、水平半规管管结石症(hc - BPPV)、前半规管管结石症(ac - BPPV)和多半规管管结石症(mc - BPPV)的患者均纳入本研究。询问患者出现最大症状的一侧并记录。所有患者进行的首次位置试验是Dix - Hallpike手法,并采用最小刺激策略治疗BPPV。采用适当的管结石复位手法(CRM)治疗BPPV。在同一次就诊中,CRM后重复进行位置手法,如果重复位置试验时眼球震颤消失,则认为治疗成功。记录Epley手法过程中第三步眩晕的出现情况。本研究共纳入71例患者。患者在76.31%的病例中正确识别出BPPV的患侧。第三步眩晕能够预测Epley手法治疗pc - BPPV成功,其敏感性和特异性分别为41.67%和60%。在41.37%的pc - BPPV患者和90.9%的mc - BPPV患者中观察到第三步眩晕的发生。最小刺激策略有助于减轻BPPV患者治疗期间的不适,从而提高对治疗手法的依从性。患者在76.31%的病例中能够正确识别出BPPV的患侧。在我们的队列中,第三步眩晕能够预测Epley复位手法成功,敏感性为41.67%,特异性为60%。然而,需要更多样本量更大的研究来确定其作为“恢复性眼球震颤”替代标志物的作用。

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Indian J Otolaryngol Head Neck Surg. 2024-12

[2]
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[3]
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[6]
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[8]
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[9]
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本文引用的文献

[1]
Effectiveness of Brandt Daroff, Semont and Epley maneuvers in the treatment of Benign Paroxysmal Positional Vertigo: A Randomized Controlled Clinical Trial.

Indian J Otolaryngol Head Neck Surg. 2022-9

[2]
Clinical Interpretation of Positional Nystagmus Provoked by both Dix-Hallpike and Supine Head-Roll Tests.

J Int Adv Otol. 2022-7

[3]
Minimum Stimulus Strategy: A step-by-step diagnostic approach to BPPV.

J Neurol Sci. 2022-3-15

[4]
Diagnostic and Therapeutic Maneuvers for Anterior Canal BPPV Canalithiasis: Three-Dimensional Simulations.

Front Neurol. 2021-9-24

[5]
Orthotropic nystagmus in predicting the efficacy of treatment in posterior canal benign paroxysmal positional vertigo.

Am J Otolaryngol. 2020-4-1

[6]
Questionnaire-based diagnosis of benign paroxysmal positional vertigo.

Neurology. 2019-12-30

[7]
Probable benign paroxysmal positional vertigo, spontaneously resolved: Incidence in medical practice, patients' characteristics and the natural course.

J Otol. 2019-9

[8]
Benign positional vertigo, its diagnosis, treatment and mimics.

Clin Neurophysiol Pract. 2019-4-6

[9]
Benign paroxysmal positional vertigo.

Laryngoscope Investig Otolaryngol. 2018-12-14

[10]
Asking about dizziness when turning in bed predicts examination findings for benign paroxysmal positional vertigo.

J Vestib Res. 2018

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