Coppo G F, Singarelli S, Fracchia P
Divisione ORL, Ospedale Santo Spirito, USL 21 Casale Monferrato (AL).
Acta Otorhinolaryngol Ital. 1996 Dec;16(6):508-12.
The purpose of the present work has been to evaluate the effectiveness of the Semont's liberatory maneuver in treating benign paroxysmal positional vertigo (BPPV) stemming from lithiasis of the posterior semicircular canal. After taking an overview of the history, epidemiology and clinical manifestation of this pathology, the cases studied are presented: 165 cases of BPPV of the posterior semicircular canal diagnosed between September 1992 and December 1994 at the Audiology and E.N.T. Clinic of the Santo Spirito Hospital in Casale Monferrato, Italy. Diagnosis was based on careful examination of the case history and the finding of typical paroxysmal positional vertigo. Among the 1096 patients who came under observation for vertigo or instability, the incidence of BPPV was rather high: approximately 23%, predominantly females (64% of the cases). In 56% of the cases the right labyrinth was involved while the left labyrinth was involved in 39% (in 5% the form was bilateral). The average age of the patients was 60 years, with incidence being greatest in the 6th and 7th decades of life. In 10% of the cases the etiology was traumatic (cranial, cervical trauma or post otological or general surgery), in 5% it was of viral origin, in 1% of vascular origin; however, in the vast majority of cases (84%) it was idiopathic. All the patients were treated with the Semont's liberatory maneuver (repeated 1-3 times in subsequent sessions at 48 hour intervals). A full 62% of the patients treated were freed of the disorder after a single maneuver and 95.5% after 3 treatments. In 5% of the cases (3 very elderly patients), the disorder persisted even after rehabilitation with Brand Daroff's exercises. To evaluate the evolution in time, all the patients were sent a written questionnaire aimed at determining the progression of symptoms, any recurrences, the number of recurrences, and the length of time from the date of treatment. In the case of positive response, the patients were invited in for a clinical-instrumental check-up. This follow-up ranged from 6 to 30 months. At the end of May 1995 the case breakdown was as follows: 80.7% of the patients were still symptom free, most being quite satisfied with the results; 18% had had one or more recurrence of the paroxysmal positional vertigo which were successfully treated by one or more application of the Semont's maneuver.
本研究的目的是评估Semont手法复位治疗后半规管结石症所致良性阵发性位置性眩晕（BPPV）的有效性。在概述了该疾病的病史、流行病学和临床表现之后，介绍了所研究的病例：1992年9月至1994年12月期间，在意大利卡萨莱蒙费拉托圣斯皮里托医院的听力与耳鼻喉科诊所诊断出165例后半规管BPPV。诊断基于对病史的仔细检查以及典型阵发性位置性眩晕的发现。在1096名因眩晕或平衡不稳前来就诊的患者中，BPPV的发病率相当高：约为23%，以女性为主（占病例的64%）。56%的病例右侧迷路受累，39%的病例左侧迷路受累（5%为双侧形式）。患者的平均年龄为60岁，发病高峰在60至70岁之间。10%的病例病因是创伤性的（颅脑、颈椎创伤或耳科或普通外科手术后），5%为病毒源性，1%为血管源性；然而，绝大多数病例（84%）病因不明。所有患者均接受Semont手法复位治疗（后续 sessions 中每隔48小时重复1至3次）。接受治疗的患者中，62%在单次手法复位后症状消失，95.5%在3次治疗后症状消失。5%的病例（3名高龄患者）即使在进行Brand Daroff练习康复后症状仍持续存在。为了评估随时间的演变情况，向所有患者发送了一份书面问卷，旨在确定症状的进展、是否复发、复发次数以及自治疗之日起的时间长度。如回复为阳性，则邀请患者前来进行临床仪器检查。随访时间为6至30个月。1995年5月底病例分类如下：80.7%的患者仍无症状，大多数对结果相当满意；18%的患者阵发性位置性眩晕有一次或多次复发，通过一次或多次应用Semont手法成功治疗。
