内耳病变并发良性阵发性位置性眩晕

Benign paroxysmal positioning vertigo related to inner ear disorders

目的了解继发于几种内耳疾病的良性阵发性位置性眩晕(benign paroxysmalpositional vertigo,BPPV)的发病情况,进一步了解 BPPV 的可能发病机制。方法观察眩晕诊疗中心2004年1月至2006年11月53例前庭神经炎、90例突发性聋(包括伴眩晕的突发性聋)、381例梅尼埃病 BPPV 等的发病情况,并与同期183例原发性 BPPV 比较。结果 4种内耳疾病后可以出现BPPV,分别是前庭神经炎、突发性聋、梅尼埃病和 Bell 麻痹。前庭神经炎后出现 BPPV 为9.4%(5/53);突发性聋后出现 BPPV 为38.9%(35/90);梅尼埃病后出现 BPPV 为0.3%(1/381);1例 Bell麻痹后出现 BPPV。其中外半规管 BPPV 5例;后半规管37例,其中1例后半规管 BPPV 在复位过程中出现同侧前半规管 BPPV。管结石症39例,外半规管嵴顶结石症3例。内耳病变后出现 BPPV 在发病后半年内出现者占75.0%(27/36)。继发性 BPPV 的手法复位效果与原发性 BPPV 相似,大多都可1、2次就诊后治愈。结论内耳病突发性聋、前庭神经炎和梅尼埃病后可以出现 BPPV。这种类型的 BPPV 主要表现为后半规管管结石,偶见外半规管嵴帽结石。原发性 BPPV 与内耳病变后出现的BPPV 手法复位疗效相似。

Objective To investigate the incidence of benign paroxysmal positional vertigo（BPPV） and to further understand the possible mechanism of BPPV. Methods To observe the incidence of BPPV among vestibular neuritis, sudden deafness, Meniere＇s disease and Bell＇s palsy at vertigo clinic from January at 2004 to November at 2006 and to compare the therapeutic results with that of the primary BPPV. Results There are 4 types of inner ear disorders involved in the concomitant BPPV, ie, vestibular neuritis, sudeen deafness, Meniere＇s disease and Bell＇s palsy and the incidence are 9. 5% （5/53）, 38. 9% （35/90）and 0. 3% （1/381） respectively; and there was 1 case of BPPV concomitant to Bell＇s palsy. Among the 42 concomitant BPPV, 5 cases were horizintal canal BPPV, 37 cases were posterior canal BPPV, and 1 cases had complicated anterior BPPV during repositioning maneuver. 39 cases of concomitant BPPV were canalithiasis and 3 cases were cupuliothiathitis, of which 75 % （27/36）of concomitant BPPV emerged within 1/2 years after the onset of primary inner ear disorders. The therapeutic efficacy of the concomitant BPPV with canalith repositioning was similar to that of the primary type of BPPV. Conclusions Following some inner ear disorder, BPPV could emerge, such as sudden deafness, vestibular neuritis and Meniere＇s disease. The most common type of BPPV was canalithiasis of posterior canal, and the cupulolithiasis of horizontal canal was uncommon. The anterior canal therapeutic efficacy of the concomitant BPPV with canalith repositioning was similar to that of the primary type of BPPV. The therapeutic efficacy of the concomitant BPPV with canalith repositioning was similar to that of the primary type of BPPV.