继发梅尼埃病良性阵发性位置性眩晕的临床特点

The clinical characteristics of the benign paroxysmal positional vertigo associated with Meniere＇s disease

目的 回顾性分析继发于梅尼埃病（MD）的良性阵发性位置性眩晕（BPPV）的临床特点,并探讨该病的诊断与治疗特点.方法 自2007年7月至2009年6月于中山大学附属第三医院入院的梅尼埃病伴BPPV患者15例,男1例,女14例;年龄46～69岁.通过临床表现并结合甘油试验及耳蜗电图诊断为梅尼埃病,经Dix-Hallpike试验或Roll teat翻滚试验诊断为BPPV.所有病例按照BPPV类型,进行了Epley手法复位或Barbecue翻滚手法治疗,并评价其治疗效果.结果 （1）本组病例中女性患者发病（93.3%）高于男性（6.7%）;（2）BPPV均继发于梅尼埃病后发作,其中后半规管管石症13例（同侧9例,对侧2例,双侧2例）,水平半规管2例（1例为同侧嵴帽结石,1例为同侧管石）;（3）本组患者经3～4次体位治疗后治愈者10例（66.7%）,经〉5次治疗治愈者4例（26.7%）,1例治疗后膜迷路积水情况及眩晕症状无明显改善,最终行内淋巴囊减压术改善膜迷路积水后,BPPV获得治愈.结论 （1）BPPV可继发于梅尼埃病发病,膜迷路积水导致耳石脱落是BPPV发病的可能机制之一;（2）其中大部分类型为同侧后半规管BPPV,发病人群中以女性发病为主,可能存在性别倾向;（3）耳石复位是治疗继发梅尼埃病的BPPV有效的治疗方法 ,但较单纯BPPV治疗存在一定难度,需反复多次复位治疗,这可能与膜迷路反复积水有一定关系.

Objective To explore the clinical characteristics of the benign paroxysmal positional vertigo （BPPV） associated with Meniere＇s disease （MD） in retrospect in an effort to improve the diagnosis and efficacy of treatment. Method Fifteen cases （ 1 male and 14 female, aged 46 to 68 years old） of BPPV associated with MD from July 2007 to June 2009 were retrospectively analyzed. Patient clinically characterized with positional paroxysmal vertigo were diagnosed as MD by ECochG and glycerol test and were confirmed as BPPV associated with MD by Dix Hallpike test or roll test. They were treated with Epley maneuver or Barbecue rol maneuver according to the type of BPPV, and the efficacy was evaluated. Result （ 1 ） Most cases involved female patients in this study; （2） BPPV occurred after MD in al of the cases, of which 13 cases were posterior semicircular canal lithiasis （9 cases in the same ear, 2 in the other and 2 in both） and 2 cases were horizontal semicircula canal lithiasis （cupula lithiasis in the same ear） ; （3） in this study, 10 patients were cured after 3-4 times of posture treatment （66. 7% ） , 4 patients were cured after 5 times and 1 patient received endolymphatic sac decompression because of recurrent vertigo. Conclusion （ 1 ） BPPV can result from MD, for which a possible mechanism may be the hydrolabyrinth that lead to eardust falling off. （2） Most cases of BPPV occurred in the posterior semicircular canal in the same ear. Most cases in incidence rate have obvious sexual bias in female. （3） Eardust reposition is an effective treatment for BPPV caused by MD; while it is refractory compared to ordinary BPPV and requiremuhiple treatments, which may be related to the recurrence of hydrolabyrinth.