继发于突发性聋的良性阵发性位置性眩晕的临床治疗分析

Analysis of clinical features of benign paroxysmal positional vertigo secondary to sudden deafness

目的回顾性分析继发于突发性聋的良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）患者的临床表现,并探讨其可能的发病机制,探索合适的诊断与治疗方案。方法观察218例突发性聋患者中BPPV的发病情况和临床治疗效果,另有37例同期原发性BPPV作为对照组。所有患者均经Dix-Hallpike实验和Barbecue滚转检查确定诊断,继发性BPPV患者的原发病（突发性聋）符合中华医学会耳鼻咽喉头颈外科学分会制定的诊断标准。按照BPPV类型,进行Epley手法复位或Barbecue翻滚手法治疗,并评价治疗效果。结果218例突发性聋患者中有9l例出现BPPV,发生率41.7%,均为同侧患耳。BPPV经耳石复位,其中1次治愈62例（68.1%）,2次治愈16例（17.6%）,3次治愈13例（14.3%）。随访6~22个月,高频听力改善均不及低频,外半规管型BPPV复发2例,后半规管型复发5例,经过再次复位后治愈。继发性BPPV与原发性BPPV均经手法复位治愈,疗效相似。结论BPPV可继发于突发性聋,且突发性聋继发BPPV可达41.7%,其中以后半规管BPPV常见,耳石复位治疗是最为有效的治疗方法,治愈率与原发性BPPV相似。

OBJECTIVE To retrospectively analyze the clinical characteristics of the benign paroxysmal positional vertigo（BPPV） secondary to the sudden deafness（SD） and to explore the possible pathogenetic mechanism,diagnosis and treatment.METHODS 218 cases of the SD in our department were retrospectively analyzed,and 37 patients with primary BPPV during the same period were used as control group.All patients were confirmed by the examination of Dix-Hallpike and the roll check,the primary disease（sudden deafness） of secondary BPPV patients were in line with the Chinese Medical Association diagnostic criteria.RESULTS In all these patients with SD,there were 91 cases with BPPV secondary to the SD.There were67 cases of BPPV of posterior semicircular canal and 21 cases of BPPV of lateral BPPV semicircular canal.Besides,3 cases were of multi-semicircular canal affected.All patients with BPPV were diagnosed as the same ears as the SD.The symptoms were alleviated and initial success rate was 68.1%.During 6-22 month follow-ups,total success rate was 100%,and recurrence rate was7.7%（7/91）.The hearing recovery of high frequency is worse than that of the low frequency.There were 2 cases of recurrence in lateral BPPV group,5 cases in posterior BPPV group.All were cured by reposositioning maneuver.All patients with primary and secondary BPPV were cured with Epley maneuver or Barbecue roll maneuver,and the curative effect of them is similar.CONCLUSION The occurrence of BPPV may follow SD,and the majority of BPPV secondary to the SD occurs in the posterior semicircular canal.The canalith repositioning is an effective therapy for secondary BPPV.