外半规管良性阵发性位置性眩晕的诊疗

Diagnosis and treatment for benign paroxysmal positional vertigo of horizontal semicircular canal

良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）是最常见的周同性眩晕，主要表现为随头位变化出现的短暂性眩晕发作，该病分为后半规管型、外半规管型、上半规管型及多半规管。其中后半规管BPPV最常见，其次为外半规管BPPV。外半规管BPPV根据发病机制、原理、眼震方向等有多种分类方法。近年来外半规管BPPV的手法复位逐渐被熟悉，但一些患者复位后效果不佳，如外半规管嵴帽结石症，部分患者行常规手法复位后发作性眩晕仍然存在。我们将这部分手法复位后眩晕症状改善不明显的类型归结为难治型外半规管嵴帽结石症。本文主要围绕外半规管BPPV的概念及分类、流行病学、病因、发病机制、诊断及复位方法，尤其对于难治型外半规管嵴帽结石症的复位方法做一综述。

Benign paroxysmal positional vertigo （BPPV） is the most common peripheral vertigo, whose clinical feature is a paroxysmal short episode of vertigo caused by head position changes. It is divided into posterior semicircular canal （PSC-BPPV）, horizontal semicircular canal （HSC-BPPV）,anterior semicircular canal （ASC-BPPV） and multiple canal （MC-BPPV）. HSC-BPPV is second common only to the PSC -BPPV. According to the pathogenesis, the principle, the direction of the nystagmus and so on, HSC-BPPV has several classifications. In recent years, the canalith repositioning procedure （CRP） of HSC-BPPV has been familiar to us, but there are some patients whose symptoms of vertigo are still persisting after the treatment of traditional CRP, especially for horizontal semicircular canal cupulolithiasis （HSC-Cup）.We called this HSC-Cup whose symptoms of vertigo are still persisting after the treatment of traditional CRP intractable lateral semicircular cupulolithiasis （LSCC）.Concept,classification,epidemiology, etiology,pathogenesis,diagnosis and CRP relevant to HSC-BPPV are reviewed in this article, especially for intractable, lateral semicircular cupulolithiasis.