190例特发性良性阵发性位置性眩晕患者半规管功能分析

Analysis of Semicircular Canal Function in 190 Patients with Idiopathic Benign Paroxysmal Positional Vertigo

目的分析特发性良性阵发性位置性眩晕(benign paroxysmal position vertigo,BPPV)患者半规管功能的特征,为患者的治疗提供进一步帮助。方法选择本院2019年8月至2020年2月收治的单侧特发性BPPV患者190例,包括后半规管BPPV患者162例,水平半规管BPPV患者28例。行冷热试验和视频头脉冲试验(video head impulse test,vHIT)检查,分析其检测结果。结果190例特发性BPPV患者行冷热试验异常者146例(76.84%),其中后半规管BPPV异常者129例(79.63%),水平半规管BPPV异常者17例(60.71%),二者比较差异有统计学意义(χ^(2)=4.800,P=0.028)。146例异常患者中与BPPV患者同侧半规管异常者61例(41.78%),对侧半规管异常者54例(36.99%),双侧半规管均异常31例(21.23%)。后半规管BPPV患者与水平半规管BPPV患者冷热试验异常侧别分布情况比较,差异无统计学意义(χ^(2)=0.475,P=0.789)。26例特发性BPPV患者行视频头脉冲试验,异常者17例(65.38%),其中后半规管BPPV异常者12例(70.59%),水平半规管BPPV异常者5例(55.56%),二者比较,差异无统计学意义(P=0.667);17例异常患者中与BPPV患者同侧半规管异常者10例(58.82%),对侧半规管异常7例(41.18%)。后半规管BPPV患者与水平半规管BPPV患者vHIT检查结果异常侧别分布情况比较,差异无统计学意义(P=1.000)。结论部分特发性BPPV患者存在广泛的半规管损伤,异位耳石不是其损伤的主要原因;冷热试验联合视频头脉冲试验能提高BPPV患者半规管损伤的检出率,有助于患者的治疗与康复。

Objective To report characteristics of semicircular canal function in patients with idiopathic benign paroxysmal position vertigo(BPPV).Method A total of 190 patients with unilateral idiopathic BPPV seen at our hospital from Augest 2019 to February 2020 were included,involving the posterior semicircular canal(n=162)and horizontal semicircular canal(n=28).Caloric test and video head impulse test were conducted and the results were analyzed.Result Among the 190 patients,146(76.84%)had abnormal caloric test,of whom the posterior semicircular canal was indicated in 129(79.63%)and the horizontal semicircular canal in 17(60.71%)(χ^(2)=4.800,P=0.028).Among the 146 patients with abnormal caloric test,the ipsilateral semicircular canal was involved in 61(41.78%),contralateral semicircular canal in 54(36.99%)cases with and bilateral canals in 31(21.23%),with no statistically significant difference between posterior semicircular canal BPPV and horizontal semicircular canal BPPV(χ^(2)=0.475,P=0.789).In the 26 patients with idiopathic BPPV,video head impulse test was abnormal in 17(65.38%),indicating the posterior semicircular canal in 12(70.59%)and horizontal semicircular canal in 5(55.56%)(P=0.667);Among the 17 patients with abnormal vHIT,ipsilateral semicircular canals were involved in 10(58.82%)and contralateral semicircular canals in 7(41.18%),with no statistically significant difference between posterior and horizontal semicircular canal(P=1.000).Conclusion A wide range of semicircular canal injury exists in patients with idiopathic BPPV and ectopic otolith is not the main cause.Caloric test combined with video head impulse test can improve the detection rate in patients with semicircular canal dysfunction,which is helpful for the treatment and rehabilitation of patients with BPPV.