Benign paroxysmal positional vertigo
Benign paroxysmal positional vertigo
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DOI：
10.1016/j.anl.2022.03.012
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发表时间：
2022-05-27
影响因子：
1.7
通讯作者：
Inohara, Hidenori
中科院分区：
文献类型：
--
作者：
Imai, Takao;Inohara, Hidenori
良性阵发性体位性眩晕（BPPV）以体位性眩晕（由头部位置改变引起的旋转性眩晕的短暂发作）为特征，是眩晕最常见的外周原因。BPPV有两种病理生理类型：管状结石和管状结石。在耳管结石中，耳锥碎片与耳石膜分离，在耳管内淋巴内自由漂浮。在耳穴结石中，耳石膜释放的耳锥体碎片沉积在半规管丘上，丘的比重增加。关于BPPV的三种亚型已达成共识：管后型BPPV（管结石），管侧型BPPV（管结石）和管侧型BPPV（管结石）。在基于访谈的BPPV医学检查中，询问眩晕的特征、眩晕的触发运动、眩晕持续时间和眩晕发作时的耳蜗症状对BPPV的诊断很重要。Dix-Hallpike试验是一种定位眼球震颤试验，用于诊断后管型BPPV。头滚试验是一种定位性眼球震颤试验，用于诊断侧管型BPPV。当重复进行Dix-Hallpike测试时，位置性眼球震颤和眩晕感通常会减弱。这种现象被称为BPPV疲劳。BPPV疲劳的影响通常在30分钟内消失，此时Dix-Hallpike试验再次引起明显的位置性眼球震颤，即使BPPV疲劳先前引起位置性眼球震颤消失。对于BPPV的治疗，患者连续的头部运动可导致半规管内的耳圆锥碎片移动到耳室。这一系列的头部运动被称为导管复位程序（CRP）。合适的CRP类型取决于耳蜗碎片所在的半规管。后管型BPPV的CRP称为Epley手法，侧管型BPPV的CRP称为Gufoni手法。在Epley机动中，每个头部位置之间的时间间隔减少了机动的即时效果。这一发现可以为减少医生在Epley操作过程中所施加的努力和后管型BPPV患者所经历的不适的方法的发展提供信息。(c) 2022日本耳鼻咽喉头颈外科学会，Inc.；Elsevier B.V.版权所有。
Benign paroxysmal positional vertigo (BPPV) is characterized by positional vertigo (brief attacks of rotatory vertigo triggered by head position changes in the direction of gravity) and is the most common peripheral cause of vertigo. There are two types of BPPV pathophysiology: canalolithiasis and cupulolithiasis. In canalolithiasis, otoconial debris is detached from the otolithic membrane and floats freely within the endolymph of the canal. In cupulolithiasis, the otoconial debris released from the otolithic membrane settles on the cupula of the semicircular canal and the specific gravity of the cupula is increased. Consensus has been reached regarding three subtypes of BPPV: posterior-canal-type BPPV (canalolithiasis), lateral-canal-type BPPV (canalolithiasis) and lateral-canal-type BPPV (cupulolithiasis). In the interview-based medical examination of BPPV, questions regarding the characteristics of vertigo, triggered movement of vertigo, duration of vertigo and cochlear symptoms during vertigo attacks are important for the diagnosis of BPPV. The Dix-Hallpike test is a positioning nystagmus test used for diagnosis of posterior-canal-type BPPV. The head roll test is a positional nystagmus test used for diagnosis of lateral-canal-type BPPV. When the Dix-Hallpike test is repeated, positional nystagmus and the feeling of vertigo typically become weaker. This phenomenon is called BPPV fatigue. The effect of BPPV fatigue typically disappears within 30 min, at which point the Dix-Hallpike test again induces clear positional nystagmus even though BPPV fatigue had previously caused the positional nystagmus to disappear. For the treatment of BPPV, sequential head movements of patients can cause the otoconial debris in the semicircular canal to move to the utricle. This series of head movements is called the canalith repositioning procedure (CRP). The appropriate type of CRP depends on the semicircular canal in which the otoconial debris is located. The CRP for posterior-canal-type BPPV is called the Epley maneuver, and the CRP for lateral-canal-type BPPV is called the Gufoni maneuver. Including a time interval between each head position in the Epley maneuver reduces the immediate effect of the maneuver. This finding can inform the development of methods for reducing the effort exerted by doctors and the discomfort experienced by patients with posterior-canal-type BPPV during the Epley maneuver.(c) 2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.