Idiopathic benign paroxysmal positional vertigo with persistent vertigo/dizziness sensation is associated with latent canal paresis, endolymphatic hydrops, and osteoporosis
Idiopathic benign paroxysmal positional vertigo with persistent vertigo/dizziness sensation is associated with latent canal paresis, endolymphatic hydrops, and osteoporosis
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DOI：
10.1016/j.anl.2018.05.010
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发表时间：
2019-02-01
影响因子：
1.7
通讯作者：
Yamanaka, Toshiaki
中科院分区：
文献类型：
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作者：
Kitahara, Tadashi;Ota, Ichiro;Yamanaka, Toshiaki
目的：本研究的目的是检查神经耳科检查，血液检查和评分问卷数据与特发性良性阵发性位置性眩晕（BPPV）patients.Methods治疗顽固性的关联：我们经历了1520个连续的眩晕/头晕患者在眩晕/头晕中心在奈良医科大学在2014年5月至2018年4月。确诊BPPV患者611例（611/1520; 40.2%）根据2015年国际前庭疾病分类诊断指南，BPPV患者中，难治性患者201例（201/611; 32.9%），其中66例为特发性，入选住院并接受神经耳科检查，包括冷热试验（C试验），前庭诱发颈肌源性电位（cVEMP）、主观视觉垂直（SVV）、甘油试验（G-test）、耳蜗电图（ECoG）、内耳磁共振成像（ieMRI）、血液检查（包括抗利尿激素（ADH）和骨碱性磷酸酶（BAP））以及抑郁评分自评问卷（SDS）。66例患者被诊断为水平型壶腹（hBPPVcu; n = 30）、水平型管（hBPPVca; n = 10）、后部型（n = 20）和可能和/或不典型BPPV（n = 6）。数据表示为检查和问卷调查数据超出正常范围的特发性BPPV患者数量的比率（+）。C检验= 21.2%（14/66），cVEMP = 24.2%（16/66），SVV = 48.5%（32/66），G检验= 18.2%（12/66），ECoG = 18.2%（12/66），ieMRI = 12.1%（8/66），ADH = 9.1%（6/66），BAP = 13.6%（9/66），SDS = 37.9%（25/66）。多因素回归分析显示，hBPPVcu、C试验（+）、内淋巴积水（+）和BAP（+）的BPPV患者持续眩晕/头晕的时间明显长于阴性结果的患者。虽然特发性BPPV患者通常在1个月内可治疗和治愈，但hBPPVcu、椎管轻瘫、内淋巴积水，BAP升高可能使疾病难以治愈，因此需要额外的治疗。(C)2018爱思唯尔B. V.保留所有权利。
Objective: The aim of the present study was to examine the association of neuro-otological examination, blood test, and scoring questionnaire data with treatment-resistant intractability in idiopathic benign paroxysmal positional vertigo (BPPV) patients.Methods: We experienced 1520 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University during May 2014 to April 2018. Six hundred and eleven patients were diagnosed as BPPV (611/1520; 40.2%) according to the diagnostic guideline of the International Classification of Vestibular Disorder in 2015, Among BPPV patients, there were 201 intractable patients (201/611; 32.9%), 66 of whom were idiopathic and enrolled to be hospitalized and receive neuro-otological examinations, including the caloric test (C-test), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV), glycerol test (G-test), electrocochleogram (ECoG), inner ear magnetic resonance imaging (ieMRI), blood tests including anti-diuretic hormone (ADH) and bone alkaline phosphatase (BAP), and self-rating questionnaires of depression score (SDS). Sixty-six patients were diagnosed as horizontal type cupula (hBPPVcu; n = 30), horizontal type canal (hBPPVca; n = 10), posterior type (n = 20), and probable and/or atypical BPPV (n = 6). Data are presented as ratios (+) of the number of idiopathic BPPV patients with examination and questionnaire data outside of the normal range.Results: The ratio (+) data were as follows: C-test = 21.2% (14/66), cVEMP = 24.2% (16/66), SVV = 48.5% (32/66), G-test = 18.2% (12/66), ECoG = 18.2% (12/66), ieMRI = 12.1% (8/66), ADH = 9.1% (6/66), BAP = 13.6% (9/66), and SDS = 37.9% (25/66). Multivariate regression analysis revealed that the periods of persistent vertigo/dizziness were significantly longer in BPPV patients with hBPPVcu, C-test (+), endolymphatic hydrops (+), and BAP (+) compared with those with negative findings.Conclusion: Although patients with idiopathic BPPV are usually treatable and curable within 1 month, the presence of hBPPVcu, canal paresis, endolymphatic hydrops, and elevated BAP may make the disease intractable, and thus require additional treatments. (C) 2018 Elsevier B.V. All rights reserved.