英语学习园地-关于颈性眩晕

英语学习园地-关于颈性眩晕

Database, Ovid MEDLINE(R)

Unique Identifier, 10714534

Authors, Bracher ES. Almeida CI. Almeida RR. Duprat AC. Bracher CB.

Title, A combined approach for the treatment of cervicalvertigo.

Source, Journal of Manipulative & Physiological Therapeutics. 23(2):96-100, 2000 Feb.

　　

Abstract, BACKGROUND: Cervicalvertigo is a diagnosis commonly made at both otorhinolaryngologist and chiropractic offices. Hypothesized non-vascular mechanisms are reviewed. Therapeutic approaches have been suggested in the literature, ranging from cervical immobilization to vertebral manipulation.

OBJECTIVE: To characterize the patient population with cervicalvertigo and observe therapeutic results of a treatment protocol by using distinct conservative modalities.

METHODS: Fifteen subjects with cervicalvertigowere selected from patients presenting with dizziness at an otorhinolaryngology medical office. Diagnosis was based on specific criteria and results of an otoneurologic examination. All patients were submitted to a treatment protocol, including spinal manipulation, manual therapy on affected muscle groups, analgesic electrotherapy, labyrinth sedation, surface electromyography biofeedback, and an exercise program. Evolution of dizziness complaints and related musculoskeletal dysfunction was observed. RESULTS: Musculoskeletal complaints were present in 93% of the patients, mainly cervical pain, shoulder-girdle pain, and tension-type headache. Median durationof musculoskeletal symptoms was 7.5 years, whereas the median duration of dizziness before the beginning of treatmentwas 52 days. Treatment duration averaged 5 sessions and 41 days. At the end of treatment, 60% of patients reported remission, 20% reported consistent improvement of vertigo. Remission of musculoskeletal symptoms was observed in 26.7% of patients, and improvement was observed in 60% of patients.

CONCLUSION: Chronic, nontraumatic, cervical and shoulder-girdle dysfunction was an important causal and perpetuating factor of cervicalvertigo in the population studied, and a consistent improvement was observed with the use of a conservative treatment protocol involving multiple modalities for patients with cervicalvertigo. Further controlled studies are needed to access its validity.

　　

应用联合方法治疗颈性眩晕

　　

摘要：背景：颈性眩晕是耳鼻喉科和脊柱科常做的诊断，假设不存在血管方面的机制。文献中报道的治疗方法主要是颈椎制动和脊柱的手法治疗。
目的：描述颈性眩晕患病人群的特征，并观察应用一种特殊的保守治疗模式草案的治疗效果。
方法：在耳鼻喉检查室从头晕的患者中选择出50例颈性眩晕的病人。诊断依据于特殊的标准和神经耳科学的检查结果。所有的患者均接受一种治疗方案，包括：脊柱操作、受累肌群的手法治疗、电止痛治疗、迷路镇定、表面肌电图生物反馈和锻炼计划。观察眩晕主诉的演变过程和相关的肌骨骼功能障碍。
结果：93％患者有肌肉骨骼方面的主诉，主要是颈部疼痛、肩部放射痛和紧张性头疼。肌骨骼症状的平均病史为7.5年，而治疗前眩晕症状的病史为52天。治疗期平均为5个疗程41天。在治疗末期，60％的患者眩晕症状消失，20％的患者眩晕持续改善。根据观察，患者肌骨骼方面的症状：26.7％的患者症状消失，60％的患者症状缓解。
结论：在人群调查中发现：慢性、无创伤的颈肩部功能障碍是颈性眩晕引发和持续的因素，接受包括多种模式的保守治疗草案的颈性眩晕患者有持续的改善。需要进一步的对照研究确定其有效性。

　　　　　　

Database, Ovid MEDLINE(R)

Unique Identifier, 9390801

Authors, Brandt T.
Institution, Department of Neurology, Klinikum Grosshadern, University of Munich, Germany.

Title, Cervical vertigo--reality or fiction?. [Review] [106 refs]

Source, Audiology & Neuro-Otology. 1(4):187-96, 1996 Jul-Aug.

Abstract, Neck afferents not only assist the coordination of eye, head, and body, but they also affect spatial orientation and control of posture. This implies that stimulation of, or lesions in, these structures can produce cervicalvertigo. In fact, unilateral local anesthesia of the upper dorsal cervical roots induces ataxia and nystagmus in animals, and ataxia without nystagmus in humans. If cervicalvertigoexists outside these experimental conditions, it is obviously characterized by ataxia and unsteadiness of gait, and not by a clear rotational or linear vertigo. Neurological, vestibular, and psychosomatic disorders must first be excluded before the dizziness and unsteadiness in cervical pain syndromes can be attributed to a cervical origin. To date, however, the syndrome remains only a theoretical possibility awaiting a reliable clinical test to demonstrate its independent existence. [References: 106]

　　

颈性眩晕——确实存在还是纯属虚构？

　　　

摘要：颈部传入冲动不仅协助眼、头、身体的协调，而且影响空间方位和姿势的控制。这意味着这些结构受刺激或发生损坏可以导致颈性眩晕。事实上，在动物试验中单侧局部麻醉上颈椎背侧神经根可以产生共济失调和眼球震颤，而在人体只有共济失调没有眼球震颤。如果颈性眩晕在实验条件以外存在，它会明显的以共济失调和步态失稳为特征而不是以明显的旋转性或线性的眩晕为特征。在确定头晕和不稳的颈部疼痛症状为颈源性之前必须首先排除神经学、前庭、心理等方面的疾病。但是，迄今为止这些症状还只是在理论上的可能性，还需要可靠的临床实验去证实它是一个独立的实体。

　　　　　

Database, Ovid MEDLINE(R)

Unique Identifier, 3673567

Authors, Norre ME.
Institution, Department of Otoneurology and Equilibriometry, University of Leuven.

Title, Cervical vertigo. Diagnostic and semiological problem with special emphasis upon "cervical nystagmus".

Source, Acta Oto-Rhino-Laryngologica Belgica. 41(3):436-52, 1987.

Abstract, There is a strong evidence that vertigo can be produced by cervical disturbance, either via the neck-proprioceptor, or via the vascular supply by the vertebral artery. However, it is very difficult to confirm the cervicalorigin of the vertigo in a particular patient. "Cervical nystagmus" has been proposed as a diagnostic clue. But critical analysis, discussed in this paper, has raised doubt about its reliability. The most know type, the neck torsion nystagmus, appears to be in fact a "normal" cervico-ocular reflex. Its inconstancy and low gain makes that it is only present in 50% of the subjects. Reduced vestibular input as well as enhanced cervical proprioceptive input favour its appearance. In this way the presence of NTN is suggestive for a cervical component but doesn't mean that the vertigo is cervical. Correlation with other cervical data is needed to conclude to a "cervical component" in the vertigo.

　　　　

　　

颈性眩晕，诊断和症状问题－特别强调“颈源性眼震”

　　

摘要：有足够的证据证明眩晕可由颈部的紊乱导致，无论是通过颈部的本体感受器还是椎动脉的血液供应。但是，确定某一特定患者的眩晕为颈源性的却十分困难。“颈源性眼震”已经被作为一种诊断线索。但是本文讨论的评论性分析增加了其可靠性的可疑性。众所周知的例子是颈部旋转性眼震，事实上似乎是一种“正常”的颈眼反射。它的不稳定性和低获得性使它仅在50％的个体中存在。减少的前庭冲动和加强的颈部本体感受冲动有助于它的出现。从这方面考虑颈部旋转眼震的出现仅说明颈部因素的参与而不能说明眩晕是颈性的。要得出眩晕由颈部因素参与的结论需要其它一些相关的颈部数据。

　　　　　　

Database, Ovid MEDLINE(R)

Unique Identifier, 123997

Authors, Hulse M. Partsch CJ. Wolff HD.

Title, [The acute cervicalvertigo under otologic and osteopathic view (author's transl)]. [German]

Original Title, Akuter zervikaler Schwindel: Darstellung aus otologischer und manualmedizinischer Sicht

Source, Laryngologie, Rhinologie, Otologie. 54(3):263-7, 1975 Mar.

　　

Abstract, The acute cervical vertigo with the single symptome of rotary vertigo is most probably caused by a functional disturbance in the upper third of the cervical spine. Distinct patho-anatomical changes could not be observed. The findings on the cervical spine are based on an osteopathic examination. The therapy of choice is a manipulation. Three cases are reported.

　　

从耳科和骨科角度看急性颈性眩晕

　　

摘要：有单一的旋转性头晕症状的急性颈性眩晕可能主要由于上三位颈椎的功能紊乱导致。没有发现明显的病理解剖变化。这些关于颈椎的发现是骨科检查的基础上作出的。治疗方法选择手法治疗。报道了三例病例。
　　　　
　　

Database, Ovid MEDLINE(R)

Unique Identifier, 15339526

Authors, Chen L. Zhan HS.

Institution, Centre of Rehabilitation, Naval Convalescent Hospital of People's Liberation Army, Hangzhou, Zhejiang Province 310000, China.

Title, [An transcranial Doppler ultrasonography and X-ray study of cervicalvertigo patients treated by manipulation in supine position]. [Chinese]

Source, Zhong Xi Yi Jie He Xue Bao/Journal of Chinese Integrative Medicine. 1(4):262-4, 2003 Nov.

Abstract, OBJECTIVE: To observe the transcranial Doppler ultrasonography and X-ray changes of cervical vertigo patients caused by cervical instability before and after the manipulation treatment in supine position.

METHODS: Sixteen cervicalvertigo patients who underwent supine manipulation treatment were reviewed retrospectively. After the treatment, the changes of transcranial Doppler ultrasonography of cervicalvertebral artery and X-ray of cervical spine were observed.

RESULTS: Before the treatment, the mean blood flow velocityof vertebral artery was (48.6+/-3.1) cm/s, much higher than that of the normal group (P<0.05), the means of the horizontal displacement of C3,4 and **,5 were (3.18+/-0.42) mm and (3.46+/-0.26) mm respectively. After the treatment, the blood flow velocity and the C3,4 horizontal displacement decreased significantly (P<0.05). The effective rate of the manipulation treatment was 100%. CONCLUSION: The manipulation treatment is an effective method for cervicalvertigo patients caused by cervical instability, and the effect is correlated with the improvement of the blood flow of cervicalartery and the restoration of cervical stability.

　　　

接受仰卧位手法治疗的颈性眩晕患者的经颅多普勒超声检查和X－线检查的

研究

　　

摘要：目的：观察由于颈椎不稳导致的颈性眩晕的患者在接受仰卧位手法治疗前后经颅多普勒超声检查和X－检查的变化。

方法：本文回顾性的研究了六例接受仰卧位手法治疗的颈性眩晕的患者。在治疗后，观察颈部椎动脉的经颅多普勒超声和颈椎的X－线的变化。

结果：在治疗前椎动脉平均血流速度为(48.6+/-3.1)cm/s明显高于正常组血流速度（P<0.05），C3、4和**、5的平均水平移位分别为(3.18+/-0.42) mm 和 (3.46+/-0.26) mm。治疗后，血流速度和C3、4水平位移明显减少(P<0.05)。手法治疗的有效率为100％。

结论：手法治疗是由于颈椎不稳导致的颈性眩晕的一种有效地治疗方法，疗效与椎动脉血流量的改善和颈椎稳定性的恢复有关。

Database, Ovid MEDLINE(R)

Unique Identifier, 14737984

Authors, Nwaorgu OG. Onakaoya PA. Usman MA.

Institution, Department of Otorhinolarygology, University College Hospital, Ibadan.

Title, Cervicalvertigo and cervical spondylosis--a need for adequate evaluation.

Source, Nigerian Journal of Medicine: Journal of the National Association of Resident Doctors of Nigeria. 12(3):140-4, 2003 Jul-Sep.

Abstract, BACKGROUND: Cervical spine spondylotic changes are known to cause vertigo. The mechanism by which cervicalvertigo is induced is very debatable. This study was to highlight the prevalence of vertigo and other vestibulocochlear organ affectation in patients with cervicalspondylosis and to serve as a template for further research in this area.

METHODOLOGY: A six-year retrospective review of vertiginous patients with radiological evidence of cervicalspondylosis seen at the Otorhinolaryngology Clinic of University College Hospital (UCH), Ibadan.

RESULTS: Forty-three patients, 23 males (53.5%) and 20 females (46.5%) had vertigo as a symptom and radiological evaluation for cervical spondylosis. The radiological findings were normal in 11 patients (26%) and abnormal in 32 patients (74%). Of the twenty-five patients who had pure tone audiometry, 40% were normal and 60% abnormal. Out of 20 affected ears, seven patients (47%) had right, 3 patients (20%) left and 5 patients (33%) both ear involved respectively. High frequency range was affected in 8 (40%), low in 2 (10%) and all in 10 (50%) ears respectively. Decibel hearing level (dBHL) loss ranged from 30-90 dBHL with a mean binaural of 43 (+/- 8.5) dBHL.

CONCLUSION: We advocate early multidisciplinary approach in the management of all established cases of cervicalvertigo.

　　

颈性眩晕和颈椎病——适当评价的必要性

　　

摘要：背景：一般认为颈椎的强直性改变导致眩晕。导致颈性眩晕的机制是很有争议的。本文主要强调眩晕的流行情况和其它前庭耳器对眩晕患者的影响，并为在此领域的进一步研究鉴定基础。

方法：在伊巴丹大学专科医院耳鼻喉门诊发现的有颈椎病的影象学根据的眩晕的患者进行了长达六年的回顾性分析。

结果：53例患者有眩晕的症状并且有颈椎病的影像学根据，其中男23例（53.5％）、女20例（46.5％）。11例（26％）患者影像学检查正常，32例（74％）影像学检查异常。接受单调听力测试的25例患者，40％的正常，60％的异常。20个受累的耳朵中，7例（47％）患者右耳受累，3例（20％）患者左耳受累，5例（33％）患者双耳受累。高频受累的有8个（40％），低频受累的有2个（10％），全部受累的有10个（50％）。听力水平丢失范围为30－90分贝，平均双耳为43 (+/- 8.5)分贝。

结论：我们提倡对确诊颈性眩晕的患者早期进行多学科的治疗。

　　

Database, Ovid MEDLINE(R)

Unique Identifier, 11153554

Authors, Wrisley DM. Sparto PJ. Whitney SL. Furman JM.

Institution, Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA 15260, USA.

Title, Cervicogenicdizziness: a review of diagnosis and treatment. [Review] [79 refs]

Source, Journal of Orthopaedic & Sports Physical Therapy. 30(12):755-66, 2000 Dec.

　　　

Abstract, The diagnosis of cervicogenicdizziness is characterized by dizzinessand dysequilibrium that is associated with neck pain in patients with cervical pathology. The diagnosis and treatment of an individual presenting with cervical spine dysfunction and associated dizziness complaints can be a challenging experience to orthopaedic and vestibular rehabilitation specialists. The purpose of this article is to review the incidence and prevalence, historical background, and proposed pathophysiology underlying cervicogenicdizziness. In addition, we have outlined the diagnostic criteria, evaluation, and treatment of dizziness attributed to disorders of the cervical spine. The diagnosis of cervicogenicdizziness is dependent upon correlating symptoms of imbalance and dizziness with neck pain and excluding other vestibular disorders based on history, examination, and vestibular function tests. When diagnosed correctly, cervicogenicdizziness can be successfully treated using a combination of manual therapy and vestibular rehabilitation. We present 2 cases, of patients diagnosed with cervicogenicdizziness, as an illustration of the clinical decision-making process in regard to this diagnosis. [References: 79]

　　

颈源性头晕：诊断与治疗回顾

　　　

摘要：颈源性头晕的诊断以有颈椎病理变化的患者出现伴有颈部疼痛的眩晕和共济失调为特征。对于一个骨科和前庭康复专家来说诊断和治疗一位表现为颈椎功能障碍伴有头晕主诉的个体可能是一个有挑战性的经历。本文的目的是回顾颈源性头晕的发生率和流行情况、历史背景，以及颈源性头晕潜在的可能的病理生理变化。另外，我们总结了由于颈椎疾病导致的头晕的诊断标准、评价和治疗。颈源性头晕的诊断根据于：伴有颈部疼痛的平衡失调和眩晕等相关症状，并排除其它根据病史、体格检查和前庭功能实验诊断的前庭病变。一旦诊断正确，颈源性头疼可以应用联合手法治疗和前庭康复疗法成功治疗。我们以2例诊断为颈源性头晕的患者为例说明关于它的诊断的临床决策程序。

　　　　

Database, Ovid MEDLINE(R)

Unique Identifier, 9548360

Authors, Galm R. Rittmeister M. Schmitt E.

Institution, Wirbelsaulenklinik Bad Homburg, Kaiser-Friedrich Promenade, Germany.

Title, Vertigo in patientswithcervicalspinedysfunction.

Source, European Spine Journal. 7(1):55-8, 1998.

　　　　

Abstract, To our knowledge, quantitative studies on the significance of disorders of the upper cervicalspine as a cause of vertigo or impaired hearing do not exist. We examined the cervicalspines of 67 patients who presented withsymptoms of dizziness. Prior to the orthopaedic examination, causes of vertigo relating to the field of ENT and neurology had been ruled out. Fifty patients of the above-mentioned group were studied. They followed the outlined treatment protocol with physical therapy and were available for 3 months of follow-up. Thirty-one patients, hereinafter referred to as group A, were diagnosed withdysfunctions of the upper cervicalspine. Nineteenpatients, hereinafter referred to as group B, did not show signs of dysfunction. Cervicalspinedysfunctions were documented as published by Bischoff. In group A dysfunctions were found at level C1 in 14 cases, at level C2 in 6 cases and at level C3 in 4 cases. In seven cases more than one upper cervicalspine motion segment was affected. Dysfunctions were treated and resolved withmobilising and manipulative techniques of manual medicine. Regardless of cervicalspine findings seen at the initial visit, group A and B patientsreceived intensive outpatient physical therapy. At the final 3-month follow-up, 24 patients of group A (77.4%) reported an improvement of their chief symptom and 5 patients were completely free of vertigo. Improvement of vertigo was recorded in 5 group B patients(26.3%); however, nobody in group B was free of symptoms. We concluded that a functional examination of motion segments of the upper cervicalspine is important in diagnosing and treating vertigo, because a non-resolved dysfunctionof the upper cervicalspine was a common long-lasting dizziness in our population.

　　　

颈椎功能障碍患者的眩晕

　　　

摘要：据我们所知，大量的关于上颈椎疾病是导致眩晕或听力损害的一个原因的意义的研究是不存在的。我们检查了67例表现为头晕症状的患者的颈椎。在骨科检查之前首先排除由于耳鼻喉和神经系统导致的眩晕。从上述患者中选出50例患者进行研究。我们应用总结的物理治疗草案并随访三个月。31例患者属于下文提到的A组，被诊断为伴有上颈椎功能障碍。19例患者属于下文提到的B组，没有上颈椎功能障碍的征象。颈椎功能障碍根据Bischoff描述的进行确定。在A组C1水平功能障碍的有14例患者，C2水平功能障碍的有6例患者，C3水平有4例患者。有7例患者一个以上的上颈椎运动阶段受累。功能障碍通过运动和手法操作治疗。不考虑首次就诊时颈椎的发现，A、B两组病人都接受全面的门诊物理治疗。在3个月随访期末，A组中有24例（77.4％）患者报道主要症状改善，有5例眩晕症状完全消失。B组患者中有5例（26.3％）眩晕症状缓解；但是B组没有症状完全缓解的患者。我们认为上颈椎运动节段的功能检查对于眩晕的诊断和治疗非常重要，因为在人群中上颈椎未治疗的功能障碍是导致头晕持续存在的常见原因。

　　　　　　

Database, Journals@Ovid Full Text

Accession Number, 00000132-200409000-00006.

Author, Gordon, C. R.; Gadoth, N.

Institution, Department of Neurology, Meir General Hospital, Kfar Saba and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Title, Repeated vs single physical maneuver in benignparoxysmalpositionalvertigo.[Article]

Source, Acta Neurologica Scandinavica. 110(3):166-169, September 2004.

　　　

Abstract, Objectives: To evaluate the effectiveness and possible side effects of a single session of repeated particle repositioning maneuver (PRM) to treat posterior canal benignparoxysmalpositionalvertigo(BPPV) and the usefulness of post-treatment restrictions. Materials and methods: A total of 125 consecutive patients with idiopathic BPPV participated in the study. Fifty patients received a single session of repeated PRM only (group I). Results were compared with those of 50 patients with BPPV who received a single PRM (group IIb), and 25 patients who received a single PRM followed by the use of a neck collar and keeping the head upright for48 h (group IIa).Results: Forty-six patients (92%) of group I, 40 patients (80%) of group IIb, and 21 patients (84%) of group IIa were completely free of signs and symptoms when re-examined 1 week after treatment. Transient nausea and disequilibrium following treatment were reported equally in all subgroups and well tolerated. Nearly all patients of group IIa considered the post-treatment restrictions very inconvenient. Conclusions: A single session of repeated physical procedure seems to be clinically superior to one single maneuver and well tolerated. Additional post-treatment measurements are inconvenient and should be abandoned.

　　　

良性阵发性体位性眩晕的多次和单次手法治疗的比较

　　　

摘要：目的：评价一个疗程的重复的轻微复位手法治疗后半规管良性阵发性体位性眩晕的疗效和可能的副作用，以及治疗后制动的有效性。材料与方法：本研究序贯的研究了125例患有先天性BPPV的患者。其中50例患者只接受了一个疗程的重复的PRM治疗（I组）。其结果与只接受一次PRM治疗的50BPPV患者（IIb组）和25例接受单次BPPV治疗后围领维持头部向上48小时的患者（Iia组）的疗效相比较。结果：I组中有56例（92％）患者、Iib组中有40例（80％）患者、Iia组中有21例（84％）治疗后1周复查症状体征完全消失。各亚组在治疗后都同样的出现恶心和平衡失调等症状但均可耐受。几乎所有的Iia组患者均认为术后限制活动非常不方便。结论：一个疗程的重复物理操作在临床上似乎优于单次操作而且容易耐受。附加的治疗后制动很不方便，应该摒弃。

Database, Journals@Ovid Full Text

Accession Number, 00002090-200306000-00008.

Author, Levrat, Emmanuel MD; van Melle, Guy PhD; Monnier, Philippe MD; Maire, Raphael MD

Institution, From the Otoneurology Unit, Otolaryngology-Head and Neck Surgery Clinic, Centre Hospitalier Universitaire Vaudois (Drs Levrat, Monnier, and Maire), and University Institute of Social and Preventive Medicine (Dr van Melle), Lausanne, Switzerland. The authors have no relevant financial interest in this article.

Title, Efficacy of the Semont Maneuver in BenignParoxysmalPositional Vertigo.[Article]

Source, Archives of Otolaryngology -- Head & Neck Surgery. 129(6):629-633, June 2003.

Abstract, Objectives: To assess the efficacy of the Semont maneuver in the treatment of benignparoxysmalpositionalvertigo (BPPV) of the posterior semicircular canal and to evaluate the possible effect of various factors on the efficacy of this maneuver.Design and Setting: Retrospective study in an outpatient clinic.Patients: Two hundred seventy-eight patients presenting with symptomatic, unilateral BPPV of the posterior semicircular canal, exclusively treated with the Semont maneuver.Interventions: During the first consultation, each patient was treated with a Semont maneuver. When BPPV persisted, this maneuver was repeated during follow-up visits, performed at weekly intervals.Main Outcome Measures: Patients were considered cured when vertigo disappeared within 30 days (allowing up to 4 maneuvers).Results: More than 90% of patients were cured after a maximum of 4 maneuvers, and 83.5% were cured after only 2 maneuvers. The efficacy of the maneuver decreased each time it was repeated (from 62.6% at the first maneuver to 18.2% at the fourth). The duration of symptoms before initial consultation and the etiology of BPPV had a significant effect on the maneuver's efficacy (P<.001 and P = .002, respectively), whereas age (P = .12), sex (P = .06), and affected side (P = .20) had no effect.Conclusions: The Semont maneuver demonstrated a 90.3% cure rate after a maximum of 4 sessions. Patients consulting late (>6 months after the beginning of symptoms) or having traumatic BPPV had lower recovery rates than patients without these factors (74.7% vs 96.5%).Copyright 2003 by the American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use. American Medical Association, 515 N. State St, Chicago, IL 60610.

　　

Semont法在治疗良性阵发性眩晕的疗效

　　

摘要：目的：评价Semont方法治疗后半规管引起的良性阵发性体位性眩晕（BPPV）的疗效，并评价各种因素对该方法疗效可能的作用。试验设计：门诊临床回顾性研究。患者：278例只接受Semont方法治疗的有症状的单侧的后半规管的良性阵发性体位性眩晕的患者。干预措施：首诊时所有患者均接受Semont方法治疗如果症状持续存在，则在随访期内重复使用该方法，时间间隔为1周。主要结果测量：如果患者在30天以内（最多允许4次治疗）眩晕症状消失则认为患者治愈。结果：90％以上的患者在4次治疗以内治愈，83.5％的患者仅治疗两次就治愈。重复应用该方法时其疗效递减（首次治疗疗效为62.6％，第四次治疗疗效为18.2％）。首次就诊时的病史和BPPV的病因对该方法的疗效有显著的影响（分别是P<0.01和P=0.02），然而年龄（P＝1.2）、性别（P=0.6）、哪一侧受累（P=2.0）对结果没有影响。结论：Semont方法4个疗程以内的治愈率为90.3％。患者病程长（症状首发>6个月）或创伤后BPPV比没有上述因素的患者的恢复率要低。

　　　　

Database, Ovid MEDLINE(R)

Unique Identifier, 15011204

Authors, Cohen HS. Kimball KT.

Institution, Depatment of Otorhinolaryngology, Baylor College of Medicine, Houston, TX 77030, USA. hcohen@bcm.tmc.edu

Title, Treatment variations on the Epley maneuverforbenignparoxysmalpositionalvertigo.

Source, American Journal of Otolaryngology. 25(1):33-7, 2004 Jan-Feb.

Abstract, PURPOSE: To determine if using more head rotation during the Epley maneuveror specific post treatment instructions for sleeping position would affect treatment effectiveness, compared with the usual maneuverwithout extra instructions.

MATERIALS AND METHODS: Patients with unilateral benignparoxysmalpositionalvertigo of the posterior semicircular canal were randomized to a standard Epley maneuver group, a group that received an additional 45 degrees head rotation during the maneuver (Augmented Epley), and a group that received instructions about sleeping position after treatment.

RESULTS: Post tests from 1 week to 6 months showed no differences in vertigo intensity or frequency or responses to the Dix-Hallpike maneuver. All groups showed significant decreases in vertigo and Dix-Hallpike responses. Some subjects in each group had abnormal pretreatment scores on computerized dynamic posturography. Those subjects in the Augmented Epley group who had abnormal pretreatment posturography scores had significantly better post treatment scores than those subjects in the Home Instruction group who had abnormal pretreatment scores. All subjects with abnormal responses, however, showed improvement.

CONCLUSIONS: Although clinicians continue to give patients home instructions and to use additional head rotation during the maneuver, these variations are not essential for achieving improvement in symptoms.

　　

Epley方法治疗良性阵发性体位性眩晕的疗法变异

　　

摘要目的：确定应用Epley法治疗时附加更多的头部旋转或治疗后附加特殊的睡姿说明时与没有附加操作的常规方法相比是否会影响结果。

材料与方法：患有单侧后半规管的良性阵发性体位性眩晕的患者随机分为：标准Epley方法治疗组、Epley方法附加45度头部旋转（加强的Epley法）治疗组、附加睡姿说明的治疗组。

结果：治疗后1周6个月在眩晕的强度或频率或对Dix-Hallpike操作的反应上没有差异。所有治疗组的眩晕和Dix-Hallpike反应都明显降低。各组部分患者的计算机化的动态姿势图的治疗前评分异常。治疗前姿势图异常的患者接受加强的Epley方法治疗比接受家庭指导的治疗的治疗后评分要高。但是所有反应异常的患者都有改善。

结论：虽然在接受该方法治疗时临床医生继续给予家庭指导和附加的头部运动，但这些方法对于改善症状并不重要。

　　　　

Database, Ovid MEDLINE(R)

Unique Identifier, 10807329

Authors, Hain TC. Helminski JO. Reis IL. Uddin MK.

Institution, Department of Otolaryngology, Northwestern University Medical School, Chicago, Ill, USA. t-hain@nwu.edu

Title, Vibrationdoesnotimproveresults of thecanalithrepositioning procedure.

Source, Archives of Otolaryngology -- Head & Neck Surgery. 126(5):617-22, 2000 May.

Abstract, OBJECTIVE: To determine whether, in patients with benign paroxysmal positional vertigo (BPPV), thecanalithrepositioningprocedureperformed with vibration applied over themastoid bone of the affected ear is more effective in resolving the symptoms and preventing recurrence of BPPV than theprocedure performed without vibration.

DESIGN: Retrospective case review.

SETTING: Tertiary referral center.

PATIENTS: Ninety-four patients diagnosed as having BPPV involving the posterior semicircular canal.

INTERVENTIONS: Patients were assigned to one of 2 treatment groups: thecanalithrepositioningprocedurewith vibration (n=44) and with no vibration (n=50).

MAIN OUTCOME MEASURES: Effectiveness of treatment was determined through clinical reevaluation or reported through a telephone interview 1 week after treatment. Intensity of symptoms was quantified on a scale of 1 to 3 (mild, moderate, or severe); effectiveness of treatment was categorized on a scale of 1 to 4 (cure, much better, better, or no change). Rate of recurrence was determined through later clinical reevaluation or a telephone interview. RESULTS: At 1 week, 57 of the 94 patients were cured and 16 were much better, providing a 78% overall success rate. There was no significant difference in effectiveness of the treatment or thefrequency of reoccurrence of BPPV between thevibration and no-vibration groups as determined from theKaplan-Meier product-limit method and log-rank test. Rate of recurrence was47% at a maximum follow-up of 5.25 years. CONCLUSIONS: Our resultssuggest that, while thecanalithrepositioningprocedure is effective in thetreatment of BPPV, vibration applied during the maneuver doesnotsignificantly affect short-term or long-term outcomes.

　　

振动疗法不能改善耳石复位术的疗效

　　

摘要：目的：确定对于良性阵发性体位性眩晕患者应用伴在患耳乳突上的振动疗法的耳石复位术是否比单纯的应用耳石复位术更能有效地改善症状和防止BPPV的复发。

设计：病例回顾。

单位：第三治疗安排中心。

病例：94例后半规管受累及的诊断为BPPV的患者。

干预：所有患者分为两组：伴有振动疗法的耳石复位术（n=44）和不伴振动疗法的耳石复位术（n=50）。

主要的测量结果：治疗效果通过术后1周的重新测评或电话随访确定。症状的程度应用1－3分量化（轻度、中度、重度）；治疗效果应用1－4分分类（治愈、明显好转、好转、无效）；复发率通过后期的临床重新评定和电话随访确定。

结果：1周时，94例患者中优57例治愈、16例明显好转、成功率在78％。通过Kaplan-Meier结果界限和对数秩和检验确定在疗效和复发率上振动疗法组和非振动疗法组的差别没有统计学意义。最长随访5.25年复发率为47％。

结论：我们的结果显示：如果耳石复位疗法治疗良性阵发性眩晕有效，操作过程中的振动疗法对近期和远期的临床效果没有明显的影响。