Research On Treatment And Prevention Of Recurrent Benign Paroxysmal Positional Vertigo

PartⅠThe Effects of Sleeping Position Intervention on the Prevention of Recurrent Benign Paroxysmal Positional VertigoObjective:The aim of this study was to assess whether avoiding sleeping towards the affected side could decrease short-term recurrence of benign paroxysmal positional vertigo after canalith repositioning procedure.Methods:BPPV patients were distributed into two groups after they were successfully treated by CRP. Patients in the intervention group were told to avoid sleeping towards the affected side of BPPV in the nights (semirecumbent position for at least1week was recommended), whereas patients in the control group got no advice on sleeping position after treatment. Recurrence of BPPV and sleeping position distribution would be followed-up twice after treatment.Results:There were88patients in the control group and80patients in the intervention group. There were no statistical differences in1-week recurrence (17.05%versus10.00%, Chi-square test p=0.18>0.05) or1-month recurrence (23.86%versus18.75%, Chi-square test p=0.42>0.05) between two groups. Then we found there was a significant higher1-week recurrence rate (35.29%) in patients who slept towards the affected side during1week after CRP compared with that in patients who didn’t sleep towards the affected side (Yates chi-square test p=0.01,χ2=6.38). For BPPV patients who didn’t relapse during1week after CRP, sleeping towards the affected side in the next3weeks had no effects on increasing the recurrence rate(Yates chi-square test p=0.32,χ2=0.98). For BPPV patients who relapsed during1week after CRP, avoiding sleeping towards the affected side in the next3weeks had no effects on increasing the self-healing rate. In addition, there were no statistical differences in age, sex or subtypes distribution between recurrent BPPV patients with all BPPV patients。Conclusions:In order to decrease the short-term recurrence, it is important for BPPV patients to avoid sleeping towards the affected side as soon as possible after CRP. Part ⅡClinical Research on BPPV Treatment with Multi-step Repositioning Maneuvers in Otolith Repositioning InstrumentObjectives:The aim of this study is to compare the therapeutic effects and prognoses between multi-step repositioning maneuvers with classical repositioning maneuvers.Methods:We developed a new kind of otolith repositioning maneuvers in order to improve the therapeutic effect and prognosis of BPPV. The biggest difference from classical repositioning maneuvers was that multi-step repositioning maneuvers subdivided the treatment procedure and gave more pauses. We began a randomized controlled study which focused on PC-BPPV (the most common type of BPPV).40PC-BPPV cases were treated with classical repositioning maneuvers, whereas38PC-BPPV cases were treated with multi-step repositioning maneuvers. We recorded how many times of treatment were performed before the disappearance of nystagmus or dizziness. We used VNG to obtain nystagmus parameters in Dix-hallpike maneuver before and after the first treatment. We used VAS to assess the discomforts before and after the whole treatment. Finally, we would follow-up the recurrence rates of both the two groups.Results:The rate of nystagmus disappearance after using multi-step repositioning maneuvers once (47.4%) was significantly higher than that after using classical repositioning maneuvers(22.5%), chi-square test p<0.05, χ2=5.32. The rate of dizziness disappearance after using multi-step repositioning maneuvers once (44.7%) was significantly higher than that after using classical repositioning maneuvers (17.5%), chi-square test p<0.05, χ2=6.79.But after more performances, there were no more significant differences between two repositioning maneuvers. Each patient met the treatment goal after performing multi-step repositioning maneuvers at most3times. In contrast,17.5%of the patients couldn’t meet the treatment goal after performing classical repositioning maneuvers at most3times. The initial nystagmus frequencies and the nystagmus durations were smaller after performing multi-step repositioning maneuvers once than those after performing classical repositioning maneuvers once(t-test:p<0.05). There were no significant differences in remission of discomforts between two groups.1-week recurrence rate of multi-step group is10.5%, which is lower than17.5%of classical group.Conclusions:We can get better therapeutic effects by performing multi-step repositioning maneuvers in otolith repositioning instrument than classical repositioning maneuvers.