The Analysis Of Clinical Features Of Secondary Benign Paroxysmal Positional Vertigo

Objective: The Benign paroxysmal positional vertigo（BPPV）, the most commonvertigo of clinical means when the head moves rapidly to a specific head position thebrief paroxysmal episodes of vertigo and nystagmus appears. The purpose of this studyis to investigate the clinical characteristics of secondary BPPV, to understand itsaetiological agent, main points of the diagnosis and treatment and the prognosis.Methods:100cases of BPPV who was treated as primary and secondary BPPVpatients in the First Affiliated Hospital of Dalian Medical University from January2009to June2011were analyzed retrospectively. All patients were confirmed by theexamination of Dix-Hallpike and the roll check, the primary disease (sudden deafness,Meniere’s disease) of secondary BPPV patients were in line with the Chinese MedicalAssociation diagnostic criteria. Part of the BPPV patients were conducted with theauditory function and vestibular function tests.Otolith repositioning therapy conductedto the diagnosis of patients with clear BPPV.we followed-up6~30months tounderstand the recurrence status.All the data of the two groups were analyzed andcompared using SPSS13.0statistical package for Windows.Results：①The general condition:100cases of the secondary BPPV group:64cases offemales,36cases of males, aged16to86years, the average age was of56.19±13.88years old. The percentage of trauma, Meniere’s disease, acute vestibular disease, suddendeafness, migraine, ear surgery of etiology was50%,14%,13%,4%,3%,2%respectively.100cases of the primary BPPV group: including70cases of female and30males, aged from24to83years old, the average age was of53.84±13.29years old.②The situation of affected semicircular canal: in the100cases of primary BPPVpatients,90cases were of the posterior semicircular canal BPPV;7cases were of the horizontal semicircular canal BPPV;3cases were of the muiti-semicircular canalaffected.In the100cases of secondary BPPV patients,76cases were of the posteriorsemicircular canal BPPV;12cases were of the horizontal semicircular canal BPPV;12cases were of the muiti-semicircular canal affected.③The test results of the BPPV auditory-vestibular function:70cases (140ears)ofprimary BPPV patients were conducted with pure-tone threshold testing.There are18cases’(34ears)average threshold more than25dBnHL.Among them,the mild,moderate, severe, very severe hearing loss of the secondary BPPV were6ears,15ears,8ears,5ears respectively; the mild, moderate, severe, very severe hearing loss of theprimary BPPV was4ears,5ears,6ears,2ears respectively;In the secondaryBPPV,Most patients were of moderate to severe sensorineural hearing impairment.took the average hearing threshold of the primary BPPV patients and that of thesecondary BPPV patients to execute The statistical analysis, there was no significantdifference between the two groups (t=1.524, p=0.13).34cases of primary andsecondary BPPV patients were conducted with videonystagmograghy(VNG)respectively.Hypofunction in the unilateral semicircular canal cases of the secondaryBPPV and the primary BPPV was21cases and19cases. Took the caloric test of theprimary BPPV patients and that of the secondary BPPV patients to execute chi-squaretest, there was no significant difference between the two groups, x~2=0.812, P=0.98.④The consequence of treatment and prognosis: The cure rates of otolithrepositioning therapy in the first time, the secondary of the secondary BPPV group wereof78%,97.5%respectively,2.5%of which in the treatment was ineffective; The curerates of otolith repositioning therapy in the first time, the secondary of the primaryBPPV group were of were89%,100%respectively. Compare with the secondary BPPVgroup,the primary BPPV groups’ otolith repositioning therapy is more effective.usingStatistical analysis,there was significant difference of the reduction treatment efficacy ofbetween two groups of the primary BPPV group and the secondary BPPV grouppatients with X2=5.330, P=0.021, recurrence rate of the secondary BPPV was23%(cases), while it was3%of the primary BPPV; Took the relapse frequency of theprimary BPPV patients and that of the secondary BPPV patients to execute chi-squaretest, x~2=5.330, P=0.021, there was significant difference.Conclusions:1.The patients of secondary BPPV were prone to injury inmulti-semicircular canal compared with the primary BPPV.2.Most patients were ofmoderate to severe sensorineural hearing impairment in the secondary BPPV, there was no significant correlation of suffering from BPPV with semicircular canal dysfunction.3. Compared with primary BPPV, secondary BPPV often requires several times ofcanalith repositioning therapy, and its recurrence rate was relatively high.