Clinical Analysis Of Benign Paroxysmal Positional Vertigo In Otorhinolaryngology Clinic

ObjectiveBenign paroxysmal positional vertigo(BPPV)is the most common peripheral vertigo in the vertigo clinic.With the popularization of popular science knowledge of vertigo in the public and the deepening of clinicians' understanding of BPPV,the number of patients with BPPV in Otorhinolaryngology is on the rise year by year.The main purpose of this study is to improve the diagnosis rate of BPPV and the treatment of BPPV,though retrospective analysis of the clinical characteristics of BPPV patients in the Otorhinolaryngology clinic from March 2017 to February 2019.The diagnosis,treatment and the efficacy evaluation of the patients were conducted according to guildlines for diagnosis and treatment of benign paroxysmal positional vertigo(2017).MethodsPatients diagnosed as BPPV from March 2017 to February 2019 and patients diagnosed as sudden deafness with BPPV clinic from January 2016 to February 2019 in the otorhinolaryngology were analyzed retrospectively and their clinical data were collected.The research was divided into the following three aspects:(1)The clinical data of 529 patients with BPPV were analyzed,such as age,sex and type.(2)A retrospective study of patients with evidence of idiopathic BPPV or ISSNHL with BPPV between 2016 and 2019 at a single medical center.All participants were identified and categorized by using the Dix-Hallpike test and roll test,and then followed by canalith reposition procedures(CRPs)2 to 3 times.The assessment of outcome was conducted at one-hour and one-week post-CRPs,respectively.(3)The clinical characteristics of 529 patients who was diagnosed as BPPV from March 2017 to February 2019 were reviewed to compare the diagnostic rate of forearm lateral before and after the use of specific roll test.(4)For the patients with lateral semicircular canal BPPV,they were divided into two groups: the modified barbecue group and the normal barbecue group.The probability of the involved semicircular canal changed after canalith repositioning procedures was compared between the two groups.Results(1)The mean age of 529 patients with BPPV was 56.52 ± 14.57 years,and their age ranged from 10 to 84 years.There were 178 males and 351 females.Among them,291 patients(55.01%)were diagnosed with BPPV of posterior semicircular canal,213 patients(40.26%)with BPPV of lateral semicircular canal,8 patients(1.51%)with BPPV of anterior semicircular canal and 17 patients(3.21%)with BPPV of multi-semicircular canal.(2)64 BPPV adults secondary to sudden sensorineural hearing loss and 328 adults with idiopathic BPPV were included.The posterior canal is the most affected in either group.At one-hour post-treatment,the cured rate of the BPPV with sudden sensorineural hearing loss group was 45.31%,which was significantly lower than that of the i-BPPV group(94.82%,P<0.01).At one-week post-treatment,the cured rate of the BPPV with ISSNHL group was 66.67%,significantly lower than that of the i-BPPV group(98.78%,P<0.01).BPPV with sudden sensorineural hearing loss was associated with poorer outcomes than i-BPPV in the short term.(3)According to the inclusion exclusion criteria,529 BPPV patients were collected,of which 66 were lateral semicircular canal BPPV patients with apogeotropic nystagmus.Among them,17 patients were diagnosed with normal roll test,2 patients were diagnosed as forearm canalolithiasis,49 were diagnosed with specific roll test besides normal roll test,and 24 were diagnosed as forearm canalolithiasis.(4)There were 147 patients with lateral semicircular canal BPPV,5 patients(7.46%)of 67 patients in the normalbarbecue group were involved in the transition from lateral semicircular canal to posterior semicircular canal after canalith repositioning procedures,and only 1 patient(1.25%)of 80 patients in the modified barbecue group was involved in the transition from latral semicircular canal to posterior semicircular canal after canalith repositioning procedures.Conclusion1.The BPPV was high in the age range of 50-59 years old.The male patients are less than the female patients,and the ratio of male to female is about 1:2.The proportion of posterior semicircular canal BPPV was the highest,and the proportion of lateral semicircular canal BPPVwas the second.The proportion of anterior semicircular canal BPPV and multi-semicircular canal BPPV were the rarest.2.BPPV is one of the common causes of vertigo in patients with sudden sensorineural hearing loss.The clinical characteristics of BPPV secondary tosudden sensorineural hearing loss were like those of i-BPPV,while BPPV secondary to sudden sensorineural hearing loss was associated with poorer outcomes than BPPV in the short term.What is more,the cured rate was significantly improved without repeated canalith repositioning procedures after medication for one week in BPPV with sudden sensorineural hearing loss group.Thus,due to the adverse reactions such as vertigo,vomiting,and hyperventilation during the canalith repositioning procedure and its high cost,it might be a cost-effective way to take medication after the initial canalith repositioning procedures while not repeating canalith repositioning procedures in the first week for BPPV secondary to sudden sensorineural hearing loss.3.A specific rolling test was put forward,which can transform forearm canalolithiasis of lateral semicircular canaltocanalolithiasis of lateral semicircular canal.On the one hand,it solves the difficulty of diagnosis and classification of BPPV of lateral semicircular canal with apogeotropic nystagmus,on the other hand,it layed a foundation for furthertreatment and improved the diagnosis and treatment of BPPV of the lateral semicircular canal.Specific roll test can improve the diagnosis rate of forearm canalolithiasis of lateral semicircular.4.The modified barbecue method did not reduce the changes of the involved semicircular canals in the canalith repositioning procedures of patients with lateral semicircular canal BPPV.