Clinical Research On Precision Evaluation Of MD And Efficacy And Safety Of BPPV Diagnosis And Treatment System In BPPV Patients

Part 1.A comparative study of Correlation Between staging and vertigo severity with accurate assessment of vestibular function and the vertigo severity in Meniere DiseaseObjective: This study was aimed to compare association of staging and vertigo severity with association of accurate assessment of vestibular function and the vertigo severity and provide new evaluation proposals for clinical staging with MD,the correlation between different consequences of accurate assessment of audio-vestibular function was also evaluated.Methods: Altogether,80 patients with definite unilateral MD were recruited between August 2018 and October 2019 for this prospective case-series study.The patients' self-assessed severity of MD was documented by a comprehensive medical history with number of vertigo attacks in the past 6 months and a Dizziness Handicap Inventory(DHI)questionnaire,and laboratory evidence of the disease was evaluated by audiological and vestibular tests,which including rotatory chair test(RCT),video head impulse test(v HIT),the cervical and ocular vestibular-evoked myogenic potentials(c VEMPs and o VEMPs).According to guideline of diagnosis and treatment of Meniere disease(2017),staging is based on the three-tone average of the pure-tone thresholds at 0.5,1,and 2 k Hz of the worst audiogram during the interval 6 months before treatment.The involvement of each vestibular sensorial organs was verified by various tests targeting different vestibular sensorial organs and the number was counted.Correlations between stages and DHI scores,number of vertigo attacks in the past 6 months were evaluated using one-way ANOVA and Kruskal-Wallis test,respectively.Correlations between vestibular function parameters,number of the involved vestibular end organs and DHI,number of vertigo attacks in the past 6 months were evaluated using Pearson correlation and Spearman rank correlation,respectively,multivariate logistic regression analysis was also done to identify the correlation of number of the involved vestibular end organs with DHI.Correlations between stages and vestibular functions parameters were evaluated using Chi-square test and correlations between consequences of vestibular function evaluations were evaluated using Pearson correlation and Spearman rank correlation.Results:All subjects had mean age of 56.7±13.5 years,among whom 43 were female.There were 19 in stage 1,16 in stage 2,34 in stage 3,11 in stage 4.No significant differences were detected in DHI scores,number of vertigo attacks in the past 6 months across the four stages.The number of the involved vestibular end organs was significantly associated with DHI scores and number of vertigo attacks in the past 6 months.The vestibulo-ocular reflex gain at 0.08 Hz in the rotatory chair test was significantly correlated with DHI-P scores and number of vertigo attacks in the past 6 months at 0.08 Hz.There was no significant difference in vestibular function parameters and number of involved vestibular organs across four stages.Furthermore,IAR in c VEMPs and o VEMPs were positively associated with the number of involved inner ear organs,which were also negative associated with VOR gains of posterior/anterior canal in v HIT.Conclusions: Audiological stages has no association with DHI scores,number of vertigo attacks in the past 6 months.The number of involved vestibular organs is significantly correlated with DHI scores and number of vertigo attacks in the past 6 months,IAR in c VEMPs and o VEMPs,and VOR gains of posterior/anterior canal in v HIT,and a significant predictor for vertigo severity.Part 2.Efficacy and safety of benign paroxysmal positional vertigo diagnosis and treatment system in patients with BPPV: a multicenter,randomized,controlled trialObjective: Delays in the final diagnosis and appropriate treatment were common in the management of BPPV and significant improvements are urgent.This study aimed to determine the efficacies and safety of BPPV diagnosis and treatment system(BDTS)maneuvers in benign paroxysmal positional vertigo(BPPV),and diagnosis accuracy of BDTS,the satisfaction of nystagmus recording and comfort of videonystagmoscopy were also evaluated.Methods: In 3 otolaryngology departments of tertiary hospitals in China,289 consecutive patients with BPPV involving the posterior and horizontal semicircular canal were randomized to BDTS maneuvers(n=145),or classic canalith repositioning maneuvers(CRM)(n=144)after standard screening and randomization.For BDTS maneuvers,patients underwent CRM using a computer-controlled chair for migration of the debris toward the vestibule.Effective and resolved responses were determined in weekly follow-ups after a maximum of 3 trials of each maneuver for 1 month.The cumulative long-term effect of each maneuver was determined with Kaplan-Meier survival analysis and was compared among the groups using the log-rank test.Results: All 289 patients were recruited in FAS with 186 women,ranged from 21-76 years old,with mean age 46.91±13.33 years and 263 were recruited in PPS.In first week after initial visit day,BDTS maneuvers showed better effective responses(133/145,98.52%)than the classic CRM(119/144,86.23%).There was no significant difference in the incidence of adverse events between the two groups.The resolution rates were slightly higher in BDTS group than classic CRM in first week.The cumulative therapeutic effects were also better with BDTS maneuvers than with the CRM(P=0.0001)in Kaplan-Meier survival curve.The consistency between the diagnosis results of BDTS and manual diagnosis was 91.59%,95% CI(84.78%,95.51%).Repeated maneuvers and the patients need repeated maneuvers in BDTS group were significantly less than in classic CRM.The satisfaction of nystagmus video and comfort of videonystagmoscopy in the BDTS group were better than that of the control group.Conclusion: BDTS is effective and safe to treat BPPV involving the posterior and horizontal semicircular canal and showed better effective responses than the classic CRM.BDTS has the advantages of high accuracy of automatic diagnosis,good quality of nystagmus acquisition,and similar security with classic CRM.