Analysis Of Occurrence Regularity And Diagnosis Of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo

Objective:To explore the regularity of onset time of horizontal semicircular canal benign paroxysmal positional vertigo in accordance with the patient complaint,make use of the rolling test,bow and lean test and subjective vertigo sensation of the patients positioning affected side,based on the diagnosis results of the three methods,analysis the efficacy of different otoconia repositioning procedurein treatment HSC-Can and HSC-Cup.Method:138 patients(94 HSC-Can and 44 HSC-Cup)with HSC-BPPV were enrolled from June 2015 to September 2016 in department of Otolaryngology Headand Neck Surgery of Tianjin Union Medical Center.First of all,making comprehensive medical history of inquiry and collection for all patients with HSC-BPPV,focusing on and recording patient's onset time.According to the patient's complaint,analysis the regularity of patient's onset timee.Second,patients were tested with Head roll test(HRT)and then were asked about subjective vertigo sensation(SVS),interval 15 to 20 minutes,performing Bow and Lean Test(BLT).Based on the results of HRT,SVS and BLT,HSC-Can and HSC-Cup were repositioned by Barbecue method and Kim method respectively.The detection rate ofthe affected side of HRT,BLT,SVS and the curative effect were analyzed.Result:(1)94 patients with HSC-Can,of which 32 cases(34.04%)occurred at the time of rising in the morning,20 cases(21.28%)occurred after morning(after morning to going to bed),42 cases(44.68%)occurred during sleep,Which accounted for 74cases(78.72%)from during sleep to the time of rising in the morning.(2)44 patients with HSC-Cup,of which20 cases(45.45%)occurred at the time of rising in the morning,15 cases(34.09%)occurred after morning(after morning to going to bed),9 cases(20.45%)occurred during sleep,Which accounted for29 cases(65.90%)from during sleep to the time of rising in the morning.(3)In 94 HSC-Can patients,BN and/or LN were induced different direction by BLT to be 81.91%.HRT induced bilateral asymmetric nystagmus 90.43%,SVS told Vertigo symptoms worse side 60.61%,two patients in whom the comparison among HRT ? BLT ? SVS were inconclusive.There was no significant difference in the detection rate of HRT and BLT(P>0.05),but have significant difference with SVS(P< 0.05).Treatment for patients with affected side,only by the result of HRT66.67%,only by BLT71.43% and 70.37% in whom the HRT and BLT were positive as well as ipsilateral of the affected side,these difference were not statistically significant(P>0.05),but there has significant difference in 37.50%(according to BLT results performing otoconia repositioning treatment for the first time)whom the HRT and BLT were positive but contralateral of the affected side(P < 0.05),the curative effect of one week,only by the result of HRT86.67%,only by BLT85.71% and90.74%in whom the HRT and BLTwere positive as well as ipsilateral of the affected side,these difference were not statistically significant(P>0.05),(according to HRT results performing otoconia repositioning treatment for one week later)whom the HRT and BLT were positive but contralateral of the affected side81.25%,there has no statistically significant difference with above result(P>0.05).(4)In 44 HSC-Cup patients,BN and/or LN were induced different direction by BLT to be 84.09%.HRT induced bilateral asymmetric nystagmus 88.64%,SVS told Vertigo symptoms worse side 63.64%,two patients in whom the comparison among HRT ? BLT ? SVS were inconclusive.There was no significant difference in the detection rate of HRT and BLT(P>0.05),but have significant difference with SVS(P< 0.05).Treatment for patients with affected side,only by the result of HRT60.00%,only by BLT66.67% and 62.50%in whom the HRT and BLT were positive as well as ipsilateral of the affected side,these differencewere not statistically significant(P>0.05),but there has significant difference in 30.00%(according to BLT results performing otoconia repositioning treatment for the first time)whom the HRT and BLT were positive but contralateral of theaffected side(P < 0.05),the curative effect of one week,only by the result of HRT80.00%,only by BLT100.00%and79.17% in whom the HRT and BLT were positive as well as ipsilateral of the affected side,these difference were not statistically significant(P>0.05),(according to HRT results performing otoconia repositioning treatment for one week later)whom the HRT and BLT were positive but contralateral of the affected side70.00%,there has no statistically significantwith above result(P>0.05).Conclusion:(1)BPPV is strongly related to sleep,HSC-BPPV most frequently occurs during sleep to the time of rising in the morning which is a relatively long period,and the patient's position changes less during the time leading to shedding otoliths accumulates.During sleep and rising in the morning,when sufficient to induce typical symptoms under head position changes.(2)Compared with BLT and SVS,HRT is the most effective method for detecting affected side of HSC-BPPV,but BLT and SVS also have auxiliary diagnostic value as HSC-BPPV localization methods.