The Clinical Treatment Study Of Benign Paroxysmal Positional Vertigo

Objective With the in-depth study of benign paroxysmal positional vertigo(BPPV),many therapies have been formed.However,repositioning maneuver is still the primary treatment.In the process of treating BPPV,we not only studied the existing repositioning maneuver,but we also innovated to form new repositioning maneuver.We conduct a series of studies on repositioning maneuver,so the purposes of this thesis are:1.To observe the short-term efficacy of modified Semont maneuver for posterior canal benign paroxysmal positional vertigo.2.To observe the short-term efficacy of Li horizontal canal quick repositioning maneuver for geotropic horizontal canal benign paroxysmal positional vertigo.3.To explore the short-term outcome of Li horizontal canal quick repositioning maneuver for apogeotropic horizontal canal benign paroxysmal positional vertigo.4.To retrospective analyze characteristics and repositioning maneuver outcomes in typical 907 patients with benign paroxysmal positional vertigo.Methods1.This was a prospective randomized controlled trial on 130 PC-BPPV patients between July 2014 and December 2016.Subjects were randomized divided into two groups:modified Semont(65 patients),and Epley(65 patients).Each maneuver was repeated twice,and the presence of sequelae,nystagmus and vertigo on positional testing were evaluated 3rd day and 1week after treatment.2.The single-blind method was used to conduct a prospective controlled study on 127 patients with HC-BPPV from May 2014 to May 2017.Patients were randomly assigned to the Li horizontal canal quick repositioning maneuver(Li maneuver)group or the barbecue repositioning maneuver(barbecue maneuver)group.Follow-up checks were performed 1 day,3 days,1 week and 1 month after the initial repositioning maneuver.3.The clinical data of HC-BPPV with apo geotropic nystagmus(30cases)and geotropic nystagmus(43cases)from May 2014 to July 2016 were analyzed retrospectively.The patients in both groups were repositioned with Li horizontal canal quick repositioning maneuver,and each maneuver was repeated twice.4.Data from typical 907 patients with BPPV who were treated with Epley or modified Semont or Li posterior canal quick repositioning maneuver or Barbecue or Gufoni or Li horizontal canal quick repositioning maneuver or Li anterior canal quick repositioning maneuver,and follow-up checks were performed 1 day,3 days 1 week and 1 month after the initial repositioning therapy.Results1.The efficacy rates at the 3rd day and 1 week after modified Semont maneuver were 91.7%and 98.3%,and 91.9%and 96.8%in Epley group retrospectively.The short-term effective rate of patients in modified Semont group was no difference when compared with that in Epley group.2.The success rates of repositioning at the 1st day,3rd day,1 week and 1 month after of Barbecue repositioning maneuver group were 53.3%,70.4%,90.7%and 92.3%,and 61.7%,80.7%,93.0%and 96.3%in Li horizontal canal quick repositioning maneuver group.The success rates of Li horizontal canal quick repositioning maneuver group was no difference when compared with that in Barbecue repositioning maneuver group.3.The efficacy rates at the 3rd day and 1 week after of Li horizontal canal quick repositioning maneuver were 83.7%and 95.3%in geotropic nystagmus group,and 90.0%and 96.7%in apogeotropic nystagmus group.The short-term effective rate of apogeotropic nystagmus was no difference when compared with that in geotropic nystagmus group.4.July 2009 to December 2017 were treated 907 cases of patients with typical BPPV nystagmus,including 585 females and 322 males.The distribution of semi-circular canal involvement in these 907 patients:489 cases of posterior semicircular canal,312 cases of horizontal semicircular canal,63 cases of anterior semicircular canal,and 43 cases of multiple semicircular canal.According to Kaplan-Meier survival analysis curve,the median cure time for the modified Semont and Li posterior canal quick and Epley repositioning maneuver in PC-BPPV groups was 3 days,and there was no significant difference in survival curves between the two repositioning maneuver.Meanwhile,the median cure time for Barbecue and Li horizontal canal quick repositioning maneuver groups was 3 days,and 1 day for Gufoni repositioning maneuver group in PC-BPPV groups.And there was no significant difference in survival curves of the three repositioning maneuver.In the AC-BPPV,the Li anterior there was no significant difference in survival curves of the threerepositioning maneuver.In the AC-BPPV,the Li anterior canal quick repositioning maneuver was used to cure 7 cases,31 cases,57 cases,58 cases in 1st day,3rd day,1 week,and 1 month,and 5 cases lost to follow-up.According to Kaplan-Meier survival analysis curve,the median cure time for the Li anterior canal quick repositioning maneuverin AC-BPPV groups was 3 days.Conclusion1.ModifiedSemont maneuver represents a simple rapid and effective approach to the treatment of posterior canal benign paroxysmal positional vertigo.2.The Li horizontal canal quickrepositioningmaneuver is a efficacious,simpleandrapidHC-BPPV repositioning method,and can be widely applied in clinical practice as an alternative treatment method.3.The Li horizontal canal quickrepositioningmaneuver is an effective and simple method for patients with apogeotropicnystagmus HC-BPPV.4.The study considered that canalith repositioning maneuver represents a simple rapid safe and efficacious treatment in the majority of patients with BPPV.It is the treatment of choice for BPPV patients.