Clinical Features And Recurrent Risk Factors Analysis Of 569 Patients With Benign Paroxysmal Positional Vertigo

Objective:Through clinical analysis of 569 patients with benign paroxysmal positional vertigo(BPPV)in neurology clinic of our hospital,the clinical characteristics of BPPV were summarized to reduce the misdiagnosis and missed diagnosis rate of BPPV,and the recurrence rate and risk factors of BPPV were analyzed and summarized to prevent recurrence of BPPV.Methods:From May 2017 to December 2017,patients with benign paroxysmal positional vertigo diagnosed and treated by SRM-IV BPPV diagnostic and therapeutic system in neurology clinic of the First Hospital of Jilin University were investigated by questionnaires.Age,sex,degree of vertigo,duration of vertigo at each attack,position of inducing and aggravating vertigo and accompanying symptoms as well as past medical history(hypertension,diabetes mellitus,hyperlipidemia,head trauma,otitis media,Meniere's disease and other medical history),auxiliary examination,diagnosis and treatment were recorded in detail.Telephone follow-up of patients for one year,the recurrence of patients,clinical data and related recurrence risk factors were recorded for statistical processing.Results:(1)Among 569 BPPV patients,188(33%)were males,381(67%)were females;the ratio of males to females was close to 1:2.(2)The oldest patient was 81 years old,the youngest patient was 17 years old,the average age of onset was 50.95 years old,and the population of onset was mainly between 50 to 69 years old.(3)There were 423 cases of PC-BPPV(74.3%),110 cases of HC-BPPV(19.4%),25 cases of mixed BPPV(4.4%)and 11 cases of SC-BPPV(1.99%).(4)339(80.1%)patients with PC-BPPV had vertigo induced or aggravated when they got up,lay down,raised or lowered their heads,and 77(18.2%)patients had vertigo induced or aggravated when they turned left and right.Among HC-BPPV patients,65 patients(59.1%)had vertigo induced or aggravated by turning left and right,while 42 patients(39.2%)had vertigo induced or aggravated by getting up,lying down,raising or lowering their heads.Eight patients(72.7%)with SC-BPPV developed or aggravated vertigo when they got up,lay down,looked up and bowed their heads.Seventeen patients(68%)with mixed BPPV could induce or aggravate vertigo when they woke up,lay down,raised their heads or lowered their heads,and seven patients(28%)could induce or aggravate vertigo when they turned left and right.(5)522 cases(91.7%)of BPPV patients had vertigo lasting from seconds to one minute.Thirty one patients(5.4%)lasted for one minute to five minutes and fifteen patients(2.6%)lasted for five to ten minutes.(6)The total effective rate(including cure and relief of symptoms)was 97.53% in BPPV patients treated with reduction.(7)During a follow-up period of 1 year,569 patients with BPPV were followed up,54 of them lost contact,515 were treated effectively and maintained follow-up.Among them,412 patients did not relapse,103 patients relapsed,and the recurrence rate of BPPV was 20%.The history of head trauma,migraine,hypertension and diabetes were independent risk factors for BPPV recurrence.Conclusion:There were more female patients than male patients in BPPV,the ratio of male to female was close to 1:2.The predisposing age of BPPV patients was 50-69 years old.The main clinical manifestations of BPPV patients were short-term vertigo related to head position,which lasted for several seconds to one minute,and could be accompanied by nausea and vomiting.A few patients might have headache or tinnitus.BPPV in the posterior semicircular canal is the most common type of BPPV,followed by BPPV in the horizontal semicircular canal and mixed BPPV,BPPV in the anterior semicircular canal is the least common type.BPPV repositioning is effective.BPPV has a high recurrence rate.Head trauma,migraine,hypertension and diabetes are independent risk factors for recurrence.There is no significant correlation between recurrence and age,seizure type,sleep quality,otitis media and Meniere's disease.