Comparison Study Of The Efficacy Of Different Repositioning Maneuvers On Horizontal Canal Benign Paroxysmal Positional Vertigo

Objective:Analyzing the nystagmus of patients with horizontal canal benign paroxysmal positional vertigo?HC-BPPV?,and comparing the three methods of Barbecue maneuver,Gufoni maneuver and Li's repositioning maneuver in the treatment of HC-BPPV patients with different nystagmus,to explore the best repositioning maneuver for HC-BPPV.Methods:A total of 135 HC-BPPV patients were enrolled,and all patients were subjected to the positional test on the videonystagmography.Randomly,the patients with geotropic nystagmus were divided into three treatment groups based on the order of the visit,and the Barbecue maneuver,Gufoni maneuver and Li's repositioning maneuver were applied respectively,with 30 cases per group;The patients with apogeotropic nystagmus were also divided into three groups based on the order of the visit,with 15 cases per group.Each method was treated twice,and after 30 minutes of the end of the repositioning maneuver,the roll test was performed again to observe and evaluate the efficacy after the first reduction,and the patients should be reviewed one week later and one month later.Patients who were cured were followed up for three months to observe the recurrence.Results:1.135 patients with HC-BPPV were 25⁸0 years old with an average age of 50.87±13.60 years old;The time from the first vertigo attack to the present visit ranged from 1 day to2 years,with a median time of 5 days;Among them,56 cases were male and 79 cases were female,which was 1.41 times more than that of male;There were 47 cases occurred in the left ear and 88 cases in the right ear,and the ratio of left to right was 1:1.87.There was no statistically significant difference among the three groups of geotropic nystagmus patients and three groups of apogeotropic nystagmus patients in age,course,gender and side in this study,which were comparable.2.For patients with geotropic nystagmus,the first efficacy of repositioning maneuver?P=0.769?,the one-week efficacy of repositioning maneuver?P=0.662?and the one-month efficacy of repositioning maneuver?P=0.952?showed no significant difference among the three groups.The three months recurrence?P=0.922?showed no significant difference among the three groups.3.For patients with apogeotropic nystagmus:?1?The first efficacy of repositioning maneuver:26.67%in the Barbecue group,73.33%in the Gufoni group,and 80.00%in the Li's group.The difference among the three groups was statistically significant?P=0.006?.The efficacy of Gufoni maneuver and Li's repositioning maneuver were superior to the Barbecue maneuver(P_GB=0.036,P_{Li B}=0.009),and there was no significant difference between Gufoni maneuver and Li's repositioning maneuver(P_{Li G}=1.000);?2?The one-week efficacy of repositioning maneuver:40.00%in the Barbecue group,80.00%in the Gufoni group,and 86.67%in the Li's group.The difference among the three groups was statistically significant?P=0.003?.The efficacy of Gufoni maneuver and Li's repositioning maneuver were superior to the Barbecue maneuver(P_GB=0.046,P_{Li B}=0.003),and there was no significant difference between Gufoni maneuver and Li's repositioning maneuver(P_{Li G}=1.000);?3?The one-month efficacy of repositioning maneuver:46.67%in the Barbecue group,86.67%in the Gufoni group,and 93.33%in the Li's group.The difference among the three groups was statistically significant?P=0.002?.The efficacy of Gufoni maneuver and Li's repositioning maneuver were superior to the Barbecue maneuver(P_GB=0.025,P_{Li B}=0.003),and there was no significant difference between Gufoni maneuver and Li's repositioning maneuver(P_{Li G}=1.000).?4?The three months recurrence?P=0.783?showed no significant difference among the three groups.Conclusions:Repositioning maneuver has significant efficacy on HC-BPPV.Especially for the patients with geotropic nystagmus,the Barbecue maneuver,Gufoni maneuver and Li's repositioning maneuver are basically the same,the effective rate is more than 80.00%.The Gufoni maneuver and the Li's repositioning maneuver are superior to the Barbecue maneuver in the treatment of patients with apogeotropic nystagmus.Clinically,the proper repositioning maneuver should be selected according to the nystagmus and the patients'own conditions.