| Objective: Benign paroxysmal positional vertigo(BPPV)is one of the most common peripheral vertigo diseases.The etiology of BPPV is complicated and the pathogenesis remains unclear.At present,the commonly accepted theories are "the theory of ampullary crest cap stone" and "the theory of semicircular canal knot stone".Although the cure rate of BPPV is high,recurrence occurs easily.The risk factors and mechanism of recurrence are still controversial.In order to study the clinical characteristics of vestibular function in recurrent patients with BPPV,VNG and VAT were performed in recurrent and non-recurrent patients with BPPV.Comparing and analyzing the results,to explore the clinical significance and application value of VNG and VAT in evaluating recurrence and the characteristics of vestibular function in recurrent patients with BPPV.Methods: Collected from March 2019 to October 2019 in the Department of Otorhinolaryngology Hearing and Dizziness in Tianjin Medical University General Hospital 87 patients were diagnosed as BPPV.According to the definition of recurrence,they were divided into recurrence group(28 cases)and non recurrence group(59 cases).30 healthy volunteers were selected as the control group.There was no significant difference in sex,age and marital status between the BPPV group and the control group.In BPPV group,patients were examined with pure tone audiometry,acoustic immittance test,VAT test,VNG test,Dix Hallpike test or roll test and reduction therapy.In the control group,patients were examined with pure tone audiometry,acoustic immittance test,VAT test,VNG test,Dix Hallpike test or roll test.All the data of the results were collected and analyzed by SPSS 22.0.Results:1.Eye movement system examination,including saccade test,tracking test,OKN,gase test,there was no statistical significance between the BPPV group and control group,as well as between the recurrent group and the non-recurrent group.2.Similarly,in spontaneous nystagmus the BPPV group and control group,recurrent group and non-recurrent group had no significant difference.3.In the cold and hot temperature test,there were 2 UW cases(6.67%)in the normal group,and 48 UW cases(55.17%)in the BPPV group.The difference between the two groups was significant(χ 2 = 21.447,P < 0.001).4.In the normal control group,6 cases(20.0%)had abnormal VAT,including 4 cases(13.3%)with abnormal gain,4 cases(13.3%)with abnormal phase shift,1 case(3.3%)with asymmetric abnormality,and 24 cases with normal VAT results,There were 71 cases(81.6%)with abnormal VAT,including 37 cases(39.1%)with abnormal gain,66 cases(75.9%)with abnormal phase shift,20 cases(23.0%)with asymmetric abnormality,and 16 cases(18.4%)with normal VAT results.The difference of the abnormal rate of VAT parameters between the two groups was statistically significant(P < 0.05).5.In the normal control group,there were 2 cases(6.7%)with abnormal results of hot and cold temperature test,and 6 cases(20.0%)with abnormal results of VAT examination.There was no significant difference in the abnormal rate between the two groups(P > 0.05).In BPPV group,48 patients(55.2%)had abnormal results of hot and cold temperature test,71 patients(81.6%)had abnormal results of various parameters of VAT test.So the difference between the two groups was significant(P < 0.05).6.In BPPV group,48 cases(55.2%)had abnormal temperature test results.Among them,20 cases(71.4%)were abnormal in cold and hot temperature test,8 cases(28.6%)were normal in recurrent group,28 cases(47.5%)were abnormal in non recurrent group and 31 cases(52.5%)were normal.The difference between the two groups was significant(χ 2 = 4.412,P < 0.05).There was no significant difference between the two groups(χ 2 = 0.139,P = 0.709).Mild and bilateral weakening: 17 cases(60.7%)in the recurrence group and 20 cases(33.9%)in the non recurrence group.It exits statistical difference between the two groups(χ 2 = 5.587,P = 0.018).It can be concluded that the UW abnormality in the recurrence group is more serious than that in the non recurrence group.7.There were 71 cases(81.6%)with abnormal VAT test results in BPPV group.Among them,24 cases(85.7%)were abnormal in the recurrent group,4 cases(14.3%)were normal,47 cases(79.7%)were abnormal in the non recurrent group,and 12 cases(20.3%)were normal.The difference between the two groups was no statistical significance(χ 2 = 0.464,P > 0.05).There was no significant difference between the two groups(χ 2 = 0.464,P = 0.496).17 cases(60.7%)and 22 cases(37.3%)of the two groups had abnormal recurrence(χ 2 = 4.2132,P = 0.040).In the relapse group,20 patients(71.4%)had abnormal results of hot and cold temperature test,24 patients(85.7%)had abnormal results of VAT test,There was statistical difference between the two groups(χ 2 = 4.929,P < 0.05),In the non recurrence group,28 patients(47.5%)had abnormal results of hot and cold temperature test,47 patients(79.7%)had abnormal results of various parameters of VAT test,the difference was significant(χ 2 = 5.728,P < 0.05).8.Among 48 patients with abnormal cold and hot temperature test in BPPV group,21 patients(43.8%)had the same UW and the lesion side,27 patients(56.2%)had the opposite or both sides weakened UW and the lesion side.Among the 71 patients with abnormal VAT examination,16(22.5%)had the same asymmetrical abnormality as the lesion side,and 55(77.5%)had normal or inconsistent abnormality.9.Three months after the successful reduction treatment,the results of VAT were abnormal in 15 patients(53.6%)and normal in 13 patients(46.4%)in the recurrence group,abnormal in 17 patients(28.8%)and normal in 42 patients(71.2%)in the non recurrence group,and There was statistical difference between the two groups(χ 2 =5.000,P < 0.05).Conclusion: 1.BPPV patients existing perivestibular injuries,often can not be detected with obvious central lesions,and the degree of vestibular function damage in recurrent patients is often more serious than that in non recurrent patients.2.VAT is often more sensitive than VNG in evaluating the vestibular function of BPPV patients.Although the two detection methods are not accurate in judging the vestibular injury side of BPPV patients,the consistency between the abnormal side and the affected side in the hot and cold temperature test is higher than that in the VAT test.3.Combined with VNG and VAT,the vestibular function of the patients with BPPV can be comprehensivly understanded,and it also has a certain guiding significance in assessing the recurrence of BPPV.4.Through analyzing VAT results of BPPV patients who had been successfully reset for 3 months,it was found that the abnormal rate of VAT in the recurrent group was higher than that in the non recurrent group,which indicated that the time needed to completly recover the vestibular function in BPPV group was more than 3 months,while the recovery time in the recurrent group was longer than that in the non recurrent group.It provides an important reference for assessing the recurrence of BPPV and evaluating the prognosis,and also can provide a new idea for the treatment of BPPV. |
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