• 四川大學(xué)華西臨床醫(yī)學(xué)院　華西醫(yī)院（成都，610041）;

【摘要】　目的　 了解原發(fā)性良性陣發(fā)性位置性眩暈（benign paroxysmal positional vertigo，BPPV）的雙溫試驗(yàn)及純音測(cè)聽結(jié)果臨床特點(diǎn)。　方法　 2009年6月—2010年6月診斷為原發(fā)性BPPV患者54例，于手法復(fù)位前行雙溫試驗(yàn)及純音聽閾測(cè)試，分析原發(fā)性BPPV患者的雙溫試驗(yàn)、純音測(cè)聽結(jié)果的臨床特點(diǎn)。　結(jié)果　 40例患耳無半規(guī)管輕癱，其病程為（4.25±2.75）周，14例患耳半規(guī)管輕癱，其病程為（9.21±5.85）周，兩組間平均病程差異具有統(tǒng)計(jì)學(xué)意義（t=4.235，P lt;0.05）；39例后半規(guī)管BPPV中11例患耳半規(guī)管輕癱，15例水平半規(guī)管BPPV中3例患耳半規(guī)管輕癱，兩組患耳半規(guī)管輕癱發(fā)生率無統(tǒng)計(jì)學(xué)意義（χ2=2.679，P gt;0.05）；39例后半規(guī)管BPPV中16例患耳聽力下降，15例水平半規(guī)管BPPV中7例患耳聽力下降，兩組患耳純音測(cè)聽異常率無明顯統(tǒng)計(jì)學(xué)差異（χ2=0.141，P gt;0.05）。　結(jié)論　 原發(fā)性后半規(guī)管BPPV與水平半規(guī)管BPPV半規(guī)管輕癱及純音聽閾異常發(fā)生率相近，病程長(zhǎng)者更易出現(xiàn)半規(guī)管輕癱。
【Abstract】　Objective　 To investigate the clinical features of results of bithermal test and pure tone test for patients with idiopathic benign paroxysmal positional vertigo (BPPV), and discuss strategies for prevention. 　Methods　 A total of 54 patients diagnosed to have BPPV during June 2009 to June 2010 underwent bithermal caloric test and pure tone test before particle repositioning maneuver. Then, we analyzed the clinical features of the test results. 　Results　 The course of 40 patients with canal paresis (CP) was (4.25±2.75) weeks, which had a significant difference from the course of 14 patients with CP in the abnormal side, which was (9.21±5.85) weeks (t=4.235, P lt;0.05). Among the 39 patients with posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV), 11 cases of canal paresis were found in the abnormal ear, and of the 15 patients with horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV), 3 cases of canal paresis were found. There was no statistical difference in the rate of canal paresis between the two groups of patients mentioned above (χ2=2.679,P gt;0.05). Sixteen out of the 39 PSC-BPPV patients and seven out of the 15 HSC-BPPV patients had hearing loss (HL) in the abnormal ear with no statistical difference between the two groups of patients in the incidence of hearing loss (χ2=0.141,P gt;0.05). 　Conclusion　 The incidence of CP and HL in the abnormal ear of patients with HSC-BPPV and PSC-BPPV is similar, and patients with long course of disease are more likely to have CP.

引用本文： 李代波,戴晴晴,尹蓉,鄭虹. 原發(fā)性良性陣發(fā)性位置性眩暈患者雙溫試驗(yàn)及純音測(cè)聽分析. 華西醫(yī)學(xué), 2011, 26(5): 726-729. doi: 復(fù)制

1. 　Molina MI, López-Escámez JA, Zapata C. Monitoring of caloric response and outcome in patients with benign paroxysmal positional vertigo[J]. Otol Neurotol, 2007, 28(6): 798-800.
2. 　高波, 宋海濤, 黃魏寧, 等. 良性陣發(fā)性位置性眩暈患者溫度試驗(yàn)結(jié)果比較[J].中國(guó)耳鼻咽喉頭頸外科, 2008, 16(8): 410-412.
3. 　吳子明, 張素珍, 周娜. 良性陣發(fā)性位置性眩暈的聽——前庭功能研究[J]. 中華耳鼻咽喉頭頸外科, 2006, 4(9): 669-672.
4. 　中華耳鼻咽喉頭頸外科雜志編輯委員會(huì), 中華醫(yī)學(xué)會(huì)耳鼻咽喉科學(xué)分會(huì). 良性陣發(fā)性位置性眩暈的診斷依據(jù)和療效評(píng)估[J]. 中華耳鼻咽喉頭頸外科雜志, 2007, 42(3): 163-164.
5. 　von Brevern M, Schmidt T, Schnfeld U, et al. Utricular dysfunction in patients with benign paroxysmal positional vertigo[J]. Otol Neurotol, 2006, 27(1): 92-96.
6. 　Yang WS, Kim SH, Lee JD, et al. Clinical significance of vestibular evoked myogenc potentials in benign paroxysmal positional vertigo[J]. Otol Neurotol, 2008, 29(1): 1162-1166.
7. 　Gentine A, Eichhorn JL, Kopp C, et al. Modelling the action of caloric stimulation of the vestibule. I. The hydrostatic model[J]. Acta Otolaryngol, 1990, 110(5): 328-333.
8. 　Gentine A, Eichhorn JL, Kopp C, et al. Modelling the action of caloric stimulation of the vestibule. Ⅱ. The mechanical model of the semi-circular canal considered as an inflatable structure[J]. Acta Otolaryngol, 1991, 111(1): 7-10.
9. 　Karlsen EA, Hassanein RM, Goetzinger CP. The effects of age, sex, hearing loss and water temperature on caloric nystagmus[J]. Laryngoscope, 1981, 91(4): 620-627.
10. 　Wetmore SJ. Extended caloric tests[J]. Ear Hearing, 2007, 7(3): 186-190.
11. 　Bachor E, Wright CG, Karmody CS. The incidence and distribution of cupular deposits in the pediatric vestibular labyrinth[J]. Laryngoscope, 2002, 112(1): 147-151.
12. 　Baloh RW, Honrubia V, Jacoboson K. Benign positional vertigo: clinical and oculographic features in 240 cases[J]. Neurology, 1987, 37(3): 371-378.
13. 　Fetter M, Dichgans J. Three-dimensional human VOR in acute vestibular lesions[J]. Ann N Y Acad Sci, 1996, 781(6): 619-621.
14. 　Aw ST, Haslwanter T, Fetter M, et al. Contribution of the vertical semicircular canals to the caloric nystagmus[J]. Acta Otolaryngol, 1998, 118(5): 618-627.
  1. 1. 　Molina MI, López-Escámez JA, Zapata C. Monitoring of caloric response and outcome in patients with benign paroxysmal positional vertigo[J]. Otol Neurotol, 2007, 28(6): 798-800.
  2. 2. 　高波, 宋海濤, 黃魏寧, 等. 良性陣發(fā)性位置性眩暈患者溫度試驗(yàn)結(jié)果比較[J].中國(guó)耳鼻咽喉頭頸外科, 2008, 16(8): 410-412.
  3. 3. 　吳子明, 張素珍, 周娜. 良性陣發(fā)性位置性眩暈的聽——前庭功能研究[J]. 中華耳鼻咽喉頭頸外科, 2006, 4(9): 669-672.
  4. 4. 　中華耳鼻咽喉頭頸外科雜志編輯委員會(huì), 中華醫(yī)學(xué)會(huì)耳鼻咽喉科學(xué)分會(huì). 良性陣發(fā)性位置性眩暈的診斷依據(jù)和療效評(píng)估[J]. 中華耳鼻咽喉頭頸外科雜志, 2007, 42(3): 163-164.
  5. 5. 　von Brevern M, Schmidt T, Schnfeld U, et al. Utricular dysfunction in patients with benign paroxysmal positional vertigo[J]. Otol Neurotol, 2006, 27(1): 92-96.
  6. 6. 　Yang WS, Kim SH, Lee JD, et al. Clinical significance of vestibular evoked myogenc potentials in benign paroxysmal positional vertigo[J]. Otol Neurotol, 2008, 29(1): 1162-1166.
  7. 7. 　Gentine A, Eichhorn JL, Kopp C, et al. Modelling the action of caloric stimulation of the vestibule. I. The hydrostatic model[J]. Acta Otolaryngol, 1990, 110(5): 328-333.
  8. 8. 　Gentine A, Eichhorn JL, Kopp C, et al. Modelling the action of caloric stimulation of the vestibule. Ⅱ. The mechanical model of the semi-circular canal considered as an inflatable structure[J]. Acta Otolaryngol, 1991, 111(1): 7-10.
  9. 9. 　Karlsen EA, Hassanein RM, Goetzinger CP. The effects of age, sex, hearing loss and water temperature on caloric nystagmus[J]. Laryngoscope, 1981, 91(4): 620-627.
  10. 10. 　Wetmore SJ. Extended caloric tests[J]. Ear Hearing, 2007, 7(3): 186-190.
  11. 11. 　Bachor E, Wright CG, Karmody CS. The incidence and distribution of cupular deposits in the pediatric vestibular labyrinth[J]. Laryngoscope, 2002, 112(1): 147-151.
  12. 12. 　Baloh RW, Honrubia V, Jacoboson K. Benign positional vertigo: clinical and oculographic features in 240 cases[J]. Neurology, 1987, 37(3): 371-378.
  13. 13. 　Fetter M, Dichgans J. Three-dimensional human VOR in acute vestibular lesions[J]. Ann N Y Acad Sci, 1996, 781(6): 619-621.
  14. 14. 　Aw ST, Haslwanter T, Fetter M, et al. Contribution of the vertical semicircular canals to the caloric nystagmus[J]. Acta Otolaryngol, 1998, 118(5): 618-627.