水平半規管良性陣發性位置性眩暈的分類與其治療原則

The Classification and Management of Horizontal Canal Benign Paroxysmal Positional Vertigo

邱文耀(Wen-Yaw Chiou) ； 蔡世哲(Shih-Che Tsai) ； 于篤學(Tu-Hsueh Yu) ； 李信賢(Xin-Xian Lee)

《台灣耳鼻喉頭頸外科雜誌》 39卷6期 (2004/12) Pp. 236-241

https://doi.org/10.6286/2004.39.6.236

摘要

背景：近年來，源自水平半規管的良性陣發性位置性眩暈(horizontal canal benign paroxysmal positional vertigo，HC-BPP)的文獻報告有日益增多的趨勢，且治療效果差，文獻上很少有超過75%的成功率。本研究依據位置性眼振型態之變化，將HC-BPPV分為不同類型，並歸納其治療原則，以提高治療成功率。
方法：本科於1999年2月至2003年2月，確定為HC-BPPV患者有72名，檢查方法為Supine to head-lateral，治療方法爲forced prolonged position(FPP)，每次治療後2日回診，直到治癒。依據陣發性水平性向地或持續性水平性逆地的位置性眼振型態，將HC-BPPV分類為管耳石型(Can)及頂帽沈石型(Cup)。再進一步將後者依據治療後的位置性眼振變化，是否由逆地轉為向地，分類為頂帽之半規管側(Cup-C)和橢圓囊側(Cup-U)。FPP法為側躺「健側」12小時， Can可由眼振較弱側判定為健側。但是Cup-U和對側Cup-C會出現同為弱側的眼振，此時可以先躺向眼振較弱側為治療原則。
結果：72名HC-BPPV中，40名為Can，32名為Cup，以FPP治療全數痊癒，最多回診4次者有2例。32名的Cup，在治療後有9名眼振由逆地轉變成向地，推測原病灶在頂帽之管側(Cup-C)，此時成為Can，故FPP治療改為躺向對側。另外23名推測應為Cup-U，其中21名以FPP治療後即無眼振。另2名經回診4次亦痊癒。
結論：由於HC-BPPV致病機轉的多樣性，需要更審慎的病情追蹤和判斷，但可歸納為躺向「眼振較弱側」的FPP法為其治療原則。

關鍵字

良性陣發性位置性眩暈 ； 水平半規管 ； 持續姿勢法

並列摘要

BACKGROUND: In recent years, the incidence of diagnosis of horizontal canal benign paroxysmal positional vertigo (HC-BPPV) has increased greatly. Compared with PCBPPV, it has a more perplexing pathogenesis and extra attention is needed to obtain the correct diagnosis and to give the correct treatment. So far, the documented overall success rate of treatment for HC-BPPV has been less than 75%. Thus, the purpose of this study was to improve the effective treatment of HC-BPPV by rational classification of this disorder and the adoption of a reasonable therapy protocol.
METHODS: There were 72 subjects diagnosed as suffering from HC-BPPV by the supine to head-lateral test. Videonystagmography was used to monitor and record the data. Three subtypes, canalolithiasis (Can), cupulolithiasis, canal sided (Cup-C) and cupulolithiasis, utricle sided (Cup-U) were identified according to geotropic or ageotropic positional nystagmus and whether there was transfer from ageotropic to geotropic on follow-up examination. Since the Cup-U and contralateral Cup-C revealed the same nystagmus pattern, it is not be possible to tell which side is the healthy side. However, a forced prolonged position (FPP) with lying on the weaker nystagmus side instead of lying on the healthy side was demonstrated to be the single most effective therapy for all subtypes of HC-BPPV
RESULTS: All patients including 40 Can, 9 Cup-C and 23 Cup-U had their symptoms and nystagmus resolved in less than 4 treatment sessions.
CONCLUSION: Based on the pathophysiological mechanism and our clinical experiences, FPP lying on the weaker nystagmus side was very effective as treatment for all the subtypes of HC-BPPV.

並列關鍵字

benign paroxysmal positional vertigo ； horizontal canal ； forced prolonged position