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目的了解继发于几种内耳疾病的良性阵发性位置性眩晕(benign paroxysmalpositional vertigo,BPPV)的发病情况,进一步了解 BPPV 的可能发病机制。方法观察眩晕诊疗中心2004年1月至2006年11月53例前庭神经炎、90例突发性聋(包括伴眩晕的突发性聋)、381例梅尼埃病 BPPV 等的发病情况,并与同期183例原发性 BPPV 比较。结果 4种内耳疾病后可以出现BPPV,分别是前庭神经炎、突发性聋、梅尼埃病和 Bell 麻痹。前庭神经炎后出现 BPPV 为9.4%(5/53);突发性聋后出现 BPPV 为38.9%(35/90);梅尼埃病后出现 BPPV 为0.3%(1/381);1例 Bell麻痹后出现 BPPV。其中外半规管 BPPV 5例;后半规管37例,其中1例后半规管 BPPV 在复位过程中出现同侧前半规管 BPPV。管结石症39例,外半规管嵴顶结石症3例。内耳病变后出现 BPPV 在发病后半年内出现者占75.0%(27/36)。继发性 BPPV 的手法复位效果与原发性 BPPV 相似,大多都可1、2次就诊后治愈。结论内耳病突发性聋、前庭神经炎和梅尼埃病后可以出现 BPPV。这种类型的 BPPV 主要表现为后半规管管结石,偶见外半规管嵴帽结石。原发性 BPPV 与内耳病变后出现的BPPV 手法复位疗效相似。
Objective To investigate the incidence of benign paroxysmal positional vertigo (BPPV) secondary to several diseases of the inner ear and to further understand the possible pathogenesis of BPPV. Methods Fifty-three cases of vestibular neuritis, 90 cases of sudden deafness (including sudden deafness with vertigo) and 381 cases of Meniere’s disease such as BPPV were observed from January 2004 to November 2006 in Dizziness Center. Compared with 183 cases of primary BPPV in the same period. Results Four kinds of inner ear diseases could appear BPPV, which were vestibular neuritis, sudden deafness, Meniere’s disease and Bell’s palsy. BPPV was 9.4% (5/53) after vestibular neuritis; BPPV was 38.9% (35/90) after sudden deafness; BPPV was 0.3% (1/381) after Meniere’s disease; 1 case of Bell BPPV appears after paralysis. Among them, 5 cases were BPPV outside the semicircular canal; 37 were the posterior semicircular canal, and 1 BPPV was found in the posterior semicircular canal in 1 case. 39 cases of stone disease, external semicircular canal crown stone disease in 3 cases. BPPV occurred within half a year after the onset of disease in the inner ear accounted for 75.0% (27/36). The efficacy of secondary BPPV resection is similar to that of primary BPPV, and most of them can be cured after 1 and 2 visits. Conclusion BPPV may occur after sudden deafness, vestibular neuritis and Meniere’s disease in the inner ear. This type of BPPV mainly manifested as semiconcusect tube stones, occasionally semicircular canal ridge cap stone. BPPV with primary BPPV after the lesion of the hand resection effect similar.