Acupuncture, Ear ; adverse effects ; Female ; Humans ; Middle Aged ; Vertigo ; etiology

Dizziness or vertigo is a common clinical symptom, and its underlying etiology is complex. Many clinicians are confused about its diagnosis and treatment. This article presents a case about chronic vestibular syndrome. And case appreciation and academic discussion are conducted by well-known domestic neurologists and otologists, so as to provide a good thinking model and basic ideas for the diagnosis and treatment of dizziness or vertigo, hoping to further improve the diagnosis and treatment level among clinicians.
Humans ; Dizziness/therapy* ; Vertigo/etiology* ; Vestibular Diseases/complications* ; Otolaryngologists

OBJECTIVETo compare the efficacy and recurrence rates of modified Epley maneuver, modified Semont maneuver and Brandt-Daroff maneuver in patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV).

METHODSOne hundred and sixty-eight patients with unilateral PC-BPPV were included in the study, which were divided into four groups randomly, 45 with modified Epley maneuver (group 1), 43 with modified Semont maneuver (group 2), and 40 with Brandt-Daroff maneuver (group 3). There were 40 controls without physical therapy technique (group 4) included. The efficacy after one week and one month, the time to recovery, the frequency of side effects and recurrence rates among the four groups were evaluated.

RESULTSThe efficacy of modified Epley maneuver was superior to the other three groups after one week (χ(2)(1, 2) = 8.55, P < 0.05; χ(2)(1, 3) = 23.23, P < 0.01;χ(2)(1, 4) = 44.00, P < 0.01) and to the Brandt-Daroff maneuver at follow-up evaluation after one month (χ(2) = 8.42, P < 0.05). The efficacy of modified Semont maneuver was superior to the control groups after one week (χ(2) = 14.49, P < 0.01), but there was no difference between the two groups after one month (χ(2) = 0.01, P > 0.05). The efficacy of Brandt-Daroff maneuver was not different with the control group at one week and one month follow-up evaluation (χ(2) = 3.35, P > 0.05;χ(2) = 0.18, P > 0.05). Kaplan-Meier testing showed that the time to recovery was significantly shorter in the modified Epley group. The frequency of side effects was not significantly different among the three physical therapy groups. There was no difference in the frequency of recurrence among the four groups (χ(2) = 4.076, P = 0.253). Duration of illness before self-treatment and age were the independent predictors of recurrence.

CONCLUSIONSThe modified Epley maneuver is more effective for self treatment of PC-BPPV than modified Semont maneuver and Brandt-Daroff maneuver. Daily routine of self-treatment does not prevent the recurrence of PC-BPPV.

Aged ; Benign Paroxysmal Positional Vertigo ; Female ; Humans ; Male ; Middle Aged ; Physical Therapy Modalities ; Semicircular Canals ; Treatment Outcome ; Vertigo ; etiology ; therapy

OBJECTIVE: To analyze the occurrence and probable etiological factors of benign paroxysmal positional vertigo (BPPV). METHOD: one hundred and twenty four BPPV cases were inquired histories, classified into different groups and analyzed relevant diseases. All patients were taken Caloric tests before Canal repositioning procedure, and compared the differences of unilateral weakness (UW) and semicircular canal involved between BPPV patients with and without relevant diseases. RESULT: There were 97 (78.2%) patients with relevant diseases while 27 (21.8%) without. Ninety-two (74.2%) patients with abnormal UW. To compare the normal and abnormal UW, posterior canal and lateral canal with abnormal UW values, unilateral or bilateral of abnormal UW values, consistency of abnormal UW side and BPPV side between BPPV patients with and without relevant diseases, there were no significant differences (Chi-square values were 0.000, 0.000, 0.306, 0.027, P>0.05). CONCLUSION BPPV patients with relevant diseases are common, which mainly occurs in middle-aged or aged people and female. Otolith ecclesiis and dysfunction of semicircular canal may have the same etiological factors. Caloric tests may do help to analyze the BPPV etiological factors.
Adolescent ; Adult ; Aged ; Benign Paroxysmal Positional Vertigo ; Caloric Tests ; Female ; Humans ; Male ; Middle Aged ; Vertigo ; diagnosis ; etiology ; pathology ; Young Adult

OBJECTIVE: To investigate the risk factor,type and characteristic nystagmus of the otolith abnormal migration during diagnosis and treatment for posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV). The therapy and prevention is also discussed. METHOD: Four hundred and seventy-nine patients with PSC-BPPV were treated by Epley's canalith repositioning procedures(CRP) from March 2009 to March 2012. We observed otolith abnormal migration complicating during diagnosis and treatment. According the type of otolith abnormal migration, the additional repositioning maneuver was performed. RESULT: The rate of complication was 8. 1%(39/479), with canal conversion in 5.4%(26/479) and primarily canal reentry in 2.7%(13/479). The rate of incidence of conversion to horizontal canal conversion and anterior canal were 4. 8%(23/479)and 0. 6%(3/479) respectively. All the patient was cured in follow up. The risk factors were unappropriated head movement during or after CRP, including another Dix-Hallpike were performed immediately. CONCLUSION To prevent the complications,the pathognostic positioning sequence and angle of head rotation are commenced during CRP. Appropriate short time postural restrictions post-treatment is necessary. Careful observation of nystagrnus variation is crucial to determine the otolith abnormal migration.
Benign Paroxysmal Positional Vertigo ; therapy ; Head ; Humans ; Incidence ; Nystagmus, Pathologic ; etiology ; Otolithic Membrane ; Patient Positioning ; adverse effects ; Semicircular Canals ; Vertigo

Humans ; Meniere Disease ; diagnosis ; etiology ; Vascular Diseases ; complications ; Vertigo ; diagnosis ; etiology

BACKGROUNDAnatomic and electrophysiological studies have revealed that the neurons located in the media vestibular nuclei (MVN) receive most of the sensory vestibular input coming from the ipsilateral labyrinth and the responses of MVN neurons to caloric stimulation directly reflect changes in primary vestibular afferent activity. The aim of this study was to clarify the intrinsic characteristics of serotonin (5-hydroxytryptamine, 5-HT) release in the MVN during the period of vertigo induced by caloric stimulation.

METHODSWe used an in vivo microdialysis technique to examine the effects of caloric stimulation on the serotoninergic system in MVN. Twenty four guinea pigs were randomly divided into the groups of irrigation of the ear canal with hot water (n = 6), ice water (n = 6) and 37 degrees C water (n = 4), and the groups of irrigation of the auricle with hot water (n = 4) and ice water (n = 4), according to different caloric vestibular stimulation. We examined the animal's caloric nystagmus with a two-channel electronystagmographic recorder (ENG), and meanwhile examine serotonin (5-hydroxytryptamine, 5-HT) level in the MVN with microdialysis technique after caloric stimulation.

RESULTSIn the caloric test the hot water (44 degrees C) irrigation of the right external auditory canal induced horizontal nystagmus towards the right side lasting about 60 seconds and the ice water irrigation of the right external auditory canal induced it towards the left side lasting for about 90 seconds. No nystagmus was induced by 37 degrees C water irrigation of the external ear canal. Therefore, it was used as a negative control stimulation to the middle ear. The MVN 5-HT levels significantly increased in the first 5-minute collecting interval and increased to 254% and 189% of the control group in the second collecting interval in response to caloric vestibular stimulation with ice water and hot water respectively. The serotonin release was not distinctly changed by the irrigation of the auricle with ice water or hot water.

CONCLUSIONSNeither somato-sensory stimulation of the middle ear nor nonspecific cold or hot stress affects the serotonin release. The rise of 5-HT in MVN may be involved in the mechanism of vertigo induced by caloric stimulation.

Animals ; Caloric Tests ; Guinea Pigs ; Microdialysis ; Serotonin ; secretion ; Vertigo ; etiology ; Vestibular Nuclei ; pathology

Female ; Humans ; Laser Therapy ; methods ; Middle Aged ; Semicircular Canals ; surgery ; Vertigo ; etiology ; surgery

Brain ; Brain Abscess ; Humans ; Meniere Disease ; Vertigo/etiology* ; Vestibular Function Tests

OBJECTIVETo investigate the etiologies and clinical features for bilateral acute sensorineural hearing loss (bi-ASNHL).

METHODSThe clinical data of 19 cases presenting with bi-ASNHL were retrospectively analyzed, including the clinical features, systemic examinations, laboratory examinations, audiology and radiology results, as well as the prognosis.

RESULTSThere were 15 non-otologic diseases in 19 patients, accounting for 78.9% of the total cases, most of which were disorders with multisystem and multi-organ disorder. The central nervous system diseases including fungal meningitis, tuberculous meningitis, and viral encephalitis in 3 patients. The clinical features of deafness were bilateral, progressive, accompanied with fever, headache, dizziness, nausea, vomiting and change of mental status. There was a decrease in speech recognition score (SRS), and speech recognition threshold (SRT) was obviously inferior to pure tone average (PTA) disproportionally. Diseases of immune system including antineural cytoplasmic antibody (ANCA)-associated systemic vasculitis (AASV), relapsing polychondritis (RP), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) in 5 patients. They showed the characteristics of bilateral, progressive and simultaneous autoimmune disease. Hematological and endocrine system diseases including diabetes mellitus, leukemia, and thyroid hypofunction in 5 patients. The deafness had the characteristics of symmetry and progressivity. Otologic diseases including large vestibular aqueduct syndrome (LVAS) and sudden sensorineural hearing loss (SSNHL) in 4 patients; Drug-induced sensorineural deafness happened in 2 patients. After the treatment aimed at the causes, 1 case was cured, 3 patients were markedly effective, 7 patients were effective, and 8 patients were ineffective(including dead and refusal cases), with a total effective rate of 57.9%.

CONCLUSIONSThe most of bi-ASNHL cases are often associated with systemic diseases. Clinicians should analyze the history and clinical characteristics in detail, and complete specific laboratory examinations, audiology and imaging examinations in order to reveal the causative diseases. It should be treated aimed at the etiology.

Autoimmune Diseases ; Deafness ; Hearing Loss, Bilateral ; diagnosis ; etiology ; Hearing Loss, Sensorineural ; diagnosis ; etiology ; Humans ; Retrospective Studies ; Syndrome ; Vertigo ; Vestibular Aqueduct