Positional vertigo is divided into two categories: benign paroxysmal positional vertigo and central positional vertigo. Patients with benign paroxysmal positional vertigo are those who excite transient paroxysmal vertigo accompanied by nystagmus in a specific head position, but not accompanied by tinnitus, deafness and other symptoms.
I. Symptoms and signs
1. Sudden onset
The onset of symptoms is often related to a certain head position or postural activity. The symptoms of vertigo appear when the head position (the affected ear is downward) is excited, and the nystagmus occurs within 3 to 10s after the change of head position, while the vertigo often lasts within 60s, and may be accompanied by nausea and vomiting.
2. Nystagmus is very special
When the head position is changed from sitting position to stimulated position, a rotational and transient fatigue-prone nystagmus occurs, which is clockwise when the ear is down and counterclockwise when the right ear is down.
3.Duration of the disease
The vertigo can be aggravated or relieved periodically, and the vertigo becomes more variable. In severe cases, the vertigo appears when the head is slightly moved, and there may be no discomfort during the interval, or there may be dizziness or light-headedness and floating feeling after the vertigo attack.
4. It is mostly seen in middle-aged patients (45 to 50 years old).
Etiology of the disease
It is mainly caused by ectopic otoliths, but may also be related to or secondary to the following diseases.
1. Otolithosis
Aging changes in the labyrinth, or degenerative changes ellipsoidal cystic plaque degeneration and otolithic membrane dislodged into and deposited in the semicircular canal, especially in the posterior semicircular canal.
2.Trauma
Cranial trauma, vascular lesions such as hypertension, hypotension, impaired blood supply to the inner ear caused by the carotid basilar artery, especially occurring days and weeks after mild cranial trauma, or trauma caused by accelerated deceleration of head movement.
3.Ear diseases
Such as middle ear and mastoid infection, post vaginitis, Meniere’s disease in remission, vestibular neuritis, and sudden deafness.
III. Diagnostic tests
1.Hallpike dislocation nystagmus test
It should be an important method for routine examination.
2.Audiomechanical examination
Generally no abnormal changes in audiology.
3.Posturographic examination
There is no specific diagnosis of patients with clinical manifestations of sudden onset of vertigo and nystagmus in certain positions and head positions with mild autonomic symptoms, but not with cochlear symptoms such as deafness and tinnitus. Positional and variable position experiments show rotational or horizontal rotational nystagmus with a latency period lasting from a few seconds to 30s, with habituation on continuous examination. Hot and cold experiments are mostly normal.
IV. Treatment options
Treatment Although benign paroxysmal positional vertigo is a self-healing disease, its self-healing time can sometimes be months or years, and in serious cases, it can make patients lose their ability to work, so it should be treated as much as possible.
1.Psychological treatment
It is pointed out that this disease is a benign process without serious sequelae to contact the patient’s mental burden.
2.Position and head position
When vertigo attacks are intense, try to avoid the body and head positions that can cause vertigo attacks.
3.Anti-vertigo drugs
Guilizine or flunarizine etc. have certain effect, and vasodilators and cidiazepines can also be added.
4.Vestibular habit therapy
The purpose is to increase the ability to tolerate vertigo, which has certain effect.
5.Posture therapy
Instruct the patient to close the eyes, go from sitting position to side lying position, sit up when the vertigo disappears, and then lie down to the other side after 30s, alternate sides until the symptoms disappear, every 3h, usually 7-10g symptoms can disappear.
6.Manipulation otolith reset
The purpose is to reset the otoliths deposited in the posterior semicircular canal. The manipulation is different according to the ectopic semicircular canal of the otolith.
7.Surgical treatment
If the above treatments are ineffective and affect the quality of life and work, posterior canal neurectomy, hallux valgus obstruction, 4% polycaine and streptomycin intra-drum injection, etc. are feasible. Surgical treatment is suitable for unilateral lesions and patients with severe hearing loss or loss.