1. What is benign paroxysmal positional vertigo Benign paroxysmal positional vertigo (BPPV) is a paroxysmal transient vertigo induced by a specific head position change and is the most common vestibular end-organ lesion, also known as otolithosis. The pathogenesis is the detachment of otoliths from the otolith membrane of the ellipsoidal sac into the semicircular canal. The disease is most common in middle-aged and elderly patients, but it can also occur in young people. Most cases have no obvious cause, but the possible triggering factors are head trauma, mood swings and exertion. 2. What are the clinical characteristics of benign paroxysmal positional vertigo? (1) The occurrence of symptoms is often related to certain head position or postural activities: vertigo symptoms appear when the head position is stimulated (e.g., turning over, getting up or having the affected ear down), nystagmus occurs within 3-10 seconds after the head position change, and vertigo often lasts within 60 seconds, and may be accompanied by nausea and vomiting. (2) Characteristics of nystagmus: To confirm the diagnosis of BPPV, the doctor usually has to do a position change test, one is called the roll test and the other is called the DIX-HALLPIKE test, which is similar to turning over in bed and getting up in our normal life, when rolling over and turning over, horizontal groundward or backward nystagmus will appear; when falling down from the sitting position to the excited head position, a rotating and transient fatigue-prone nystagmus will appear, and when the left ear The nystagmus is clockwise when the left ear is downward and counterclockwise when the right ear is downward. The nystagmus continues, first gradually increasing and then gradually decreasing, and when returning from the prone position to the seated position, nystagmus in the opposite direction occurs. This test used to be performed on the examination bed, but now there is a fully automated vestibular function diagnosis system that can be relied on to help patients perform the above actions, which is a better choice for patients who are obese and suffer from cervical spondylosis, and the examination is more accurate than manual operation. (3) The duration of BPPV can be from hours to weeks, and individual can be months or years. The vertigo can be aggravated or relieved periodically, and in severe cases, the vertigo can appear when the head is slightly moved, and there can be no discomfort during the interval, or the vertigo can be followed by a long period of light-headedness and floating sensation. What is the treatment and prognosis of benign paroxysmal positional vertigo? Benign paroxysmal positional vertigo is a benign and self-limiting disease, but it may take months or years to heal itself, and in serious cases, the patient may lose the ability to work, so it should be treated as much as possible. (1) Otolith repositioning The aim is to reposition the otoliths deposited in the semicircular canal. Depending on the ectopic hemithorax of the otolith, the technique is different. (2) Psychological treatment The disease is a benign process without serious sequelae, and the patient should not have an excessive mental burden. (3) Health care of body and head position When vertigo attacks are intense, try to avoid using body and head positions that can cause vertigo attacks. (4) Anti-vertigo medication You can take medication to improve microcirculation in the inner ear, such as Cipro (flunarizine), Minzhuilang (betahistine mesylate), and Chinese herbal medicine with evidence. (5) Vestibular rehabilitation exercises and vestibular practice therapy The purpose is to promote the compensation and recovery of vestibular function and increase the tolerance of vertigo, which can be performed under the guidance of doctors. (1) Treatment of posterior semicircular canal BPPV This method was proposed by Epley in 1992 and is based on the theory of semicircular canal calculus. The aim is to gradually redirect the stone from the posterior semicircular canal back to the ellipsoidal sac by means of directed cephalic movement and oscillation. The specific treatment is carried out in five steps (taking the right posterior semicircular canal as an example): (1) the patient is rapidly turned to the right by 450, with the head hanging supine; (2) the head is turned to the left by 450; (3) the head and trunk are simultaneously turned to the left by 1350, so that the face is facing down by 450; (4) the head and body are kept turned to the right, and the patient is helped to sit up; (5) the head is turned to the front and the head is lowered by 200. 30s are needed for each head position, or until the nystagmus disappears completely, and each completed step is observed and The nystagmus should be observed and recorded at each step, and the next step should be done only after the nystagmus is terminated. After the treatment, the patient was instructed to keep the head relatively vertical for 24h to minimize the possibility of the otolith returning to the posterior semicircular canal. (2) Treatment of external semicircular canal BPPV – Lempert method (Barbecue tumbling method) The repositioning method designed by Lempert et al. (1996) is commonly used as follows: (1) ask the patient to lie on his back; (2) turn the head to the healthy side by 900; (3) turn the body by 1800 from supine to prone while keeping the head position unchanged; (4) continue to turn the head by 900 to face down; ⑤ continue to turn the head 900 to the affected ear down; ⑥ return to upright. Each head position change should be completed quickly within 0.5s, and each position should be maintained for 30~60s until the nystagmus disappears. In addition to the traditional reset, instrument reset has been introduced in China, such as SRM benign paroxysmal positional vertigo diagnosis and treatment system reset treatment, which is more accurate, more effective and has lower recurrence rate. 5.How to do the practice of BPPV The patient should quickly lie down to the affected side and keep it for 30 seconds after the vertigo disappears, and then sit up and wait for the vertigo to disappear. Patients should repeat the above exercise to the opposite side, stay for 30 seconds and sit up. The whole treatment exercise is repeated 10 to 20 times. 3 times a day, if no vertigo appears for 2 consecutive days, treatment can be stopped. 6.What are the precautions after the reset and will it recur after the reset After the reset, the patient should rest as much as possible to ensure sufficient sleep and avoid tilting the head to the affected side, preferably in a relatively fixed position for 24 hours. According to clinical data, the success rate of this disease can be more than 80%, but a few patients (about 4%-7%) may relapse, and the treatment of relapse is still based on reset treatment.