I. Benign paroxysmal positional vertigo 1. What is benign paroxysmal positional vertigo? Benign paroxysmal positional vertigo (BPPV) is a paroxysmal transient vertigo induced by specific head position change and is the most common vestibular end-organ lesion. It is 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, and 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 a certain head position or postural activity. The symptoms of vertigo appear when the head position is stimulated (such as turning over left or right, getting up or having the affected ear down). (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, there will be horizontal groundward or backward nystagmus; when falling down from the sitting position to the excited head position, there will be a rotational transient fatigue-prone nystagmus, when The nystagmus is clockwise when the left ear is down and counterclockwise when the right ear is down. The nystagmus continues, first gradually increasing and then gradually decreasing, and when returning from the prone position to the sitting 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 rely on the equipment 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 there can be a long period of light-headedness and floating feeling after the vertigo attack. 3.Treatment and prognosis of benign paroxysmal positional vertigo: Benign paroxysmal positional vertigo is a benign and self-limiting disease, but it may take several months or years to heal itself, and in severe cases, it may make the patient incapacitated, 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 Cipirin (flunarizine), Minzhuilang (betahistine mesylate), and Chinese herbal medicine, etc. (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. 4.What are the repositioning treatments for benign paroxysmal positional vertigo? (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 purpose of which is to make the canal stone gradually return to the elliptical sac from the posterior semicircular canal by its own gravity with the help of directed head movement and oscillation. The specific treatment is performed in five steps (taking the right posterior semicircular canal as an example): 1) the patient is rapidly turned to the right 450 with the head suspended on the back; 2) the head is turned back to the left 450; 3) the head and trunk are simultaneously turned to the left 1350 so that the face is facing down 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 200. each head position takes 30 s, or until the nystagmus disappears completely, and each step is completed Observe and record the nystagmus, and wait for the termination of nystagmus before doing the next step. After the treatment, the patient is 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 BPPV in the external semicircular canal: Lempert method (Barbecue tumbling method): The repositioning method designed by Lempert et al. (1996) is more commonly used. The method is as follows: 1) ask the patient to lie supine; 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 turning the head by 900 until the face is down; 5) continue turning the head by 900 until the affected ear is down; 6) return to upright position. Each head position change should be completed quickly within 0.5s, and each position should be maintained for 30-60s until the nystagmus disappears. 5. What is the practice of BPPV? Patients quickly lie down to the affected side and hold it for 30 seconds after the vertigo disappears. 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 10-20 times. 3 times a day, if no vertigo appears for 2 consecutive days, treatment can be stopped. 6.What are the precautions after resetting? Will there be recurrence after the reset? After resetting, patients should rest as much as possible, ensure sufficient sleep, and avoid tilting the head to the affected side, preferably in a relatively fixed head position for 24 hours. According to the clinical data, the success rate of this disease can reach more than 90% in one reset, but a few patients (about 4-7%) may relapse, and the treatment of relapse is still mainly based on reset treatment.