Each human ear is divided into three parts: the outer ear, the middle ear and the inner ear, which consists of the cochlea and the vestibule. The vestibule is composed of two fluid-filled, interconnected otolithic organs and three semi-annular hemicerebral canals, which are responsible for perceiving the body’s spatial position and movement status and regulating the body’s balance. Benign paroxysmal positional vertigo (BPPV) is one of the common vertigo disorders. The basic pathology of BPPV is that the otoliths of the inner otoliths are dislodged and ectopic into one of the semicircular canals due to some pathogenic factors, and due to the effect of gravity, the ectopic otoliths swim in the semicircular canals with the change of body position or head position and drive the flow of endolymphatic fluid, which constitutes abnormal stimulation to the semicircular canal receptors, and then BPPV occurs. BPPV is characterized by the following clinical features: the patient complains that it occurs when lying down, sitting up, or turning left or right in bed, or even being restricted to a certain position for a long time, such as resting only in the left/right side; the vertigo often occurs after a latency period of several seconds in the induced position/head position; the vertigo is accompanied by nystagmus of corresponding intensity, and the intensity of the vertigo and nystagmus is characterized by gradual strength and weakness; the nystagmus of different types of BPPV has its own specificity. BPPV is not accompanied by tinnitus and deafness. Head trauma, local inflammation and viral infection, and degeneration of the nerve endings in the inner ear are the main causes, often secondary to vestibular neuritis, vaginitis, posterior circulation ischemia, etc. Some patients also have primary cases. This disease belongs to the scope of otology consultation. The pathogenesis of BPPV hemimelia and hemimelia crista has gained consensus, and the otolith repositioning treatment methods based on this theory, such as Epley (1992) and Semont, have been accepted by otology and neurology. The basic treatment process of otolith repositioning is to first locate the ectopic otolith that causes BPPV, and then to perform special postural movements under the supervision of infrared video nystagmography, so that the ectopic otolith that is free in the semicircular canal can return to its original position and stop the vertigo attack. In 2006, the Chinese Academy of Otorhinolaryngology published for the first time
“Diagnostic basis and efficacy assessment of benign paroxysmal positional vertigo”
In 2008, the American Academy of Otolaryngology, Head and Neck Surgery also formulated clinical guidelines for the diagnosis and treatment of BPPV, which had a standardized effect on the diagnosis and treatment of BPPV. In the past, due to the ineffectiveness of drug treatment for BPPV and the lack of other effective treatment measures, conservative treatment was mainly used in the past, mainly vestibular habit training, but patients often terminated the treatment and training because they could not tolerate the repeatedly induced vertigo during training. BPPV otolith repositioning treatment is another miracle in the history of human medicine because of its immediate and reliable effect, and it is also a benefit for the majority of BPPV patients. The “Vertigo Treatment and Rehabilitation Center” of the Department of Otolaryngology, Head and Neck Surgery of our hospital was the first to successfully introduce this technology in Tianjin in 1999, and now this treatment method has become the first choice for the treatment of benign positional vertigo at home and abroad. As the most convenient and effective treatment for BPPV, otolith repositioning is based on accurate localization of the responsible semicircular canal and otoliths, and needs to be differentiated from general positional vertigo. Therefore, accurate positioning of the responsible semicircular canal and otoliths and differentiation from general positional vertigo are the key aspects of successful otolith repositioning for BPPV under the condition of mature otolith repositioning technology. Therefore, accurate localization of the responsible semicircular canal and otolith and differentiation from general positional vertigo are the key aspects of successful BPPV otolith repositioning. Our hospital
The “Vertigo Treatment and Rehabilitation Center” is in the forefront of research on this key link in the country. One of the long-term consensus of BPPV treatment is that drugs are ineffective, but this is an inaccurate conclusion when the etiology of BPPV is not clear in the past. For the different causes of BPPV otolith dislodgement, supportive drug therapy is necessary and reasonable to prevent or reduce otolith dislodgement and promote its metabolism and cytosolic absorption based on the purpose of preventing recurrence.