Доброкачественное пароксизмальное позиционное головокружение: клинические аспекты диагностики и лечения

Пальчун В.Т., Гусева А.Л., Чистов С.Д. Доброкачественное пароксизмальное позиционное головокружение: клинические аспекты диагностики и лечения. Consilium Medicum. 2015; 3: 46–52.

________________________________________________

Palchun V.T., Guseva A.L., Chistov S.D. Benign paroxysmal positional vertigo: clinical features, diagnosis and treatment. Consilium Medicum. 2015; 3: 46–52.

Читать PDF

Аннотация

Доброкачественное пароксизмальное позиционное головокружение (ДППГ) является самым распространенным заболеванием периферического отдела вестибулярной системы и самой частой причиной головокружения системного характера. Диагностика его базируется на провокационных тестах, а лечение – на репозиционных маневрах. В статье рассматриваются этиология, эпидемиология, диагностика и дифференциальная диагностика ДППГ, представлены наиболее распространенные, простые в проведении провокационные пробы при различных типах ДППГ и эффективные лечебные маневры.

Ключевые слова: доброкачественное пароксизмальное позиционное головокружение, провокационные тесты, каналолитиаз, купулолитиаз, репозиционные маневры.

________________________________________________

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular disorders and one of the most common causes of vertigo. The confirmation of BPPV is based on a set of positioning tests, and the treatment includes different types of repositioning maneuvers. The authors focus one tiology, epidemiology, diagnosis and treatment of BPPV. The most widely used, simple and effective positioning tests and repositioning procedures are described.

Key words: benign paroxysmal positional vertigo, positioning test, canalithiasis, cupulolithiasis, repositioning maneuver.

Полный текст

Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.

Список литературы

1. Bhattacharyya N, Baugh R, Orvidas L et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2008; 139 (Suppl. 4): s47–81.
2. Von Brevern M, Radtke A, Lezius F et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiat 2007; 78: 710–5.
3. Пальчун В.Т., Кунельская Н.Л., Ротермель Е.В. Диагностика и лечение доброкачественного пароксизмального позиционного головокружения. Вестн. оториноларингологии. 2007; 1: 4–7. / Pal'chun V.T., Kunel'skaia N.L., Rotermel' E.V. Diagnostika i lechenie dobrokachestvennogo paroksizmal'nogo pozitsionnogo golovokruzheniia. Vestn. otorinolaringologii. 2007; 1: 4–7. [in Russian]
4. Furman J, Cass S. Benign paroxysmal positional vertigo. N Engl J Med 1999; 341: 1590–6.
5. Мельников О.А., Замерград М.В. Доброкачественное позиционное головокружение. Леч. врач. 2000; 1: 19–21. / Mel'nikov O.A., Zamergrad M.V. Dobrokachestvennoe pozitsionnoe golovokruzhenie. Lech. vrach. 2000; 1: 19–21. [in Russian]
6. Nunez R, Cass S, Furman J. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2000; 122: 647–52.
7. Lopez-Escamez J, Gamiz M, Fernandez-Perez A, Gomez-Fiñana M. Longterm outcome and health-related quality of life in benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 2005; 262: 507–11.
8. Froehling D, Silverstein M, Mohr D et al. Benign positional vertigo: incidence and prognosis in a population-based study in Olmsted County, Minnesota. Mayo Clin Proc 1991; 66 (6): 596–601.
9. Jeong S, Choi S, Kim J et al. Osteopenia and osteoporosis in idiopathic benign positional vertigo. Neurology 2009; 72: 1069–76.
10. Jeong S, Kim J, Shin J et al. Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol 2013; 260: 832–8.
11. McClure J. Horizontal canal BPV. J Otolaryngol 1985; 14: 30–5.
12. Nuti D, Zee D. Positional vertigo and benign paroxysmal positional vertigo. In: Bronstein A, ed. Oxford textbook of vertigo and imbalance. Oxford, England: Oxford University Press, 2013; p. 217–30.
13. Kattah J, Talkad A, Wang D et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40: 3504–10.
14. Кунельская Н.Л., Лучихин Л.А., Гусева А.Л. и др. Чувствительность, специфичность и прогностическая значимость статокоординаторных и статокинетических тестов в обследовании пациента с головокружением. Омский науч. вестн. 2014; 2 (134): 84–7. / Kunel'skaia N.L., Luchikhin L.A., Guseva A.L. i dr. Chuvstvitel'nost', spetsifichnost' i prognosticheskaia znachimost' statokoordinatornykh i statokineticheskikh testov v obsledovanii patsienta s golovokruzheniem. Omskii nauch. vestn. 2014; 2 (134): 84–7. [in Russian]
15. Dix M, Hallpike C. The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med 1952; 45: 341–54.
16. Ibekwe T, Rogers C. Clinical evaluation of posterior canal benign paroxysmal positional vertigo. Niger Med J 2012; 53 (2): 94–101.
17. Balatsouras D, Korres S. Subjective benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2012; 146: 98–103.
18. Steddin S, Ing D, Brandt T. Horizontal canal benign paroxysmal positioning vertigo (h-BPPV): transition of canalolithiasis to cupulolithiasis. Ann Neurol 1996; 40: 918–22.
19. Choung Y, Shin Y, Kahng H et al. «Bow and lean test» to determine the affected ear of horizontal canal benign paroxysmal positional vertigo. Laryngoscope 2006; 116 (10): 1776–81.
20. Bertholon P, Bronstein A, Davies R et al. Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis. J Neurol Neurosurg Psychiat 2002; 72: 366–72.
21. Cambi J, Astore S, Mandalà M et al. Natural course of positional down-beating nystagmus of peripheral origin. J Neurol 2013; 260: 1489–96.
22. Imai T, Ito M, Takeda N et al. Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology 2005; 64: 920–1.
23. Helminski J, Zee D, Janssen I, Hain T. Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Phys Ther 2010; 90: 663–78.
24. Silverstein H. Partial or total eighth nerve section in the treatment of vertigo. Otolaryngol 1978; 86 (1): ORL 47–60.
25. Parnes L, McClure J. Posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 1990; 99 (5 Pt. 1): 330–4.
26. Epley J. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992; 107: 399–404.
27. Gordon C, Gadoth N. Repeated vs. single physical maneuver in benign paroxysmal positional vertigo. Acta Neurol Scand 2004; 110: 166–9.
28. Ruckenstein M, Shepard N. The canalith repositioning procedure with and without mastoid oscillation for the treatment of benign paroxysmal positional vertigo. ORL J Otorhinolaryngol Relat Spec 2007; 69 (5): 295–8.
29. Devaiah A, Andreoli S. Post maneuver restrictions in benign paroxysmal positional vertigo: an individual patient data meta-analysis. Otolaryngol Head Neck Surg 2010; 142: 155–9.
30. Oh H, Kim J, Han B, Lim J. Predicting a successful treatment in posterior canal benign paroxysmal positional vertigo. Neurology 2007; 68: 1219–22.
31. Semont A, Freyss G, Vitte E. Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 1988; 42: 290–3.
32. Faldon M, Bronstein A. Head accelerations during particle repositioning manoeuvres. Audiol Neurotol 2008; 13: 345–56.
33. Radtke A, von Brevern M, Tiel-Wilck K et al. Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs. Epley procedure. Neurology 2004; 63: 150–2.
34. Brandt T, Daroff R. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 1980; 106 (8): 484–5.
35. Herdman S, Tusa R. Complications of the canalith repositioning procedure. Arch Otolaryngol Head Neck Surg 1996; 122: 281–6.
36. Lempert T. Horizontal benign positional vertigo. Neurology 1994; 44: 2213–4.
37. Vannucchi P, Giannoni B, Pagnini P. Treatment of horizontal semicircular canal benign paroxysmal positional vertigo. J Vestib Res 1997; 7: 1–6.
38. Asprella Libonati G. Diagnostic and treatment strategy of lateral semicircular canal canalolithiasis. Acta Otorhinolaryngol Ital 2005; 25 (5): 277–83.
39. Gufoni M, Mastrosimone L, Di Nasso F. Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal. Acta Otorhinolaryngol Ital 1998; 18: 363–7.
40. Nuti D, Mandalà M, Salerni L. Lateral canal paroxysmal positional vertigo revisited. Ann NY Acad Sci 2009; 1164: 316–23.
41. Gufoni M, Mastrosimone L, Di Nasso F. Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal. Acta Otorhinolaryngol Ital 1998; 18 (6): 363–7.
42. Casani A, Vannucci G, Fattori B, Berrettini S. The treatment of horizontal canal positional vertigo: our experience in 66 cases. Laryngoscope 2002; 112 (1): 172–8.
43. Kim Y, Shin J, Chung J. The effect of canalith repositioning for anterior semicircular canal canalithiasis. ORL J Otorhinolaryngol Relat Spec 2005; 67 (1): 56–60.
44. Yacovino D, Hain T, Gualtieri F. New therapeutic maneuver for anterior canal benign paroxysmal positional vertigo. J Neurol 2009; 256 (11): 1851–5.

________________________________________________

1. Bhattacharyya N, Baugh R, Orvidas L et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2008; 139 (Suppl. 4): s47–81.
2. Von Brevern M, Radtke A, Lezius F et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiat 2007; 78: 710–5.
3. Pal'chun V.T., Kunel'skaia N.L., Rotermel' E.V. Diagnostika i lechenie dobrokachestvennogo paroksizmal'nogo pozitsionnogo golovokruzheniia. Vestn. otorinolaringologii. 2007; 1: 4–7. [in Russian]
4. Furman J, Cass S. Benign paroxysmal positional vertigo. N Engl J Med 1999; 341: 1590–6.
5. Mel'nikov O.A., Zamergrad M.V. Dobrokachestvennoe pozitsionnoe golovokruzhenie. Lech. vrach. 2000; 1: 19–21. [in Russian]
6. Nunez R, Cass S, Furman J. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2000; 122: 647–52.
7. Lopez-Escamez J, Gamiz M, Fernandez-Perez A, Gomez-Fiñana M. Longterm outcome and health-related quality of life in benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 2005; 262: 507–11.
8. Froehling D, Silverstein M, Mohr D et al. Benign positional vertigo: incidence and prognosis in a population-based study in Olmsted County, Minnesota. Mayo Clin Proc 1991; 66 (6): 596–601.
9. Jeong S, Choi S, Kim J et al. Osteopenia and osteoporosis in idiopathic benign positional vertigo. Neurology 2009; 72: 1069–76.
10. Jeong S, Kim J, Shin J et al. Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol 2013; 260: 832–8.
11. McClure J. Horizontal canal BPV. J Otolaryngol 1985; 14: 30–5.
12. Nuti D, Zee D. Positional vertigo and benign paroxysmal positional vertigo. In: Bronstein A, ed. Oxford textbook of vertigo and imbalance. Oxford, England: Oxford University Press, 2013; p. 217–30.
13. Kattah J, Talkad A, Wang D et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40: 3504–10.
14. Kunel'skaia N.L., Luchikhin L.A., Guseva A.L. i dr. Chuvstvitel'nost', spetsifichnost' i prognosticheskaia znachimost' statokoordinatornykh i statokineticheskikh testov v obsledovanii patsienta s golovokruzheniem. Omskii nauch. vestn. 2014; 2 (134): 84–7. [in Russian]
15. Dix M, Hallpike C. The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med 1952; 45: 341–54.
16. Ibekwe T, Rogers C. Clinical evaluation of posterior canal benign paroxysmal positional vertigo. Niger Med J 2012; 53 (2): 94–101.
17. Balatsouras D, Korres S. Subjective benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2012; 146: 98–103.
18. Steddin S, Ing D, Brandt T. Horizontal canal benign paroxysmal positioning vertigo (h-BPPV): transition of canalolithiasis to cupulolithiasis. Ann Neurol 1996; 40: 918–22.
19. Choung Y, Shin Y, Kahng H et al. «Bow and lean test» to determine the affected ear of horizontal canal benign paroxysmal positional vertigo. Laryngoscope 2006; 116 (10): 1776–81.
20. Bertholon P, Bronstein A, Davies R et al. Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis. J Neurol Neurosurg Psychiat 2002; 72: 366–72.
21. Cambi J, Astore S, Mandalà M et al. Natural course of positional down-beating nystagmus of peripheral origin. J Neurol 2013; 260: 1489–96.
22. Imai T, Ito M, Takeda N et al. Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology 2005; 64: 920–1.
23. Helminski J, Zee D, Janssen I, Hain T. Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Phys Ther 2010; 90: 663–78.
24. Silverstein H. Partial or total eighth nerve section in the treatment of vertigo. Otolaryngol 1978; 86 (1): ORL 47–60.
25. Parnes L, McClure J. Posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 1990; 99 (5 Pt. 1): 330–4.
26. Epley J. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992; 107: 399–404.
27. Gordon C, Gadoth N. Repeated vs. single physical maneuver in benign paroxysmal positional vertigo. Acta Neurol Scand 2004; 110: 166–9.
28. Ruckenstein M, Shepard N. The canalith repositioning procedure with and without mastoid oscillation for the treatment of benign paroxysmal positional vertigo. ORL J Otorhinolaryngol Relat Spec 2007; 69 (5): 295–8.
29. Devaiah A, Andreoli S. Post maneuver restrictions in benign paroxysmal positional vertigo: an individual patient data meta-analysis. Otolaryngol Head Neck Surg 2010; 142: 155–9.
30. Oh H, Kim J, Han B, Lim J. Predicting a successful treatment in posterior canal benign paroxysmal positional vertigo. Neurology 2007; 68: 1219–22.
31. Semont A, Freyss G, Vitte E. Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 1988; 42: 290–3.
32. Faldon M, Bronstein A. Head accelerations during particle repositioning manoeuvres. Audiol Neurotol 2008; 13: 345–56.
33. Radtke A, von Brevern M, Tiel-Wilck K et al. Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs. Epley procedure. Neurology 2004; 63: 150–2.
34. Brandt T, Daroff R. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 1980; 106 (8): 484–5.
35. Herdman S, Tusa R. Complications of the canalith repositioning procedure. Arch Otolaryngol Head Neck Surg 1996; 122: 281–6.
36. Lempert T. Horizontal benign positional vertigo. Neurology 1994; 44: 2213–4.
37. Vannucchi P, Giannoni B, Pagnini P. Treatment of horizontal semicircular canal benign paroxysmal positional vertigo. J Vestib Res 1997; 7: 1–6.
38. Asprella Libonati G. Diagnostic and treatment strategy of lateral semicircular canal canalolithiasis. Acta Otorhinolaryngol Ital 2005; 25 (5): 277–83.
39. Gufoni M, Mastrosimone L, Di Nasso F. Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal. Acta Otorhinolaryngol Ital 1998; 18: 363–7.
40. Nuti D, Mandalà M, Salerni L. Lateral canal paroxysmal positional vertigo revisited. Ann NY Acad Sci 2009; 1164: 316–23.
41. Gufoni M, Mastrosimone L, Di Nasso F. Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal. Acta Otorhinolaryngol Ital 1998; 18 (6): 363–7.
42. Casani A, Vannucci G, Fattori B, Berrettini S. The treatment of horizontal canal positional vertigo: our experience in 66 cases. Laryngoscope 2002; 112 (1): 172–8.
43. Kim Y, Shin J, Chung J. The effect of canalith repositioning for anterior semicircular canal canalithiasis. ORL J Otorhinolaryngol Relat Spec 2005; 67 (1): 56–60.
44. Yacovino D, Hain T, Gualtieri F. New therapeutic maneuver for anterior canal benign paroxysmal positional vertigo. J Neurol 2009; 256 (11): 1851–5.

Авторы

В.Т.Пальчун*, А.Л.Гусева, С.Д.Чистов

ГБОУ ВПО Российский национальный исследовательский медицинский университет им. Н.И.Пирогова Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*lorrsmu@mail.ru

________________________________________________

V.T.Palchun*, A.L.Guseva, S.D.Chistov

N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation.117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*lorrsmu@mail.ru

Назад к списку

Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.