KISEP Information Korean J Otolaryngol 2004;47:491-506 단국대학교의과대학이비인후 - 두경부외과교실 이정구 Benign Paroxysmal Positional Vertigo Chung Ku Rhee, MD Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Dankook University, Cheonan, Korea - - 491
- - Table 1-1. Incidence of BPPV by age Age yrs Katsarkas n171 No of patients % Nunez n168 Table 1-2. Incidence of BPPV by canal % Korea n1455 DKU n400 19 000. 01.1 00.7010 02.7 2029 05.3 04.7 03.7054 04.0 3039 13.5 08.3 09.4137 10.2 4049 31.0 09.5 21.6314 17.0 5059 33.3 15.4 28.1409 26.2 6069 11.7 27.9 27.3397 300. 7079 05.3 22.1 08.1118 08.5 80 000. 10.0 01.1016 01.2 Katsarkas1978 n 171 Nunez19931996 n168 DKU Dankook university19982003 n400 Korea20022003 n1455 DKU Marciano Korres Sex FM 1.61 2.61 1.41 P SCC 70.3 59.50 830. 900. canalolithiasis 69.4 58.50 cupulolithiasis 00.9 010. 0 L SCC 24.6 28.00 110. 080. canalolithiasis 15.5 23.50 cupulithiasis 09.1 04.50 S SCC 02.1 04.50 00.5 01.6 canalolithiasis 01.9 04.25 cupuloithiasis 00.2 00.25 Mixed type 080. 0 050. PcanalLcanal 02.1 220. 0 PcanalLcupul 00.3 030. 0 PcanalScanal 00.1 030. 0 LcanalScanal 00.2 030. 0 LcupulScupul 00.2 010. 0 Bilateral 00.5 Korea20022003 n1455 Korres20002002 n122 Marciano19981999 n810 DKU Dankook university19982003400 Pposterior, Llateral, Ssuperior, SCCsemicircular canal, canalcanalolithiasis, cupulcupulolithiasis 492 Korean J Otolaryngol 2004;47:491-506
이정구 - Table 2. The etiologic or associated diseases of BPPV number of patients Etilology Baloh 1987 Blessing 1986 Hughes 1997 Karlberg 2000 O Reilly 2000 Idiopathic 118 092 052 2766 41 337 1142 Post-TA 043 04 017 0085 V.N. 037 017 004 0036 19 004 0021 Cervical-basilar a. insufficiency 011 03 004 0006 Meniere s D 005 045 0016 02 003 0045 Post general op. 005 008 0019 Post COM op 005 002 0037 Ototoxicity 004 001 0003 Syphillis Labyrithitis 002 COM 009 0035 Bilateral vestibulopathy 0021 SNHL 031 0008 Sudden HL 015 0032 Etc. 002 011 04 0v20 Total 240 140 112 2847 73 400 1455 TAtraffic accident, VNvestibular neuronitis, COMchronic otitis media, aartery, opoperation, Ddisease, SNHLsensoryneural hearing loss, HLhearing loss, DKUDankook university DKU 2003 Korea 2003 493
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이정구 - - Table 3. Various diagnostic maneuver of BPPV Posterior canal canalolithiasis Dix-Hallpike maneuver & cupulolithiasis Lateral canal canalolithiasis Lateral head positioning & cupulolithiasis Superior canal canalolithiasis Dix-Hallpike or sidelying & cupulolithiasis maneuver Involvement of more than 2 Dix-Hallpike & lateral head canals positioning Diagnostic criteria of cupulolithiasis Nystagmus Short or no latency, lasting longer Vertigo Less responsive to treatment Vibrator or tapping If cupulolithiasis is converted to canalolithiasis by vibrator or tapping Lateral cupulolithiasis Ageotropic nystagmus Diagnostic criteria of superior canal BPPV Dix-Hallpike test Opposite side canal involvement when down beat nystagmus is seen Rahko maneuver Body moves to lesionside 497
498 Fig. 1. Brandt-Daroff habituation exercise. Patient is moved quickly into the position that provokes the vertigo and remains in that position until vertigo clears up and remains in that position for another 30 seconds. The patient is then turned rapidly to the opposite side, and repeats this same exercise several times daily. Fig. 2. Semont maneuver. The patient is moved quickly into the position that provokes the vertigo and remains in that position for 4 minutes. The patient is then turned rapidly to the opposite side ear down, and remains in this second position before slowly siting up. Korean J Otolaryngol 2004;47:491-506
이정구 - 1 3 5 Fig. 3. Modified epley maneuver of right posterior SCC BPPV. The patient is in sitting position. The head is lowed into the right Dix-Hallpike position. The head is moved about 90 into the left Dix-Hallpike position. The head is moved another 90 so that the patient s nose is pointing downward toward the floor. The patient is returned to the upright position. The patient s chin is lowered slightly. 2 4 6 499
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이정구 - 1 2 3 45 45 Fig. 4. Modified rahko maneuver 4 5 Modified from Rahko 2002 The 45 patient lies on healthy side with head turned 45to left side. The head is lowed 45into the left Dix- Hallpike position. The head is raised horizontally upward 45for 30 seconds The head is moved another 45for another 30 seconds. The patient is returned to the upright position and stays up for at least 3 minutes. 501
- Table 4. Therapeutic maneuver of BPPV in Korea Epley maneuver, Semont maneuver Epley Brandt-Daroff Vibrator tapping Epley Epley Brandt-Daroff Barbecue Rotation, FPP, Barbecue FPP Head shaking, vibrator, finger tapping Barbecue FPP Brandt-Daroff maneuver Head shaking, vibrator Head shaking, vibrator Barbecue FPP Modified Semont maneuver Casani type FPP vibratorbarbecue Head shaking Brandt-Daroff Dix-Hallpike Barbecue Reversed epley maneuver / Rahko maneuver vibrator Brandt- Daroff maneuver Modified Dix-Hallpike maneuverdix-hallpike maneuver 30. FPPforced prolonged position 502 Korean J Otolaryngol 2004;47:491-506
이정구 Probability of No recurrence 1.0 0.8 0.6 0.4 0.2 0.0 0 10 20 30 40 50 Follow-up months Fig. 5. Kaplan-Meier estimation of recurrence rate From Nunez 2002. The recurrence rate is approximately 15% per year, with approximately 50% recurrence by 40 months. 503
504 박현민 전상준 이광선 오승하 한규철 이원상김창우 변성완 박성용 조용범 고의경 정원호 김규철 안성기 우훈영 김리석 장철호 강성호 박현민, 송병호 이승철 REFERENCES 1) Barany R. Diagnose von krankheitserscheinungen im bereiche des otolithenapparates. Acta Otolaryngol (Stockh) 1921;2:434-7. 2) Dix R, Hallpike CS. The pathology, symptomology and diagnosis of certain common disorders of the vestibular system. Ann Otol Rhinol Laryngol 1952;6:987-1016. 3) Schuknecht HF. Cupulolithiasis. Arch Otolaryngol 1969;90:765-78. 4) Hall SF, Ruby RR, McClure JA. The mechanics of benign paroxysmal vertigo. J Otolaryngol 1979;8:151-8. 5) Kveton JF, Kashgarian M. Particulate matter within the membranous labyrinth: Pathologic or normal? Am J Otol 1994;15:173-6. 6) Epidermiological studies on benign paroxysmal positional vertigo in Japan. Acta Otolaryngol (Stockh) Suppl 1988;447:67-72. 7) Froehling DA, Bowen JM, Mohr DN, Brey RH, Beatty CW, Wollan PC, et al. Benign positional vertigo: A randomized controlled trial. Mayo Clin Proc 2000;75:695-700. 8) Baloh RW. Benign positional vertigo. In: Baloh RW, Halmagyi GM, editors. Disorders of the vestibular system. Oxford Uni Press;1996. p.328-39. Korean J Otolaryngol 2004;47:491-506
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