Benign paroksismal pozisyonel vertigo varyantlarının video elektronistagmografi ile değerlendirilmesi
Files
Date
2014
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Benign paroksismal pozisyonel vertigo (BPPV), periferik vertigonun en sık periferik nedenidir. BPPV, hızlı bir baş pozisyonu değişikliği ile oluşan karakteristik paroksismal pozisyonel nistagmus ile birlikte geçici vertigo olarak tanımlanabilir. Posterior kanal benign paroksismal pozisyonel vertigo en sık görülen BPPV formudur. Bu çalışmamızın amacı BPPV varyantlarının kliğimizde kullanılan videoelektronistagmografi (VENG) eşliğinde tanısının konulması ve tedavisinin yapılmasıdır. BPPV'lu hastaların VENG sonuçları incelenmiştir. VENG ile elde edilen elektrofizyolojik bulguların ne sıklıkta görüldüğü ve hangi BPPV varyantlarında nasıl bulgular verdiği incelenmiştir. Aynı zamanda en sık görülen posterior semisirküler kanal BPPV'sunun tedavisinde uygulanan modifiye Epley manevrası ile Brandt-Daroff ev egzersizinin tedavideki etkinliği değerlendirilmiştir. Uludağ Üniversitesi Tıp Fakültesi Hastanesi KBB Anabilim Dalı'na Mart 2012-Mayıs 2014 tarihleri arasında baş dönmesi yakınmasıyla başvuran ve dinamik pozisyonel testler ile BPPV tanısı konulan, 27-76 yaşları arasında toplam 63 hasta ile yapılan bu prospektif çalışmada hastaların epidemiyolojik verileri ile videoelektronistagmografi (VENG) bulguları ve tedavi sonuçları kaydedildi. 50 hasta posterior kanal, 8 hastada lateral kanal ve 2 hastada anterior kanal tutulumu, 2 hastada bilateral posterior kanal ve 1 hastada santral pozisyonel vertigo mevcuttu. Posterior kanal BPPV hastaları randomize olarak iki gruba bölündü. İlk gruba (25 hasta) tedavi olarak modifiye Epley manevrası uygulandı. İkinci gruba (25 hasta) tedavi olarak Brandt-Daroff egzersizi uygulandı. Hastalar haftalık takibe alındı. İyileşme süreleri kaydedildi. Modifiye Epley manevrası uygulanan grupta bu oranlar birinci haftada %76, ikinci haftada %96 ve üçüncü haftada %100 idi. Brandt Daroff ev egzersizi uygulanan grupta birinci, ikinci ve üçüncü manevradan sonraki iyilesme oranları sırasıyla %64, %88 ve %100 idi. Kalan 13 hasta üçüncü grup olarak değerlendirildi. VENG kaydında aşağı atımlı nistagmus tespit edilen iki hasta anterior kanal BPPV olarak değerlendirildi. 8 hastada horizontal kanal BPPV bulundu. Geotropik nistagmus tespit edilen 5 hastada horizontal kanal kanalolitiazisi düşünüldü. Hastalar Barbekü manevrası ile tedavi edildi. Ageotropik nistagmus tespit edilen 3 hastada horizontal kanal kupulolitiaizisi düşünüldü. Hastalara tedavi olarak modifiye Semont manevrası yapıldı. Tüm hastalara VENG eşiliğinde tanı konuldu. VENG ile yapılan göz hareketlerinin kaydı bize tanı ve tedavide oldukça yarar sağlamaktadır. Brandt-Daroff egzersizi ve Modifiye Epley manevralarının her ikisinin de BPPV tedavisinde oldukca etkili yöntemler olduğu görüldü. Klinik bulguları ve iyileşme zamanları karşılaştırıldığında iki grup arasında, istatistiksel olarak anlamlı farklılık saptanmadı.
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by a rapid head position change, associated with a characteristic paroxysmal positional nystagmus. Posterior canal benign paroxysmal positional vertigo is the most frequent form of BPPV. The aim of our study is to establish a diagnosis of BPPV variants by videoelectronystagmography (VENG) that is used in our clinic and their treatment to be done. VENG results of patients who have BPPV were examined. On the prevalence of electrophysiological findings obtained by VENG and how findings have given for which BPPV variants were examined. At the same time the effectiveness of Brandt-Daroff home exercises in the treatment with modified Epley maneuver implemented in treatment of most common posterior semicircular canal BPPV. A total of 63 patients between 27 and 76 years old who were referred to the Department of Otorhinolaryngology of Uludağ University Faculty of Medicine Hospital between March 2012 and May 2014 complaining of positional vertigo who were diagnosed as BPPV with the dynamic positional tests were enrolled in a prospective study patients, epidemiological data and results from the videoelectronystagmography (VENG), were recorded. 50 patients had involvement of the posterior canal, 8 of the horizontal canal, and 2 of the anterior canal, 2 of the bilateral posterior canal and one of the santral positional vertigo. Posterior canal BPPV patients were randomly divided into two groups. The first group (25 patients) was treated as the modified particle repositioning maneuver. Brandt-Daroff exercises as the second group ( 25 patients) underwent treatment. Patients were followed weekly. Cure weeks were recorded. The ratios for Modified Epley maneuver applied group were 76%, 96% and 100% respectively. The recovery ratios for Brandt-Daroff applied group after first, second and third maneuvers were 64%, 88% and 100% respectively. The remaining 13 patients were evaluated as the third group. VENG record two patients anterior semicircular canal BPPV with positional downbeat nystagmus. Horizontal canal BPPV were found in 8 patients. Geotropic nystagmus in 5 patients who were considered semicircular canal canalithiasis. Patients were treated with barbecue maneuver. Ageotropic nystagmus in 3 patients who were considered semisircular canal cupulolithiasis. Patients were treated with modified maneuver Semont. All patients were diagnosed guided VENG. VENG control is helpful for the diagnosis and for the registration of the eye movements during the therapeutic manoeuvres. It was concluded that both Brandt-Daroff Exercises and Modified Epley maneuvers are very effective maneuvers in the treatment of BPPV. Clinical findings and cure time compared between the two groups, statistically significant differences were not detected.
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by a rapid head position change, associated with a characteristic paroxysmal positional nystagmus. Posterior canal benign paroxysmal positional vertigo is the most frequent form of BPPV. The aim of our study is to establish a diagnosis of BPPV variants by videoelectronystagmography (VENG) that is used in our clinic and their treatment to be done. VENG results of patients who have BPPV were examined. On the prevalence of electrophysiological findings obtained by VENG and how findings have given for which BPPV variants were examined. At the same time the effectiveness of Brandt-Daroff home exercises in the treatment with modified Epley maneuver implemented in treatment of most common posterior semicircular canal BPPV. A total of 63 patients between 27 and 76 years old who were referred to the Department of Otorhinolaryngology of Uludağ University Faculty of Medicine Hospital between March 2012 and May 2014 complaining of positional vertigo who were diagnosed as BPPV with the dynamic positional tests were enrolled in a prospective study patients, epidemiological data and results from the videoelectronystagmography (VENG), were recorded. 50 patients had involvement of the posterior canal, 8 of the horizontal canal, and 2 of the anterior canal, 2 of the bilateral posterior canal and one of the santral positional vertigo. Posterior canal BPPV patients were randomly divided into two groups. The first group (25 patients) was treated as the modified particle repositioning maneuver. Brandt-Daroff exercises as the second group ( 25 patients) underwent treatment. Patients were followed weekly. Cure weeks were recorded. The ratios for Modified Epley maneuver applied group were 76%, 96% and 100% respectively. The recovery ratios for Brandt-Daroff applied group after first, second and third maneuvers were 64%, 88% and 100% respectively. The remaining 13 patients were evaluated as the third group. VENG record two patients anterior semicircular canal BPPV with positional downbeat nystagmus. Horizontal canal BPPV were found in 8 patients. Geotropic nystagmus in 5 patients who were considered semicircular canal canalithiasis. Patients were treated with barbecue maneuver. Ageotropic nystagmus in 3 patients who were considered semisircular canal cupulolithiasis. Patients were treated with modified maneuver Semont. All patients were diagnosed guided VENG. VENG control is helpful for the diagnosis and for the registration of the eye movements during the therapeutic manoeuvres. It was concluded that both Brandt-Daroff Exercises and Modified Epley maneuvers are very effective maneuvers in the treatment of BPPV. Clinical findings and cure time compared between the two groups, statistically significant differences were not detected.
Description
Keywords
Benign pozisyonel paroksismal vertigo, BrandtDaroff, Kanalit repozisyon manevraları, Videoelektronistagmografi, Benign positional paroxysmal vertigo, Canalith repositioning maneuvers, Videoelectronystagmography
Citation
Çetin, Y. S. (2014). Benign paroksismal pozisyonel vertigo varyantlarının video elektronistagmografi ile değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.