Практические аспекты диагностики и лечения доброкачественного пароксизмального позиционного головокружения при каналолитиазе заднего полукружного канала

Abstract

Objective: The aim of the study is to assess the effectiveness of diagnosis of benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal (PSC) when using different types of Frenzel glasses compared to visual observation of nystagmus, as well as the features of diagnostic tests and therapeutic maneuvers during the initial treatment of patients with DPPV of PPC and their subsequent treatment, if necessary, multiple repetition of therapeutic maneuvers. Materials and methods: The study included 240 patients with newly diagnosed idiopathic BPPG canalolithiasis of PSC, which were divided into groups to determine 1) the appropriateness of using different types of Fresnel goggles in the diagnosis of BPPPV, 2) to determine the optimal sequence of testing of the supposed affected and unaffected parties in the test Dix-Hallpike, 3) to determine the optimal number of Epley healing maneuvers during one consultation. Results: Diagnosis of BPPPV of PPC during initial patient treatment significantly increases when using modified Fresnel goggles or video Frenzel in the Dix-Hallpike test. At the initial consultation, when conducting diagnostic tests and medical maneuvers to detect BPPV of PSC in a patient with positional vertigo, it is advisable to begin their execution from the supposed affected side according to the anamnesis in order to optimize the doctor’s time expenditures. In the absence of resolution of otolithiasis in case of BPPV of PSC after a single maneuver, multiple therapeutic maneuvers significantly prolong the visit approximately until 28 minutes. The treatment of patients with resistant persistent BPPV should be organized during the special prolonged otoneurologist consultation in order repeating maneuvers could be carried out. During one consultation not more than three repositioning maneuvers should be done, as the increase of number of maneuvers does not affect the effectiveness of BPPV treatment.