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שאלה לגבי טיפול
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- פורסם בתאריך
BPPV
Posterior canal benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo זה סוג של וארטיגו שנגרם ע"י תזוזה של מעין "קריסטלים" קטנים באוזן הפנימית. ישנו טיפול מאוד יעיל שמחזיר את ה"קריסטלים" למקום. יעילות של כ80 עד90 אחוז בפעם הראשונה שעוברים את הטיפול. יש לי איפה-שהוא מאמר על זה אני יצרף אותו למטה אבל זה באנגלית ביי עמי
Posterior canal benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo זה סוג של וארטיגו שנגרם ע"י תזוזה של מעין "קריסטלים" קטנים באוזן הפנימית. ישנו טיפול מאוד יעיל שמחזיר את ה"קריסטלים" למקום. יעילות של כ80 עד90 אחוז בפעם הראשונה שעוברים את הטיפול. יש לי איפה-שהוא מאמר על זה אני יצרף אותו למטה אבל זה באנגלית ביי עמי
sorry../images/Emo68.gif Part 1
I tried to put the article as an attachement to the last message no luck so here it is in its entirety Ami Advance for PT and PTA's Issue Date: September 13, 2004 Vol. 15 •Issue 20 • Page 55 Posterior Canal BPPV Management techniques are used to restore balance By Kamran Barin, PhD Posterior canal benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo.1 Fortunately, it can be treated by simple and effective procedures. The success rate for the first use of the procedure is approximately 90 percent and even higher after two attempts. The effectiveness of these procedures has dramatically reduced the need for more invasive surgical treatment approaches.2 Although BPPV can be due to disturbances in any of the semicircular canals, approximately 90 percent of the cases originate from one of the posterior canals.2 The majority of BPPV cases resolve spontaneously over a period of several weeks. However, there are now safe and effective treatment procedures that provide immediate relief.3,4 Successful treatment of BPPV requires identifying the involved canal and determining if it is due to canalithiasis or cupulolithiasis.5 Posterior canal canalithiasis can be readily identified by the Dix-Hallpike maneuver. Sitting on the exam table, the patient turns the head 45 degrees toward one ear. While maintaining the head orientation, the patient then is rapidly moved from a sitting to supine position, with the head hanging slightly over the edge of the table. The examiner should support the patient's neck to prevent overextension. After returning the patient slowly to the sitting position, the maneuver is repeated, with the patient's head turned 45 degrees toward the opposite ear. Patients with posterior canal canalithiasis have a characteristic nystagmus accompanied by vertigo and possible nausea when the involved ear is undermost.2 The responses appear after a delay of a few seconds and last less than a minute. The nystagmus has a torsional component, with fast phases directed toward the involved ear and a vertical component with fast phases directed upward. If the Dix-Hallpike maneuver provokes an abnormal response, the examiner can proceed directly to the treatment phase without returning the patient to the sitting position.5 If the examiner elects not to do that immediately, returning the patient to the sitting position can often provoke another abnormal response, with the nystagmus fast phases in the opposite direction. If the maneuver is repeated within a short period of time after the first abnormal response, the subsequent responses are usually weaker and eventually may disappear altogether. As a result, most examiners try to identify the suspected ear and perform the maneuver to that side first, to avoid fatiguing the response. However, there is no evidence that performing the Dix-Hallpike maneuver to the intact side diminishes the response from the involved ear.6 The examiner is free to start with either side. Some examiners turn the head 45 degrees right or left after moving the patient from a sitting to a supine position. This should be avoided, because the anterior and posterior canals in both ears are partially in the plane of rotation and will be stimulated. Thus, the incidence of false-positive bilateral BPPV will increase. Turning the head before moving the patient places only two of the canals, one in each ear, in the plane of rotation and delivers optimal stimulation to those canals.
I tried to put the article as an attachement to the last message no luck so here it is in its entirety Ami Advance for PT and PTA's Issue Date: September 13, 2004 Vol. 15 •Issue 20 • Page 55 Posterior Canal BPPV Management techniques are used to restore balance By Kamran Barin, PhD Posterior canal benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo.1 Fortunately, it can be treated by simple and effective procedures. The success rate for the first use of the procedure is approximately 90 percent and even higher after two attempts. The effectiveness of these procedures has dramatically reduced the need for more invasive surgical treatment approaches.2 Although BPPV can be due to disturbances in any of the semicircular canals, approximately 90 percent of the cases originate from one of the posterior canals.2 The majority of BPPV cases resolve spontaneously over a period of several weeks. However, there are now safe and effective treatment procedures that provide immediate relief.3,4 Successful treatment of BPPV requires identifying the involved canal and determining if it is due to canalithiasis or cupulolithiasis.5 Posterior canal canalithiasis can be readily identified by the Dix-Hallpike maneuver. Sitting on the exam table, the patient turns the head 45 degrees toward one ear. While maintaining the head orientation, the patient then is rapidly moved from a sitting to supine position, with the head hanging slightly over the edge of the table. The examiner should support the patient's neck to prevent overextension. After returning the patient slowly to the sitting position, the maneuver is repeated, with the patient's head turned 45 degrees toward the opposite ear. Patients with posterior canal canalithiasis have a characteristic nystagmus accompanied by vertigo and possible nausea when the involved ear is undermost.2 The responses appear after a delay of a few seconds and last less than a minute. The nystagmus has a torsional component, with fast phases directed toward the involved ear and a vertical component with fast phases directed upward. If the Dix-Hallpike maneuver provokes an abnormal response, the examiner can proceed directly to the treatment phase without returning the patient to the sitting position.5 If the examiner elects not to do that immediately, returning the patient to the sitting position can often provoke another abnormal response, with the nystagmus fast phases in the opposite direction. If the maneuver is repeated within a short period of time after the first abnormal response, the subsequent responses are usually weaker and eventually may disappear altogether. As a result, most examiners try to identify the suspected ear and perform the maneuver to that side first, to avoid fatiguing the response. However, there is no evidence that performing the Dix-Hallpike maneuver to the intact side diminishes the response from the involved ear.6 The examiner is free to start with either side. Some examiners turn the head 45 degrees right or left after moving the patient from a sitting to a supine position. This should be avoided, because the anterior and posterior canals in both ears are partially in the plane of rotation and will be stimulated. Thus, the incidence of false-positive bilateral BPPV will increase. Turning the head before moving the patient places only two of the canals, one in each ear, in the plane of rotation and delivers optimal stimulation to those canals.
part 2
The patient's eye movements during Dix-Hallpike should be monitored either by a videonystagmography (VNG) system or by Frenzel glasses. Recording eye movements by electronystagmography (ENG) is not recommended, because ENG is not sensitive to torsional eye movements. Dix-Hallpike maneuvers in patients with posterior canal cupulolithiasis produce abnormal responses very similar to those in patients with posterior canal canalithiasis. Two exceptions are that the latency of the response is much shorter and the duration of the response is much longer in cupulolithiasis.5 Sometimes the Dix-Hallpike maneuver provokes transient horizontal nystagmus without a torsional component.3,7 If so, the examiner should proceed to the diagnosis and treatment options for horizontal canal BPPV. Purely vertical nystagmus with no torsional component following Dix-Hallpike should be taken seriously. This type of nystagmus, most commonly downbeating, is a sign of central lesion.8 The examiner should not initiate treatment for BPPV and should refer the patient for further medical evaluation. The sidelying maneuver is an alternative provocative maneuver.5 The patient sits on the edge of the exam table, with legs hanging over the side, as the examiner turns the head 45 degrees toward one ear. While maintaining the head orientation, the patient then is moved rapidly from a sitting to a sidelying position with the opposite ear undermost. Abnormal responses are identical to those described for the Dix-Hallpike maneuver and indicate BPPV of the undermost ear. After the response subsides, the patient is returned slowly to the sitting position, and the maneuver is repeated with the patient's head turned 45 degrees toward the opposite ear. Although Dix-Hallpike and sidelying maneuvers are equally effective in provoking abnormal responses in patients with BPPV, the Dix-Hallpike maneuver is preferable because it places the .patient in an appropriate position for the immediate initiation of treatment.5 There are three treatment options for posterior canal BPPV: Canalith repositioning therapy (CRT); Liberatory maneuver; Brandt-Daroff exercises.7
The patient's eye movements during Dix-Hallpike should be monitored either by a videonystagmography (VNG) system or by Frenzel glasses. Recording eye movements by electronystagmography (ENG) is not recommended, because ENG is not sensitive to torsional eye movements. Dix-Hallpike maneuvers in patients with posterior canal cupulolithiasis produce abnormal responses very similar to those in patients with posterior canal canalithiasis. Two exceptions are that the latency of the response is much shorter and the duration of the response is much longer in cupulolithiasis.5 Sometimes the Dix-Hallpike maneuver provokes transient horizontal nystagmus without a torsional component.3,7 If so, the examiner should proceed to the diagnosis and treatment options for horizontal canal BPPV. Purely vertical nystagmus with no torsional component following Dix-Hallpike should be taken seriously. This type of nystagmus, most commonly downbeating, is a sign of central lesion.8 The examiner should not initiate treatment for BPPV and should refer the patient for further medical evaluation. The sidelying maneuver is an alternative provocative maneuver.5 The patient sits on the edge of the exam table, with legs hanging over the side, as the examiner turns the head 45 degrees toward one ear. While maintaining the head orientation, the patient then is moved rapidly from a sitting to a sidelying position with the opposite ear undermost. Abnormal responses are identical to those described for the Dix-Hallpike maneuver and indicate BPPV of the undermost ear. After the response subsides, the patient is returned slowly to the sitting position, and the maneuver is repeated with the patient's head turned 45 degrees toward the opposite ear. Although Dix-Hallpike and sidelying maneuvers are equally effective in provoking abnormal responses in patients with BPPV, the Dix-Hallpike maneuver is preferable because it places the .patient in an appropriate position for the immediate initiation of treatment.5 There are three treatment options for posterior canal BPPV: Canalith repositioning therapy (CRT); Liberatory maneuver; Brandt-Daroff exercises.7
part 3
Canalith repositioning therapy (CRT), or Epley's maneuver, is the most common procedure. The first part of CRT is identical to the provocative phase of the Dix-Hallpike maneuver. The examiner should wait until the nystagmus and symptoms dissipate after the patient is moved from a sitting to supine position, with the head turned 45 degrees toward the involved ear. The head then is rotated slowly away from the involved ear until it is turned 45 degrees toward the intact ear. The examiner maintains the head orientation with respect to the torso as the patient's body rolls 90 degrees toward the intact ear. At this point, the head will be turned 45 degrees downward, and the patient will have vertigo and nystagmus with fast phases in the same direction as those following the Dix-Hallpike maneuver. After the responses subside, the patient should be brought slowly to the sitting position while keeping the head turned toward the intact ear. The purpose of CRT is to move the canaliths out of the canal so they can no longer cause vertigo.3 As the head is rotated toward the intact ear, canaliths move through the canal until they are at the edge of the common crus. When the patient is moved to the sitting position, the particles drop out of the canal and into the utricle. The movement of canaliths is the reason for the continued vertigo and nystagmus during CRT. If the nystagmus reverses during CRT, the canaliths are moving in the wrong direction.2 The examiner should abort the procedure and repeat the CRT.
Canalith repositioning therapy (CRT), or Epley's maneuver, is the most common procedure. The first part of CRT is identical to the provocative phase of the Dix-Hallpike maneuver. The examiner should wait until the nystagmus and symptoms dissipate after the patient is moved from a sitting to supine position, with the head turned 45 degrees toward the involved ear. The head then is rotated slowly away from the involved ear until it is turned 45 degrees toward the intact ear. The examiner maintains the head orientation with respect to the torso as the patient's body rolls 90 degrees toward the intact ear. At this point, the head will be turned 45 degrees downward, and the patient will have vertigo and nystagmus with fast phases in the same direction as those following the Dix-Hallpike maneuver. After the responses subside, the patient should be brought slowly to the sitting position while keeping the head turned toward the intact ear. The purpose of CRT is to move the canaliths out of the canal so they can no longer cause vertigo.3 As the head is rotated toward the intact ear, canaliths move through the canal until they are at the edge of the common crus. When the patient is moved to the sitting position, the particles drop out of the canal and into the utricle. The movement of canaliths is the reason for the continued vertigo and nystagmus during CRT. If the nystagmus reverses during CRT, the canaliths are moving in the wrong direction.2 The examiner should abort the procedure and repeat the CRT.
part 4
If nystagmus and vertigo disappear during CRT, the canaliths have stopped moving, presumably because they have become jammed in the canal.2 Some examiners use a device such as a mastoid oscillator to vibrate the bone and disperse the particles in order to prevent this.9 Similarly, the use of an oscillator during CRT has been advocated for patients with cupulolithiasis to dislodge the particles from the cupula. Studies that have compared the success rate of CRT both with and without using an oscillator show no significant difference in the success rates.5,10 However, these studies did not separate patients with canalithiasis from those with cupulolithiasis. Since the incidence of cupulolithiasis is much less than that of canalithiasis, the absence of a difference in the success rates may reflect the patient population. As a result, the use of oscillation during CRT remains unresolved. The use of an oscillator for typical canalithiasis cases does not appear to be beneficial. The examiner should limit the use of oscillation to selected patients with cupulolithiasis or when there is evidence that the particles have become jammed in the canal. For those patients, the examiner also can use the liberatory maneuver. After undergoing CRT, most patients receive a set of instructions to sleep upright for 48 hours and to avoid sleeping on the side of the involved ear for up to a week.11 Some examiners ask the patients to wear soft collars for one week after CRT.
If nystagmus and vertigo disappear during CRT, the canaliths have stopped moving, presumably because they have become jammed in the canal.2 Some examiners use a device such as a mastoid oscillator to vibrate the bone and disperse the particles in order to prevent this.9 Similarly, the use of an oscillator during CRT has been advocated for patients with cupulolithiasis to dislodge the particles from the cupula. Studies that have compared the success rate of CRT both with and without using an oscillator show no significant difference in the success rates.5,10 However, these studies did not separate patients with canalithiasis from those with cupulolithiasis. Since the incidence of cupulolithiasis is much less than that of canalithiasis, the absence of a difference in the success rates may reflect the patient population. As a result, the use of oscillation during CRT remains unresolved. The use of an oscillator for typical canalithiasis cases does not appear to be beneficial. The examiner should limit the use of oscillation to selected patients with cupulolithiasis or when there is evidence that the particles have become jammed in the canal. For those patients, the examiner also can use the liberatory maneuver. After undergoing CRT, most patients receive a set of instructions to sleep upright for 48 hours and to avoid sleeping on the side of the involved ear for up to a week.11 Some examiners ask the patients to wear soft collars for one week after CRT.
part 5
Studies that have compared the success rate of CRT both with and without post-therapy instructions show that there is no significant difference in success rates.6,12 That means no other post-treatment instruction is necessary, other than asking the patients to avoid brisk head movements for a week. The patient should be re-evaluated approximately one week after treatment.5 If the patient continues to have abnormal responses to the provocative maneuver, a second attempt at CRT is warranted. If there is no relief after two attempts, the patient should be referred for further medical evaluation. Bilateral BPPV is an uncommon finding. When observed, the examiner should initiate CRT for the side that generates stronger responses during the provocative maneuver. When the patient returns a week later for re-evaluation, Dix-Hallpike maneuvers should be performed for both the treated and untreated sides. A second CRT for the previously untreated side should be initiated if it still generates abnormal responses. Some complications are associated with CRT.13 Sometimes the canaliths are transferred to a different canal after CRT. This usually is discovered when the patient returns for re-evaluation. In this case, the examiner should initiate treatment for the new type of BPPV. Another complication is pre-existing neck or back problems that are common in patients with BPPV, presumably because they keep the head upright and avoid movements that provoke the symptoms. Therapy aimed at treating neck and back problems in these patients can be initiated simultaneously with CRT. Finally, the examiner should be prepared in case the patient experiences severe vertigo, nausea and vomiting during CRT. Another treatment option is the liberatory, or Semont's maneuver.4,5 The first part of the liberatory maneuver is identical to the provocative phase of the sidelying maneuver. With the patient sitting on the edge of the exam table and legs hanging over the side, the head is turned 45 degrees away from the involved ear. The examiner maintains the head orientation as the patient is moved toward the involved ear and placed in the sidelying position. When the nystagmus and symptoms dissipate after a minute, the patient is moved rapidly to the opposite sidelying position, with the head still turned 45 degrees away from the involved ear. The patient is brought back to the sitting position after the abnormal responses subside.
Studies that have compared the success rate of CRT both with and without post-therapy instructions show that there is no significant difference in success rates.6,12 That means no other post-treatment instruction is necessary, other than asking the patients to avoid brisk head movements for a week. The patient should be re-evaluated approximately one week after treatment.5 If the patient continues to have abnormal responses to the provocative maneuver, a second attempt at CRT is warranted. If there is no relief after two attempts, the patient should be referred for further medical evaluation. Bilateral BPPV is an uncommon finding. When observed, the examiner should initiate CRT for the side that generates stronger responses during the provocative maneuver. When the patient returns a week later for re-evaluation, Dix-Hallpike maneuvers should be performed for both the treated and untreated sides. A second CRT for the previously untreated side should be initiated if it still generates abnormal responses. Some complications are associated with CRT.13 Sometimes the canaliths are transferred to a different canal after CRT. This usually is discovered when the patient returns for re-evaluation. In this case, the examiner should initiate treatment for the new type of BPPV. Another complication is pre-existing neck or back problems that are common in patients with BPPV, presumably because they keep the head upright and avoid movements that provoke the symptoms. Therapy aimed at treating neck and back problems in these patients can be initiated simultaneously with CRT. Finally, the examiner should be prepared in case the patient experiences severe vertigo, nausea and vomiting during CRT. Another treatment option is the liberatory, or Semont's maneuver.4,5 The first part of the liberatory maneuver is identical to the provocative phase of the sidelying maneuver. With the patient sitting on the edge of the exam table and legs hanging over the side, the head is turned 45 degrees away from the involved ear. The examiner maintains the head orientation as the patient is moved toward the involved ear and placed in the sidelying position. When the nystagmus and symptoms dissipate after a minute, the patient is moved rapidly to the opposite sidelying position, with the head still turned 45 degrees away from the involved ear. The patient is brought back to the sitting position after the abnormal responses subside.
part 6
The liberatory maneuver usually provokes more severe responses from the patient, as compared to those provoked by CRT. It should be reserved for patients with cupulolithiasis because the intensity of the head motion is more likely to dislodge particles from the cupula. The studies that have compared the liberatory maneuver with CRT show the success rates for the two procedures are similar. However, patients with cupulolithiasis were not separated from patients with canalithiasis, so the similarity most likely pertains to BPPV of canalithiasis origin. Currently, there are no studies comparing the success rates of the liberatory maneuver and CRT when the mastoid oscillations are used. The last treatment option is the Brandt-Daroff exercises.5 The patient is instructed to perform these exercises at home while sitting on the bed, with legs hanging over the side of the bed. After turning the head about 45 degrees away from the side that provokes symptoms, the patient rapidly moves to a position of lying down on the side that provokes symptoms. After the symptoms subside the patient returns rapidly back to the sitting position and waits again for the symptoms to diminish. The patient then should repeat the procedure on the opposite side. Audiologists should instruct patients to repeat the maneuver five to 10 times, two or three times a day, until they are symptom-free for two consecutive days. It was assumed initially that remission after Brandt-Daroff exercises was the result of habituation to noxious stimuli, but it now appears that repeated head movements cause the canaliths to disperse and gradually leave the canal. That means these exercises are an inefficient form of the CRT or liberatory maneuver. Although the reported success rates are close to those of CRT and liberatory maneuver, the use of Brandt-Daroff exercises should be limited to relieving residual symptoms when the CRT and liberatory maneuver are not completely successful. References 1. Hall, S.F., Ruby, R.R., McClure, J.A. (1979). The mechanics of benign paroxysmal vertigo. Journal of Otolaryngology, 8 (2), 151-158. 2. Epley, J.M. (2001). Human experience with canalith repositioning maneuvers. Annals of the New York Academy of Sciences, 942: 179-191. 3. Epley, J.M. (1992). The canalith repositioning procedure: For treat-. ment of benign paroxysmal positional vertigo. Otolaryngology-Head and Neck Surgery, 107 (3): 399-404. 4. Semont, A., Freyss, G., Vitte, E. (1988). Curing BPPV with a liberatory maneuver. Advances in Oto-Rhino-Laryngology, 42: 290-293. 5. Herdman, S.J., Tusa, R.J. (2001). Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo. Schaumberg, IL: ICS Medical. 6. Massoud, E.A., Ireland, D.J. (1996). Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. Journal of Otolaryngology, 25 (2), 121-125. 7. Herdman, S.J., Tusa, R.J., Zee, D.S., et al. (1993). Single treatment approaches to benign paroxysmal positional vertigo. Archives of Otolaryngology-Head and Neck Surgery, 119 (4): 450-454. 8. Dunniway, H.M., Welling, D.B. (1998). Intracranial tumors mimicking benign paroxysmal positional vertigo. Otolaryngology-Head . and Neck Surgery, 118 (4): 429-436. 9. Li, J.C. (1995). Mastoid oscillation: A critical factor for success in the canalith repositioning procedure. Otolaryngology-Head and Neck Surgery, 112 (6): 670-675. 10. Hain, T.C., Helminski, J.O., Reis, I.L., et al. (2000). Vibration does not improve results of the canalith repositioning procedure. Archives of Otolaryngology-Head and Neck Surgery, 126 (5): 617-622. 11. Wolf, J.S., Boyev, K.P., Manokey, B.J., et al. (1999). Success of the modified Epley maneuver in treating benign paroxysmal positional vertigo. Laryngoscope, 109 (6): 900-903. 12. Nuti, D., Nati, C., Passali, D. (2000). Treatment of benign paroxysmal positional vertigo: No need for post-maneuver restrictions. Otolaryngology-Head and Neck Surgery, 122 (3): 440-444. 13. Herdman, S.J., Tusa, R.J. (1996). Complications of the canalith repositioning procedure. Archives of Otolaryngology-Head and Neck Surgery, 122 (3): 281-286. Kamran Barin is assistant professor of otolaryngology and director of the Balance Disorders Clinic at Ohio State University in Columbus. He can be reached at 614-293-8067 or [email protected].
The liberatory maneuver usually provokes more severe responses from the patient, as compared to those provoked by CRT. It should be reserved for patients with cupulolithiasis because the intensity of the head motion is more likely to dislodge particles from the cupula. The studies that have compared the liberatory maneuver with CRT show the success rates for the two procedures are similar. However, patients with cupulolithiasis were not separated from patients with canalithiasis, so the similarity most likely pertains to BPPV of canalithiasis origin. Currently, there are no studies comparing the success rates of the liberatory maneuver and CRT when the mastoid oscillations are used. The last treatment option is the Brandt-Daroff exercises.5 The patient is instructed to perform these exercises at home while sitting on the bed, with legs hanging over the side of the bed. After turning the head about 45 degrees away from the side that provokes symptoms, the patient rapidly moves to a position of lying down on the side that provokes symptoms. After the symptoms subside the patient returns rapidly back to the sitting position and waits again for the symptoms to diminish. The patient then should repeat the procedure on the opposite side. Audiologists should instruct patients to repeat the maneuver five to 10 times, two or three times a day, until they are symptom-free for two consecutive days. It was assumed initially that remission after Brandt-Daroff exercises was the result of habituation to noxious stimuli, but it now appears that repeated head movements cause the canaliths to disperse and gradually leave the canal. That means these exercises are an inefficient form of the CRT or liberatory maneuver. Although the reported success rates are close to those of CRT and liberatory maneuver, the use of Brandt-Daroff exercises should be limited to relieving residual symptoms when the CRT and liberatory maneuver are not completely successful. References 1. Hall, S.F., Ruby, R.R., McClure, J.A. (1979). The mechanics of benign paroxysmal vertigo. Journal of Otolaryngology, 8 (2), 151-158. 2. Epley, J.M. (2001). Human experience with canalith repositioning maneuvers. Annals of the New York Academy of Sciences, 942: 179-191. 3. Epley, J.M. (1992). The canalith repositioning procedure: For treat-. ment of benign paroxysmal positional vertigo. Otolaryngology-Head and Neck Surgery, 107 (3): 399-404. 4. Semont, A., Freyss, G., Vitte, E. (1988). Curing BPPV with a liberatory maneuver. Advances in Oto-Rhino-Laryngology, 42: 290-293. 5. Herdman, S.J., Tusa, R.J. (2001). Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo. Schaumberg, IL: ICS Medical. 6. Massoud, E.A., Ireland, D.J. (1996). Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. Journal of Otolaryngology, 25 (2), 121-125. 7. Herdman, S.J., Tusa, R.J., Zee, D.S., et al. (1993). Single treatment approaches to benign paroxysmal positional vertigo. Archives of Otolaryngology-Head and Neck Surgery, 119 (4): 450-454. 8. Dunniway, H.M., Welling, D.B. (1998). Intracranial tumors mimicking benign paroxysmal positional vertigo. Otolaryngology-Head . and Neck Surgery, 118 (4): 429-436. 9. Li, J.C. (1995). Mastoid oscillation: A critical factor for success in the canalith repositioning procedure. Otolaryngology-Head and Neck Surgery, 112 (6): 670-675. 10. Hain, T.C., Helminski, J.O., Reis, I.L., et al. (2000). Vibration does not improve results of the canalith repositioning procedure. Archives of Otolaryngology-Head and Neck Surgery, 126 (5): 617-622. 11. Wolf, J.S., Boyev, K.P., Manokey, B.J., et al. (1999). Success of the modified Epley maneuver in treating benign paroxysmal positional vertigo. Laryngoscope, 109 (6): 900-903. 12. Nuti, D., Nati, C., Passali, D. (2000). Treatment of benign paroxysmal positional vertigo: No need for post-maneuver restrictions. Otolaryngology-Head and Neck Surgery, 122 (3): 440-444. 13. Herdman, S.J., Tusa, R.J. (1996). Complications of the canalith repositioning procedure. Archives of Otolaryngology-Head and Neck Surgery, 122 (3): 281-286. Kamran Barin is assistant professor of otolaryngology and director of the Balance Disorders Clinic at Ohio State University in Columbus. He can be reached at 614-293-8067 or [email protected].
בקצרה
עם BPPV ישנם קריסטלים שבאוזן, ובדרך כלל שרויים במעין ג'ל. כאשר הם לא במקום שלהם, הם נותנים למח מידע בלתי מדוייק על הגוף. והמח מתרגם ת זה כורטיגו וסחרחורות. עם מספר מסויים של תנועות/תרגילים מחזירים את הקריסטלים למקום שלהם. 1. Liberatory maneuver 2. Canalith repositioning therapy (CRT)/ Dix-Hallpike maneuver מקווה שעזרתי שבת שלום עמי
עם BPPV ישנם קריסטלים שבאוזן, ובדרך כלל שרויים במעין ג'ל. כאשר הם לא במקום שלהם, הם נותנים למח מידע בלתי מדוייק על הגוף. והמח מתרגם ת זה כורטיגו וסחרחורות. עם מספר מסויים של תנועות/תרגילים מחזירים את הקריסטלים למקום שלהם. 1. Liberatory maneuver 2. Canalith repositioning therapy (CRT)/ Dix-Hallpike maneuver מקווה שעזרתי שבת שלום עמי
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