继发性良性阵发性位置性眩晕的临床特征及心理因素对复位后残余症状的影响研究

Background??Benign paroxysmal positional vertigoBPPVis a common clinical disease characterized by self-limiting and easy recurrence. Manual reduction is effective but residual symptoms may occur in some patients after reduction. In recent yearsthere are many studies focus on the influencing factors of therapeutic efficiency of BPPVwhile the comparison among specific causes and factors influencing residual symptoms remain to be further investigated. Objective ?To analyze the clinical features of secondary BPPVinvestigate the effect of etiological classification of BPPV on the recurrence rateand clarify the risk factors of residual symptoms after BPPV reduction. Methods??A total of 340 patients diagnosed with BPPV were enrolled in the vertigo clinic of the department of otorhinolaryngology head and neck surgery department and otology department of the First Hospital of Jilin University from April 2019 to April 2021and all of them agreed to manual reduction. The included patients were divided into the primary BPPVthe primary groupand secondary BPPVthe secondary groupgroups according to the presence or absence of primary disease. The secondary group was further divided into five subgroups according to different etiologiesincluded sudden sensorineural hearing lossSSNHLvestibular migraineVMMénière diseaseMDvestibular neuritisVNand otherssuch as cranial and ear surgeryHunt syndrometemporal bone fractureetc.. The clinical features and prognosis were compared between the primary group and secondary group. Follow-up to 3 months after the first reductionthe patients were divided into the residual symptom group and non-residual symptom group according to the occurrence of residual symptoms. The differences were compared in clinical characteristics and scores of Self-rating Anxiety ScaleSASand Self-rating Depression ScaleSDSat different time periodsat diagnosis4 weeks after treatmentand 3 months after treatmentbetween the two groupsand the independent risk factors of residual symptoms after BPPV reduction were analyzed. Results??Among the 340 patients18454.1%were in the primary group and 15645.9%were in the secondary group. Compared with the primary groupthe patients of the secondary group was youngerand the proportion of patients who underwent more than two reductions was higherthe success rate of the first reduction was lowerand the recurrence rate within 3 monthsincidence of residual symptomsSAS score at diagnosisand SDS score at diagnosis in the primary group were higher than those in the secondary groupwith significant differencesP<0.05. There were statistically significant differences in the age of patients with different etiologies of secondary BPPVP<0.05and the age of patients with other etiologiessuch as cranial and ear surgeryHunt syndrometemporal bone fractureetc.was lower than that of patients with SSNHLVMMDand VN groupsP<0.05. There were no significant differences in gendersemicircular canal involvementnumber of reductionssuccess rate of the first reductionrecurrence rate within 3 monthsincidence of residual symptomsSAS and SDS scores at different time among different etiology groups of secondary BPPVP>0.05. There were 133 patients in residual symptom group and 207 patients in the non-residual symptom group. The main residual symptoms were dizziness59.4%79/133instability24.06%32/133and head and neck discomfort9.77%13/133and 6.77%9/133had two or more symptoms. The proportion of secondary BPPV and more than two reductions in the residual symptom group was higher than that in the non-residual symptom groupP<0.05and the proportion of recurrence was lessthe SAS and SDS scores at diagnosis4 weeks after treatmentand 3 months after treatment were higher than those in the non-residual symptom groupP<0.01.The results of multivariate Logistic regression analysis showed that SAS score at diagnosisOR=1.23195%CI=1.117-1.357P<0.001and SDS score at diagnosisOR=1.20995%CI=1.113-1.314P<0.001were risk factors for the occurrence of residual symptoms after reduction in BPPV patients. Conclusion??Secondary BPPV is characterized by a high incidence of residual symptoms and recurrence rate after reduction. The anxiety and depression can affect the occurrence of residual symptoms after reduction.