Objective: To compare the clinical efficacy of personalized vestibular rehabilitation and otolith reposition in treating atypical benign paroxysmal positional vertigo (BPPV). Methods: A randomized controlled trial was carried out. Fifty patients diagnosed with atypical BPPV in the Vertigo Clinic of the First Affiliated Hospital of Shandong First Medical University from October 2022 to September 2023 were recruited and randomly divided into manual reduction group (25 cases) and vestibular rehabilitation group (25 cases) according to the random number table. All patients were given flunarizine. Patients in the manual reduction group were treated by Epley maneuver and (or) Barbecue maneuver, while the vestibular rehabilitation group was given personalized vestibular rehabilitation therapy. After two weeks' treatment, the clinical symptoms (positional vertigo/nystagmus) and total dizziness handicap inventory (DHI) score, DHI physical (DHI-P), DHI emotional (DHI-E), and DHI functional (DHI-F) of the two groups were evaluated and compared. Results: A total of 50 patients diagnosed with atypical BPPV were included, including 23 males and 27 females, with an average age of (48.8±14.5) years. There was no statistically significant difference between the two groups in age, gender, disease severity, Romberg, position test abnormality ratio (Dix-hallpike/Roll test), temperature test, and video head impulse test baseline test results (all P>0.05). After 2 weeks of treatment, the effective rates of the treatment in the manual reduction and vestibular rehabilitation groups were 56.0% (14/25) and 88.0% (22/25), respectively, with a statistically significant difference (P=0.025). The total DHI score, DHI-P, DHI-E, and DHI-F scores in both groups were significantly decreased after treatment (all P<0.001). Compared with the manual reduction group, the total DHI score (23.2±2.7 vs 36.4±15.7, P=0.002), DHI-P (10.2±4.6 vs 13.7±5.3, P=0.016) and DHI-F (6.5±6.4 vs 13.0±7.2, P=0.002) in the vestibular group were lower, however, there was no significant difference in DHI-E score between the two groups (6.6±4.8 vs 9.6±7.3, P=0.087). Conclusion: Compared with otolith reposition, personalized vestibular rehabilitation therapy plays a better role in improving the symptoms and decreasing DHI score for patients with atypical BPPV.
目的： 比较个性化前庭康复和耳石复位对不典型良性阵发性位置性眩晕（BPPV）的疗效。 方法： 随机对照试验。纳入2022年10月至2023年9月就诊于山东第一医科大学第一附属医院眩晕门诊的50例不典型BPPV患者，根据随机数字表法分为耳石复位组（25例）和前庭康复组（25例）。在常规口服用药基础上，耳石复位组根据症状和体征分别给予Epley和（或）Barbecue复位法，前庭康复组则予以制定个性化前庭康复方案进行治疗。于治疗后2周进行随访，对两组患者的临床疗效、眩晕残障量表（DHI）总分及躯体（DHI-P）、情感（DHI-E）、功能（DHI-F）三个维度评分进行比较。 结果： 50例不典型BPPV患者中，男23例，女27例，年龄（48.8±14.5）岁。耳石复位组和前庭康复组患者年龄、性别、DHI评分、Romberg试验分级、位置试验异常比例、双温试验异常比例、视频头脉冲试验（vHIT）基线结果比较差异均无统计学意义（均P>0.05）。治疗2周后耳石复位组、前庭康复组的眩晕治疗有效率分别为56.0%（14/25）和88.0%（22/25），差异有统计学意义（P=0.025）。两组患者治疗后DHI总分及DHI-P、DHI-E、DHI-F三个维度评分均较治疗前改善，差异均有统计学意义（均P<0.001）。与耳石复位组比较，前庭康复组患者治疗2周后DHI总分［（23.2±2.7）分比（36.4±15.7）分，P=0.002］以及DHI-P［（10.2±4.6）分比（13.7±5.3）分，P=0.016］、DHI-F［（6.5±6.4）分比（13.0±7.2）分，P=0.002］评分均更低，但DHI-E评分两组差异无统计学意义［（6.6±4.8）分比（9.6±7.3）分，P=0.087］。 结论： 个性化前庭康复治疗可以改善不典型BPPV的眩晕残障程度，且临床疗效优于耳石复位治疗。.