良性発作性頭位めまい症に対する同一日内の頭位変換療法反復施行の検討

Efficacy of the Repeated Canalith Repositioning Procedure within the Same Day for the Treatment of Benign Paroxysmal Positional Vertigo

I．はじめに

　良性発作性頭位めまい症（benign paroxysmal positional vertigo：以下，BPPVと略す）に対しては，その原因と推測される半規管内の耳石片を卵形囊へ戻す頭位変換療法（canalith repositioning procedure：以下，CRPと略す）が第1選択の治療法となっている。当科での初回治療時の有効率は約70％^1）であり，Epleyら提唱者自身の報告^2～6）に比較すると低い有効率であった。

　そこで，CRP施行中の眼振方向の変化を観察し，その結果によってはCRPを反復することで，有効率の向上が得られるか否かを検討した。

　Canalith repositioning procedures（CRPs）are widely recognized effective methods for the treatment of benign paroxysmal positional vertigo（BPPV）,however,there still remain the unrespondent cases to these therapies. To resolve this problem,the efficacy of the repeated CRPs within the same day to the same cases of BPPV were discussed. Though the efficacy of the sole CRP on both posterior type BPPV and lateral type BPPV were about 69.2％,the efficacy was improved up to 95.5％after the repeated CRPs

　It is important to keep on observing the direction of the nystagmus during the procedure to increase the efficacy of the CRPs.

　If the reverse of direction was observed during the procedure,it should be better to repeat the CRPs until the proper direction was observed. If the nystagmus itself became unclear during the procedur,it should be better to recheck the positional and positioning nystagmus.