RU2640558C1 - Method for intensification of benign paroxysmal positional vertigo treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: medical positional manoeuvres of Szemont, Epley or Lempert are performed. In addition, in the process of any of the therapeutic positional manoeuvres, the behind-eye area in the projection of the vestibular labyrinth on the mastoid process of the temporal bone is exposed to longitudinal vibration in the pulsed mode at a vibration frequency of 10-150 Hz, amplitude of 0.01-0.5 mm with an individually selected vibration force for 5.0-30 seconds. At that, during the Epley manoeuvre, the exposure is provided in the phase of patient's head rotation in the direction opposite to the lesion by 45 and 90 degrees. During the Szemont manoeuvre, the exposure is provided when the patient is transferred to the lying position on the side opposite to the lesion with a 45-degree turn of the head. During the Lempert manoeuvre, the exposure is provided in the phase of patient's head turning to the side opposite to the lesion by 45 and 90 degrees.

EFFECT: method provides effective and intensive treatment of this pathology by vibratory action during positional manoeuvres in a certain phase of the head position.

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Description

The invention relates to medicine, namely to neurology.

Known methods of treating benign paroxysmal positional dizziness (DPPG) is to conduct therapeutic maneuvers. The results are described in the article: Antonenko L.M., Parfenov V.A. A specialized approach to the diagnosis and treatment of dizziness. Neurology, neuropsychiatry, psychosomatics. 2016; 8 (1): 56-60 [1]. The use of Semont-Tupe [2], Epley [3] and Lempert [4] positional maneuvers in 90% of cases allows improving the condition of patients with BPH within a week. The Epley maneuver has evidence level A and is part of the recommendations of the American Academy of Neurology. This maneuver is performed from the initial position of the patient - sitting on the couch with the head turning to the affected side. Then the patient lays on a couch with his head thrown back, fixed by the doctor’s hands and turned 45 degrees to the affected side, in this position after a latent period of 5-15 seconds, a sharp rotational dizziness occurs, accompanied by positional vertically rotator nystagmus, lasting up to a minute. After the dizziness stops, the patient’s head turns 90 degrees to the other side. In this position, the patient remains 30-60 seconds. Then the patient is laid on the side opposite to the lesion, with the head turned with the intact ear down, this position also lasted 30-60 seconds, after which the patient returns to the position sitting on the couch [3]. The Semont-Tupe maneuver is also used to treat BPA with damage to the posterior semicircular canal. This maneuver is performed from the initial position of the patient - sitting on the couch facing the doctor. The patient's head rotates 45 degrees in the direction opposite to the lesion. Then the patient is laid on the couch in the direction of the lesion with the doctor's hands fixed and turned 45 degrees to the opposite side of the head, in this position after a latent period of 5-15 seconds, a sharp rotational dizziness occurs, accompanied by positional vertically rotator nystagmus, lasting about a minute. After the cessation of dizziness with a quick movement, the patient is transferred to the supine position with the remaining head rotation of 45 degrees in the opposite direction to the lesion. In this position, the patient remains 30-60 seconds, after which he returns to the position, sitting on the couch facing the doctor [2].

For the treatment of benign paroxysmal positional vertigo of the horizontal semicircular canal, the Lempert maneuver is used [4]. This maneuver is performed from the initial position of the patient - lying on the couch with the head turning to the affected side, in this position, after a latent period of 5-15 seconds, a sharp rotational dizziness occurs, accompanied by positional horizontal rotator nystagmus, lasting up to a minute. After the dizziness stops, the patient’s head turns 90 degrees to the other side. In this position, the patient remains 30-60 seconds. Then the patient is laid on the opposite side, with the head turned with the intact ear down, this position also remained for 30-60 seconds, after which the patient turns on his stomach, face down, this position also remained for 30-60 seconds, then the patient turns on the opposite side, with the affected ear down, this position also lasted 30-60 seconds, then returns to the position sitting on the couch [4].

The disadvantages of the methods for conducting medical maneuvers include the need for repeated medical maneuvers (in severe cases - up to 10 times), the inability to individualize medical maneuvers, depending on the severity of the initial condition, acute manifestations of the pathological syndrome.

Known methods for improving blood flow, lymphatic drainage, activating the receptor apparatus is vibration massage carried out using various devices. Known - a method of skin care for the face and / or body (patent for the invention No. 2471471 of the Russian Federation dated 10.01.2013) [5]. The method is carried out by affecting the skin of the face and body with electromassage devices of the "CHARM" series. The essence of this method is that lymphatic drainage is carried out using an ebonite nozzle. The exposure is carried out with an amplitude of 7-10 relative units, a frequency of 70 Hz. The exposure time is 10-30 minutes. The disadvantage of this method is that this method is unsuitable for the treatment of BPP.

The aim of the method is to increase therapeutic efficacy and intensify the treatment of benign paroxysmal positional dizziness by combining vibration massage and conducting therapeutic positional maneuvers. This goal is achieved by the fact that in the process of conducting therapeutic positional maneuvers in a certain phase of the position of the head, a vibrating nozzle is applied to the area of the mastoid process behind the ear, after which an additional vibration effect is applied in a pulsed mode with an individually selected vibration force, vibration frequency 10-150 Hz and amplitude of 0.01-0.5 mm for 5.0-30 s, depending on the severity of nystagmus and dizziness.

The novelty of the proposed solution lies in the fact that for the first time in the process of conducting positional maneuvers of Semont-Tupe, Epley or Lempert, they influence the projection of the vestibular maze in the region of the mastoid process of the temporal bone by longitudinal vibration in a pulsed mode at an oscillation frequency of 10-150 Hz, an amplitude of 0.01 -0.5 mm with individually selected vibration force for 5.0-30 s. The course of treatment is 1-2 procedures.

A sparing mode of exposure to the patient’s body — the use of a small amplitude of oscillations, a short vibration time — quickly and significantly eases the patient’s condition, and also helps to more fully remove otoliths from the cavity of the semicircular canals of the vestibular labyrinth.

Technical solutions having features that match the distinguishing features of the proposed method are not identified, which allows us to conclude that the proposed method meets the criterion of "inventive step".

The proposed method is as follows. The patient sits on the couch with his back to the doctor with his head turned 45 degrees to the affected side. The first 3-5 minutes are the preparation of the patient for the perception of therapeutic maneuvers and vibration effects: the patient is warned about turning on the vibrator. The vibrator is turned on in the second and third phases of the Epley maneuver, when the patient’s head is turned 45 degrees in the direction opposite to the lesion and in the phase of the patient completely turning sideways in the opposite direction with the head turned 45 degrees for various periods of time (in the range of 5.0- 30.0 s) and with individually selected vibrational force.

The technique for performing the Epley maneuver: from the patient's starting position - sitting on the couch with the head turning to the affected side. Then the patient lays on a couch with his head thrown back, fixed by the doctor’s hands and turned 45 degrees to the affected side, in this position after a latent period of 5-15 seconds, a sharp rotational dizziness occurs, accompanied by positional vertically rotator nystagmus, lasting up to a minute. After the cessation of dizziness and nystagmus, the patient's head turns 90 degrees to the other side. In this position, the patient remains 30-60 seconds. During this period of time, a vibrator is applied to the behind-the-ear region in the projection of the affected posterior semicircular canal of the vestibular labyrinth on the mastoid process of the temporal bone and the longitudinal vibration is applied in a pulsed mode with an oscillation frequency of 10-150 Hz, amplitude 0.01-0.5 mm individually the selected force of vibration for 5.0-30 s. Then the patient is laid on the opposite side, with the head turned by the intact ear down, this position also lasted 30-60 seconds. During this period of time, a vibrator is applied to the behind-the-ear region in the projection of the affected posterior semicircular canal of the vestibular labyrinth on the mastoid process of the temporal bone and the longitudinal vibration is applied in a pulsed mode with an oscillation frequency of 10-150 Hz, amplitude 0.01-0.5 mm individually the selected vibrational force for 5.0-10 s. After that, the patient returns to the position - sitting on the couch.

When carrying out the Semont-Tupe maneuver, the patient from the starting position - sitting on the couch facing the doctor with his head turned 45 degrees to the opposite side of the lesion, fits on the couch to the side of the lesion with the doctor’s hands fixed and his head turned 45 degrees to the opposite side, In this position, after a latent period of 5-15 seconds, a sharp rotational dizziness occurs, accompanied by positional vertical rotator nystagmus, lasting about a minute. After the cessation of dizziness with a quick movement, the patient is transferred to the supine position with the remaining head rotation of 45 degrees in the opposite direction to the lesion. In this position, the patient remains 30-60 seconds. During this period of time, a vibrator is applied to the behind-the-ear region in the projection of the affected posterior semicircular canal of the vestibular labyrinth on the mastoid process of the temporal bone and the longitudinal vibration is applied in a pulsed mode with an oscillation frequency of 10-150 Hz, amplitude 0.01-0.5 mm individually the selected force of vibration for 5.0-30 s. Then the patient returns to the position - sitting on the couch facing the doctor.

When Lempert’s maneuver is performed from the patient’s initial position - lying on the couch with the head turned to the affected side, in this position, after a latent period of 5-15 seconds, a sharp rotational dizziness occurs, accompanied by positional horizontal rotator nystagmus, lasting up to a minute. After the dizziness stops, the patient’s head turns 90 degrees to the other side. In this position, the patient remains 30-60 seconds. During this period of time, a vibrator is applied to the behind-the-ear region in the projection of the affected horizontal semicircular canal of the vestibular labyrinth on the mastoid process of the temporal bone and the longitudinal vibration is applied in a pulsed mode with an oscillation frequency of 10-150 Hz, amplitude 0.01-0.5 mm individually the selected force of vibration for 5.0-30 s. Then the patient is laid on the opposite side, with the head turned upwards by the affected ear, this position also lasts 30-60 seconds. During this period of time, a vibrator is applied to the behind-the-ear region in the projection of the affected horizontal semicircular canal of the vestibular labyrinth on the mastoid process of the temporal bone and the longitudinal vibration is applied in a pulsed mode with an oscillation frequency of 10-150 Hz, amplitude 0.01-0.5 mm individually the selected force of vibration for 5.0-30 s. Then the patient turns on his stomach, facing down, this position also lasted 30-60 seconds, then the patient turns on the opposite side, with his ear down, this position also lasts 30-60 seconds, then returns to the position - sitting on the couch.

The technical result of the invention consists in the total effect of the reposition maneuver, reinforced with a dosed low-frequency (10-100 Hz) longitudinal vibration, which also affects blood circulation in the affected area, activates biochemical and electrophysiological processes in the vestibular apparatus, contributing to the faster and more complete cleaning of semicircular canals from otolithic particles. An increase in the time of vibration exposure (> 30 s) does not increase the therapeutic effect of the procedure, since the greatest neuronal response when exposed to vibration is observed during the first 30 s, with a longer exposure, an increase in the biological effect is not observed, the body adapts to the vibration effect, which reduces the level of transmission irritation to sensitive endings. Exposure to different frequencies allows you to influence a variety of tissue structures: frequencies of about 10 Hz stimulate the activity of the receptor apparatus, the speed of excitation along the nerve increases mainly at a frequency of 35 Hz, a frequency of 50 Hz has a positive effect on angiospasm, autonomic disorders. The applied frequency range of 10-150 Hz provides a more complete and faster separation of otolith particles from the walls of the affected semicircular canals of the vestibular labyrinth and accelerates the recovery of patients with DPPG during repositional maneuvers.

Of great importance is the temporal distribution of the pulse effect. The use of an intermittent mode of operation of the vibrator allows you to reduce the body's adaptation to the vibration factor, and the individually selected force of the vibration effect allows you to choose the effect depending on the severity of dizziness and nystagmus, the severity of the process and the patient's initial condition. To control the trace reactions in the patient's body, it is advisable to conduct a control examination of the patient a week after the repositional maneuver using vibration exposure. When testing the proposed method relapse was not observed.

Clinical example 1. Patient B., 45, an economist, was admitted with complaints of dizziness with a feeling of rotation of surrounding objects, which first appeared about 2 months ago at night when turning in bed. The attack lasted about a minute, accompanied by nausea, vomiting. Similar episodes were repeated when trying to sit in bed after sleep, provoked by turns, throwing the head back. Instability of walking joined.

Objectively: the patient is conscious, adequate, oriented in the place and time correctly. Cranial innervation without deviation from the norm. There are no paresis, sensitive, pelvic disorders. Tendon reflexes are lively, symmetrical. The patient performs satisfactory dynamic coordination tests. In a simple Romberg test, slight instability is detected, in a complicated Romberg test, the patient deviates to the right.

Neuro-vestibular examination did not reveal spontaneous nystagmus in a sitting position with open eyes. Samples with head-shaking (head-shaking), Halmagi, Unterberger negative. After the latency period of 9 seconds, the Dix-Hallpike test [6] to the right revealed a positionally vertical rotator nystagmus lasting 20 seconds, combined with a feeling of rotational dizziness, which made it possible to establish BPP, otolithiasis of the right posterior semicircular canal.

Diagnosis: BPPG, otolithiasis of the right posterior semicircular canal. The patient underwent a medical maneuver of Epley with vibration exposure for 30 s according to the proposed method. The treatment was well tolerated, dizziness symptoms completely regressed. The vibration frequency is 35-75 Hz, the amplitude is 0.05-0.1 mm. As a result of treatment, dizziness, nausea, instability completely disappeared, the gait recovered.

Clinical example 2. Patient P., 50 years old, a teacher, came with complaints of dizziness with a feeling of rotation of surrounding objects, which first appeared about 1 month ago, after falling on the street. The attack lasted about a minute, accompanied by nausea, vomiting. Magnetic resonance imaging of the brain did not reveal any pathology of the brain. Similar episodes were repeated when trying to sit in bed after sleep, provoked by turning the head. Instability of walking joined.

Objectively: the patient is conscious, adequate, oriented in the place and time correctly. Cranial innervation without deviation from the norm. There are no paresis, sensitive, pelvic disorders. Tendon reflexes are lively, symmetrical. The patient performs satisfactory dynamic coordination tests. In a simple Romberg test, slight instability is detected, in a complicated Romberg test, the patient deviates to the right.

Neuro-vestibular examination did not reveal spontaneous nystagmus in a sitting position with open eyes. Samples with head-shaking (head-shaking), Halmagi, Unterberger negative. The Dix-Hallpike test is negative. After the latency period of 5 seconds, the McClure-Pagnini test [7] revealed a positional horizontal rotator nystagmus lasting 60 seconds, combined with a feeling of rotational dizziness, which made it possible to establish BPP, otolithiasis of the left horizontal semicircular canal.

Diagnosis: BPPG, otolithiasis of the left horizontal semicircular canal. The patient underwent a therapeutic maneuver of Lempert with vibration exposure for 30 s according to the proposed method. The treatment was well tolerated, dizziness symptoms completely regressed. The vibration frequency is 30-150 Hz, the amplitude is 0.05-0.1 mm. As a result of treatment, dizziness, nausea, instability completely disappeared, the gait recovered.

The proposed method was applied in 23 patients with BPP. As a result of the course of treatment, all patients disappeared dizziness, nausea, vomiting, restored stability and gait. The advantages of the proposed method compared to known methods of the same purpose are in obtaining a pronounced therapeutic effect in 100% of the examined and treated patients with BPP.

Information sources

1. Antonenko L.M., Parfenov V.A. A specialized approach to the diagnosis and treatment of dizziness. Neurology, neuropsychiatry, psychosomatics. 2016; 8 (1): 56-60. DOI: 10.14412 / 2074-2711-2016-1-56-60.

2. Semont A, Freyss G, Vitte E (1988) Curing the BPPV with a liberatory manoeuvre. Adv Otorhinolaryngol 42: 290-293.

3. Epley JM (1992) The canalith repositioning procedure: for treatment of benign paroxysmal positioning vertigo. Otolaryngol Head Neck Surg 10: 299-304.

4. Lempert T, Tiel-Wilck K (1996) A positional maneuver for treatment of horizontal-canal benign positional vertigo. Laryngoscope 106: 476-478.

5. RU 2471471, A61H 23/00, dated 10.01.2013.

6. Dix MR, Hallpike CS (1952). "The pathologysymptomatology and diagnosis of certain with ommondisorders of the vestibular system" (Scanned & PDF). Proc. R. Soc. Med. 1952; 45 (6): 341-354.

7. McClure JA (1985) Horizontal canal BPV. J Otolaryngol 14: 30-35.

Claims (1)

A method of intensifying the treatment of benign paroxysmal positional dizziness, including conducting Semont, Epley or Lempert therapeutic positional maneuvers, characterized in that, in addition, in the process of performing any of the therapeutic positional maneuvers, the longitudinal region is exposed to the ear region in the projection of the vestibular labyrinth on the mastoid process of the temporal bone in pulsed mode with an oscillation frequency of 10-150 Hz, an amplitude of 0.01-0.5 mm with individually selected force of vibrational air ystviya during 5,0-30 seconds; at the same time, when performing the Epley maneuver, the effect is carried out in the phase of turning the patient's head in the direction opposite to the lesion by 45 and 90 degrees; when performing the Semont maneuver, the effect is carried out when the patient is placed in the supine position on the side opposite to the lesion with the head turned 45 degrees; when performing the Lempert maneuver, the effect is carried out in the phase of turning the patient’s head in the direction opposite to the lesion by 45 and 90 degrees.