Benign Paroksismal Pozisyonal Vertigo Tedavisinde Kullanılan Semont Ve Epley Manevralarının Karşılaştırılması
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Dosyalar
Tarih
2003
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Cilt Başlığı
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Benign paroksismal pozisyonel vertigo (BPPV) tedavisinde kullanılan Semont ve Epley manevralarını, hasta uyumu ve tedavi sonuçları açısından değerlendirmek. Gereç ve Yöntem: Ocak 2001-Mayıs 2003 tarihleri arasında Selçuk Üniversitesi Meram Tıp Fakültesi KBB Anabilim Dalında, BPPV tanısı konularak tedavi edilen, 58 hasta üzerinde yapılan prospektif bir çalışmadır. BPPV tanısı, hastanın hikayesine ve Dix-Halpike manevrasında nistagmusun karekteristik özelliklerinin belirlenmesi ile konuldu. Dix Halpike manevrası uygulandıktan 10 dakika sonra, 29 hastaya Semont’ un serbestleştirici manevrası, 29 hastaya da Epley manevrası uygulandı. Hastalar manevradan 24 saat, 1 hafta ve 1 ay sonra kontrol edildi. Kontrollerde, hastaların yakınması ve Dix Halpike manevrasına verdiği cevaplar esas alınarak tedavi metotları kıyaslandı. İstatiksel değerlendirmeler için ki-kare testi kullanıldı. Bulgular: 58 hastanın yaşları 22 ile 79 arasında (ortalama:52,5814,3) olup, 38’i (%65.5) kadın, 20’si (%34.5) erkek idi. Hastaların 29’unda (%50) sağ kulak, 23’ünde (%40) sol kulak, 6’sında ise (%10) her iki kulak etkilenmiş olup, toplam 64 kulak için manevra uygulanmıştır. Semptomların ortalama süresi yaklaşık 11.9 ay idi. Semont manevrası uygulanan 32 kulağın 21’inde (%65.6), 24 saat sonra yapılan ilk kontrolde tamamen iyileşme tespit edildi. İkinci kontrolde Dix-Halpike manevrası pozitif olan 11 kulak için tekrar manevra uygulandı, bunların 7’sinde başarı elde edildi. İkinci uygulama ile manevranın başarısı %87.5’e yükseldi. Bir ay sonraki kontrolde 4 (%12.5) kulakta semptomların hala devam ettiği görüldü. Bu hastaların birinde şikayetlerde kısmen de olsa azalma görüldü. Otuz iki kulağa Epley manevrası uygulandı. Bir gün sonraki ilk kontrolde 26 (%81.25) kulakta tam iyileşme görüldü. Bir hafta sonraki kontrolde 6 kulakta semptomların devam etmesi üzerine tekrar manevra uygulandı. Bunların 4’ünde semptomlarda azalma tarif edildi. İkinci uygulamadan sonra manevranın başarısı %93.75 idi. Bir ay sonraki kontrolde 2(%6.25) hastanın semptomları devam ediyordu. Her iki manevranın tedaviye cevap açısından karşılaştırılmasında anlamlı fark yoktu. Sonuç: Pozisyonel vertigo dışında nörolojik ve vestibüler şikayetleri olmayan hastalarda, laboratuar ve görüntüleme yöntemlerine başvurmadan tedavi manevralarının uygulanması maliyet ve zaman açısından kazanç sağlayacaktır. BPPV’nun paroksismal olması, haftalar ve aylar süren spontan remisyonlar gösterebilmesinden dolayı tedavi metodları arasında sağlıklı bir kıyaslamanın yapılması güçtür. Ancak hastanın fiziksel yapısı göz önüne alınarak yaşlı, şişman ve vertebra patolojisi olan hastalarda, Epley manevrasının daha uygun olacağı kanaatindeyiz.
Objective: To evaluate the response of the patients and the results of the treatment of Semont and Epley maneuvers used in benign paroxysmal positional vertigo (BPPV). Materials and Methods: This prospective study includes 58 cases who had been diagnosed and treated as BPPV at Department of Otolaryngology, Meram Medical School, University of Selcuk, between January 2001 and May 2003. The diagnosis of BPPV was made on the basis of patient history and a positive response to the Dix-Hallpike maneuver. Ten minutes later, Semont maneuver was applied to 29 patients, and the other 29 were treated with Epley maneuver. The patients were controlled the next day, 1 week and 1 month following the treatment. Both applications were compared in regard to the patient’s complaints and Dix-Hallpike maneuver. Results: The mean age of 58 patients was 52,5814,3 (22-79) 38 (65.5%) of them were female and 20(34.5) were male. The right ear was involved in 29 patients (50%) and the left ear in 23 (40%). BPPV was bilateral in six patients (10%). The therapeutic maneuver was performed for 64 ears. The mean duration of the symptoms was about 11.9 months. During the first visit following treatment, a complete recovery was observed in 21 (65.6%) ears out of 32 in which the Semont maneuver was performed. The same maneuver was applied to 11 patients having torsional nystagmus and vertigo when Dix-Hallpike maneuver was applied. The second maneuver was successful in seven cases. The success rate was 87.5% with two applications. Four (12.5%) patients were still suffering from positional vertigo one month following the two treatments. Epley maneuver was applied in 32 ears. Twenty-six (81.25%) ears were recovered completely with the first application. At the end of the first week, Epley maneuver was repeated in 6 ears. The symptoms were mostly diminished in 4 of the ears. The success rate was 93.75% following second maneuver. Two patients (6.25%) still had symptoms at the end of the first month. Comparison of both maneuvers Epley and Semont showed no significant differences in regard to results of treatment. Conclusion: In the patients with only positional vertigo without any additional neurological and vestibular symptoms, the consideration of the use of the treatment maneuvers may be helpful to reduce the cost effects and the time consumption. It is difficult to compare the treatment methods properly as BPPV is paroxysmal and it represents spontaneous remission lasting weeks to months. Considering the physical status, we suggest that Epley maneuver is more convenient for the patients who are old, fat and having vertebra disorders.
Objective: To evaluate the response of the patients and the results of the treatment of Semont and Epley maneuvers used in benign paroxysmal positional vertigo (BPPV). Materials and Methods: This prospective study includes 58 cases who had been diagnosed and treated as BPPV at Department of Otolaryngology, Meram Medical School, University of Selcuk, between January 2001 and May 2003. The diagnosis of BPPV was made on the basis of patient history and a positive response to the Dix-Hallpike maneuver. Ten minutes later, Semont maneuver was applied to 29 patients, and the other 29 were treated with Epley maneuver. The patients were controlled the next day, 1 week and 1 month following the treatment. Both applications were compared in regard to the patient’s complaints and Dix-Hallpike maneuver. Results: The mean age of 58 patients was 52,5814,3 (22-79) 38 (65.5%) of them were female and 20(34.5) were male. The right ear was involved in 29 patients (50%) and the left ear in 23 (40%). BPPV was bilateral in six patients (10%). The therapeutic maneuver was performed for 64 ears. The mean duration of the symptoms was about 11.9 months. During the first visit following treatment, a complete recovery was observed in 21 (65.6%) ears out of 32 in which the Semont maneuver was performed. The same maneuver was applied to 11 patients having torsional nystagmus and vertigo when Dix-Hallpike maneuver was applied. The second maneuver was successful in seven cases. The success rate was 87.5% with two applications. Four (12.5%) patients were still suffering from positional vertigo one month following the two treatments. Epley maneuver was applied in 32 ears. Twenty-six (81.25%) ears were recovered completely with the first application. At the end of the first week, Epley maneuver was repeated in 6 ears. The symptoms were mostly diminished in 4 of the ears. The success rate was 93.75% following second maneuver. Two patients (6.25%) still had symptoms at the end of the first month. Comparison of both maneuvers Epley and Semont showed no significant differences in regard to results of treatment. Conclusion: In the patients with only positional vertigo without any additional neurological and vestibular symptoms, the consideration of the use of the treatment maneuvers may be helpful to reduce the cost effects and the time consumption. It is difficult to compare the treatment methods properly as BPPV is paroxysmal and it represents spontaneous remission lasting weeks to months. Considering the physical status, we suggest that Epley maneuver is more convenient for the patients who are old, fat and having vertebra disorders.
Açıklama
Anahtar Kelimeler
Kulak, Burun, Boğaz, BPPV, Semont/Epley manevrası, Tedavi, Semont/nt Epley maneuver, Treatme
Kaynak
KBB-Forum
WoS Q Değeri
Scopus Q Değeri
Cilt
2
Sayı
3
Künye
Arbağ, H., Özer, B., Keleş, B., Ülkü, Ç. H., Öztürk, K., (2003). Benign Paroksismal Pozisyonal Vertigo Tedavisinde Kullanılan Semont Ve Epley Manevralarının Karşılaştırılması. KBB-Forum, 2(3), 44-49.
