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BENIGN PAROXYSMAL POSITIONAL VERTIGO
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In Benign Paroxysmal Positional Vertigo (BPPV) dizziness is thought to be due to debris which has collected within a part of the inner ear. This debris can be thought of as "ear rocks", although the formal name is "otoconia". Ear rocks are small crystals of calcium carbonate derived from a structure in the ear called the "utricle" (figure1 ). While the saccule also contains otoconia, they are not able to migrate into the canal system. The utricle may have been damaged by head injury, infection, or other disorder of the inner ear, or may have degenerated because of advanced age. Normally otoconia appear to have a slow turnover. They are probably dissolved naturally as well as actively reabsorbed by the "dark cells" of the labyrinth (Lim, 1973, 1984), which are found adjacent to the utricle and the crista, although this idea is not accepted by all (see Zucca, 1998, and Buckingham, 1999).
BPPV is a common cause of dizziness. About 20% of all dizziness is due to BPPV. The older you are, the more likely it is that your dizziness is due to BPPV, as about 50% of all dizziness in older people is due to BPPV. In a recent study, 9% of a group of urban dwelling elders were found to have undiagnosed BPPV (Oghalai, J. S., et al., 2000).
The symptoms of BPPV include dizziness or vertigo, lightheadedness, imbalance, and nausea. Activities which bring on symptoms will vary among persons, but symptoms are almost always precipitated by a change of position of the head with respect to gravity. Getting out of bed or rolling over in bed are common "problem" motions . Because people with BPPV often feel dizzy and unsteady when they tip their heads back to look up, sometimes BPPV is called "top shelf vertigo." Women with BPPV may find that the use of shampoo bowls in beauty parlors brings on symptoms. An intermittent pattern is common. BPPV may be present for a few weeks, then stop, then come back again.
WHAT CAUSES BPPV?
The most common cause of BPPV in people under age 50 is head injury . There is also an association with migraine (Ishiyama et al, 2000). In older people, the most common cause is degeneration of the vestibular system of the inner ear. BPPV becomes much more common with advancing age (Froeling et al, 1991). In half of all cases, BPPV is called "idiopathic," which means it occurs for no known reason. Viruses affecting the ear such as those causing vestibular neuritis , minor strokes such as those involving anterior inferior cerebellar artery (AICA) syndrome", and Meniere's disease are significant but unusual causes. Occasionally BPPV follows surgery, where the cause is felt to be a combination of a prolonged period of supine positioning, or ear trauma when the surgery is to the inner ear (Atacan et al 2001). Other causes of positional symptoms are discussed here.
What doesn't cause BPPV ?
Gacek has suggested that BPPV is due to recurrent neuritis of the inferior vestibular nerve (Gacek and Gacek, 2002). We think that this is highly unlikely as BPPV is very well explained by mechanical consequences of loose debris within the inner ear, and not at all consistent with the usual picture of vestibular neuritis. BPPV is also not caused by psychological distress, and it is not a side effect of medication.
HOW IS THE DIAGNOSIS OF BPPV MADE?
Your physician can make the diagnosis based on your history, findings on physical examination, and the results of vestibular and auditory tests. Often, the diagnosis can be made with history and physical examination. Most other conditions that have positional dizziness get worse on standing rather than lying down (e.g. orthostatic hypotension). Electronystagmography (ENG) testing may be needed to look for the characteristic nystagmus (jumping of the eyes). It has been claimed that BPPV accompanied by unilateral lateral canal paralysis is suggestive of a vascular etiology (Kim et al, 1999). For diagnosis of BPPV with laboratory tests, it is important to have the ENG test done by a laboratory that can measure vertical eye movements. A magnetic resonance imaging (MRI) scan will be performed if a stroke or brain tumor is suspected. A rotatory chair test may be used for difficult diagnostic problems. It is possible but rather uncommon to have BPPV in both ears (bilateral BPPV).
There are some rare conditions that have symptoms that resemble BPPV. Patients with certain types of central vertigo such as the spinocerebellar ataxias may have "bed spins" and prefer to sleep propped up in bed (Jen et al, 1998). These conditions can generally be detected on a careful neurological examination and also are generally accompanied by a family history of other persons with similar symptoms.
HOW MIGHT BPPV AFFECT MY LIFE?
Certain modifications in your daily activities may be necessary to cope with your dizziness. Use two or more pillows at night. Avoid sleeping on the "bad" side. In the morning, get up slowly and sit on the edge of the bed for a minute. Avoid bending down to pick up things, and extending the head, such as to get something out of a cabinet. Be careful when at the dentist's office, the beauty parlor when lying back having ones hair washed, when participating in sports activities and when you are lying flat on your back.
HOW IS BPPV TREATED?
BPPV has often been described as "self-limiting" because symptoms often subside or disappear within six months of onset. Symptoms tend to wax and wane. Motion sickness medications are sometimes helpful in controlling the nausea associated with BPPV but are otherwise rarely beneficial. However, various kinds of physical maneuvers and exercises have proved effective. Three varieties of conservative treatment, which involve exercises, and a treatment that involves surgery are described in the next sections.
OFFICE TREATMENT OF BPPV: The Epley and Semont Maneuvers
There are two treatments of BPPV that are usually performed in the doctor's office. Both treatments are very effective, with roughly an 80% cure rate, according to a study by Herdman and others (1993). If your doctor is unfamiliar with these treatments, you can find a list of knowledgeable doctors from the Vestibular Disorders Association (VEDA) .
The maneuvers, named after their inventors, are both intended to move debris or "ear rocks" out of the sensitive part of the ear (posterior canal) to a less sensitive location. Each maneuver takes about 15 minutes to complete. The Semont maneuver (also called the "liberatory" maneuver) involves a procedure whereby the patient is rapidly moved from lying on one side to lying on the other. It is a brisk maneuver that is not currently favored in the United States.
The Epley maneuver is also called the particle repositioning, canalith repositioning procedure, and modified liberatory maneuver. It is illustrated in figure 2. Click here for an animation. It involves sequential movement of the head into four positions, staying in each position for roughly 30 seconds. The recurrence rate for BPPV after these maneuvers is about 30 percent at one year, and in some instances a second treatment may be necessary. While some authors advocate use of vibration in the Epley maneuver, we have not found this useful in a study of our patients (Hain et al, 2000). Some authors also suggest leaving out some of the positions in the Epley maneuver, especially position 'D'. We suggest that you avoid therapy using this methodology.
After either of these maneuvers, you should be prepared to follow the instructions below, which are aimed at reducing the chance that debris might fall back into the sensitive back part of the ear.
INSTRUCTIONS FOR PATIENTS AFTER OFFICE TREATMENTS (Epley or Semont maneuvers)
1. Wait for 10 minutes after the maneuver is performed before going home. This is to avoid "quick spins," or brief bursts of vertigo as debris repositions itself immediately after the maneuver. Don't drive yourself home.
2. Sleep semi-recumbent for the next two nights. This means sleep with your head halfway between being flat and upright (a 45 degree angle). This is most easily done by using a recliner chair or by using pillows arranged on a couch (see figure 3). During the day, try to keep your head vertical. You must not go to the hairdresser or dentist. No exercise which requires head movement. When men shave under their chins, they should bend their bodies forward in order to keep their head vertical. If eyedrops are required, try to put them in without tilting the head back. Shampoo only under the shower.
3. For at least one week, avoid provoking head positions that might bring BPPV on again.
- Use two pillows when you sleep.
- Avoid sleeping on the "bad" side.
- Don't turn your head far up or far down.
Be careful to avoid head-extended position, in which you are lying on your back, especially with your head turned towards the affected side. This means be cautious at the beauty parlor, dentist's office, and while undergoing minor surgery. Try to stay as upright as possible. Exercises for low-back pain should be stopped for a week. No "sit-ups" should be done for at least one week and no "crawl" swimming. (Breast stroke is OK.) Also avoid far head-forward positions such as might occur in certain exercises (i.e. touching the toes). Do not start doing the Brandt-Daroff exercises immediately or 2 days after the Epley or Semont maneuver, unless specifically instructed otherwise by your health care provider.
4. At one week after treatment, put yourself in the position that usually makes you dizzy. Position yourself cautiously and under conditions in which you can't fall or hurt yourself. Let your doctor know how you did.
Comment: Massoud and Ireland (1996) stated that post-treatment instructions were not necessary. While we respect these authors, at this writing (2002), we still feel it best to follow the procedure recommended by Epley.
WHAT IF THE MANEUVERS DON'T WORK?
These maneuvers are effective in about 80% of patients with BPPV (Herdman et al, 1993). If you are among the other 20 percent, your doctor may wish you to proceed with the Brandt-Daroff exercises, as described below. If a maneuver works but symptoms recur or the response is only partial (about 40% of the time according to Smouha, 1997), another trial of the maneuver might be advised. The "habituation" exercises are also sometimes useful in the situation where all other maneuvers (Epley, Semont, Brandt-Daroff) have been tried -- in essence these consist of a more intense and prolonged series of positional exercises. When all maneuvers have been tried, the diagnosis is clear, and symptoms are still intolerable, surgical management (posterior canal plugging) may be offered.
BPPV often recurs. About 1/3 of patients have a recurrence in the first year after treatment, and by five years, about half of all patients have a recurrence (Hain et al, 2000; Nunez et al; 2000). If BPPV recurs, in our practice we usually retreat with one of the maneuvers above, and then follow this with a once/day set of the Brandt-Daroff exercises.
In some persons, the positional vertigo can be eliminated but imbalance persists. In these persons it may be reasonable to undertake a course of generic vestibular rehabilitation, as they may still need to compensate for a changed utricular mass or a component of persistent vertigo caused by cupulolithiasis. Fujino et al (1994) reported conventional rehab has some efficacy, even without specific maneuvers.
HOME TREATMENT OF BPPV:
BRANDT-DAROFF EXERCISES 
The Brandt-Daroff Exercises are a method of treating BPPV, usually used when the office treatment fails. They succeed in 95% of cases but are more arduous than the office treatments. These exercises are performed in three sets per day for two weeks. In each set, one performs the maneuver as shown five times.
1 repetition = maneuver done to each side in turn (takes 2 minutes)
| Suggested Schedule for Brandt-Daroff exercises | ||
| Time | Exercise | Duration |
| Morning | 5 repetitions | 10 minutes |
| Noon | 5 repetitions | 10 minutes |
| Evening | 5 repetitions | 10 minutes |
Start sitting upright (position 1). Then move into the side-lying position (position 2), with the head angled upward about halfway. An easy way to remember this is to imagine someone standing about 6 feet in front of you, and just keep looking at their head at all times. Stay in the side-lying position for 30 seconds, or until the dizziness subsides if this is longer, then go back to the sitting position (position 3). Stay there for 30 seconds, and then go to the opposite side (position 4) and follow the same routine..
These exercises should be performed for two weeks, three times per day, or for three weeks, twice per day. This adds up to 52 sets in total. In most persons, complete relief from symptoms is obtained after 30 sets, or about 10 days. In approximately 30 percent of patients, BPPV will recur within one year. If BPPV recurs, you may wish to add one 10-minute exercise to your daily routine (Amin et al, 1999). The Brandt-Daroff exercises as well as the Semont and Epley maneuvers are compared in an article by Brandt (1994), listed in the reference section.
 |
| Home Epley (for the left ear). |
HOME EPLEY MANEUVER
The Epley and/or Semont maneuvers as described above can be done at home (Radke et al, 1999; Furman and Hain, 2004). We often recommend the home-Epley to our patients who have a clear diagnosis. This procedure seems to be even more effective than the in-office procedure, perhaps because it is repeated every night for a week.
The method (for the left side) is performed as shown on the figure to the right. One stays in each of the supine (lying down) positions for 30 seconds, and in the sitting upright position (top) for 1 minute. Thus, once cycle takes 2 1/2 minutes. Typically 3 cycles are performed just prior to going to sleep. It is best to do them at night rather than in the morning or midday, as if one becomes dizzy following the exercises, then it can resolve while one is sleeping. The mirror image of this procedure is used for the right ear.
There are several problems with the "do it yourself" method. If the diagnosis of BPPV has not been confirmed, one may be attempting to treat another condition (such as a brain tumor or stroke) with positional exercises -- this is unlikely to be successful and may delay proper treatment. A second problem is that the home-Epley requires knowledge of the "bad" side. Sometimes this can be tricky to establish. Complications such as conversion to another canal (see below) can occur during the Epley maneuver, which are better handled in a doctor's office than at home. Finally, occasionally during the Epley maneuver neurological symptoms are provoked due to compression of the vertebral arteries. In our opinion, it is safer to have the first Epley performed in a doctors office where appropriate action can be taken in this eventuality.
We offer a home treatment DVD that illustrates the home Epley exercises.
SURGICAL TREATMENT OF BPPV
(POSTERIOR CANAL PLUGGING)
If the exercises described above are ineffective in controlling symptoms, symptoms have persisted for a year or longer, and the diagnosis is very clear, a surgical procedure called "posterior canal plugging" may be recommended. Canal plugging blocks most of the posterior canal's function without affecting the functions of the other canals or parts of the ear. This procedure poses a small risk to hearing, but is effective in about 90% of individuals who have had no response to any other treatment. Only about 1 percent of our BPPV patients eventually have this procedure done. Surgery should not be considered until all three maneuvers/exercises (Epley, Semont, and Brandt-Daroff) have been attempted and failed. See the article by Parnes (1990, 1996) in the references for more information.
There are several alternative surgeries. Dr Gacek (Syracuse, New York) has written extensively about singular nerve section. Dr. Anthony (Houston, Texas), advocates laser assisted posterior canal plugging. It seems to us that these procedures, which require unusual amounts of surgical skill, have little advantage over a canal plugging procedure. Of course, it is always advisable when planning surgery to select a surgeon who has had as wide an experience as possible.Complications are rare (Rizvi and Gauthier, 2002)
There are several surgical procedures that we feel are inadvisable for the individual with intractable BPPV. Vestibular nerve section, while effective, eliminates more of the normal vestibular system than is necessary. Labyrinthectomy and sacculotomy are also both generally inappropriate because of reduction or loss of hearing expected with these procedures.
ATYPICAL BPPV
Lateral Canal BPPV, Anterior Canal BPPV, Cupulolithiasis, Vestibulolithiasis, Multicanal patterns
There are several rarer variants of BPPV which may occur spontaneously as well as after the Brandt-Daroff maneuvers or Epley/Semont maneuvers. They are mainly thought to be caused by migration of otoconial debris into canals other than the posterior canal, the anterior or lateral canal. There is presently no data reported as to the frequency and extent of these syndromes following treatment procedures. It is the author's estimate that they occur in roughly 5% of Epley maneuvers and about 10% of the time after the Brandt-Daroff exercises. In nearly all instances, with the exception of cupulolithiasis, these variants of BPPV following maneuvers resolve within a week without any special treatment, but when they do not, there are procedures available to treat them.
In clinical practice, atypical BPPV arising spontaneously is first treated with maneuvers as is typical BPPV, and the special treatments as outlined below are entered into only after treatment failure. When atypical BPPV follows the Epley, Semont or Brandt-Daroff maneuvers, specific exercises are generally begun as soon as the diagnosis is ascertained. In patients in whom the exercise treatment of atypical BPPV fails, especially in situations where onset is spontaneous, additional diagnostic testing such as MRI scanning may be indicated. The reason for this is to look for other types of positional vertigo.
Lateral canal BPPV is the most common atypical BPPV variant, accounting for about 3-9 percent of cases (Korres et al, 2002). Most cases are seen as a consequence of an Epley maneuver. It is diagnosed by a horizontal nystagmus that changes direction according to the ear that is down. More detail about lateral canal BPPV as well as an illustration of a home exercise can be found here.
Anterior canal BPPV is also rare, and a recent study suggested that it accounts for about 2% of cases of BPPV (Korres et al, 2002). It is diagnosed by a positional nystagmus with components of downbeating and torsional movement on taking up the Dix-Hallpike position, or a nystagmus that is upbeating and torsional when sitting up from the Dix-Hallpike. There are a number of different suggestions in the literature about the direction of the torsional quick phase in anterior canal BPPV. In our view, the nystagmus during the Dix-Hallpike to one side is most likely due to excitation of the anterior canal on the opposite side. This should cause downbeating nystagmus as well as torsional nystagmus with a quick-phase towards the disturbed ear. Thus the direction of the torsional component during the down-phase of the Dix-Hallpike tells you which is the bad ear. Anterior canal BPPV can be provoked from the opposite ear to the side of the Dix-Hallpike maneuver -- in other words, if you get dizzy to the right side, the problem ear might be the left. Some authors have suggested that because the anterior canals are oriented so that parts are near the saggital plane, anterior canal BPPV can be provoked with a Dix-Hallpike maneuver to either side as well as in the "head hanging" position (Bertholon et al, 2002). The upbeating nystagmus on sitting may be very persistent as the debris settles on the cupula of the anterior canal. Anterior canal BPPV is probably rare because the anterior canal is normally the highest part of the ear. Debris would naturally tend to fall out of the posterior half of the anterior canal. From the geometry of the ear, it would seem likely that anterior canal BPPV might occasionally result as a complication of the Epley maneuver.
Debris might also be temporarily located in the common crus area, which is the shared canal between the anterior and posterior canal. Should debris be present in the common cruse, one would expect a purely torsional nystagmus. During the down phase of the Dix-Hallpike, the torsional nystagmus should beat away from the bad ear. During the up phase of the Dix-Hallpike, the torsional nystagmus should beat towards the bad ear.
Cupulolithiasis is a condition in which debris is stuck to the cupula of a semicircular canal, rather than being loose within the canal. Cupulolithiasis is not a treatment complication, but rather is part of the spectrum of BPPV. The mechanistic hypothesis is based on pathological findings of deposits on the cupula made by Schuknecht and Ruby in three patients who had BPPV during their lives (Schuknecht 1969; Schuknecht et al. 1973). Moriarty and colleagues found similar deposits in 28% of 566 temporal bones (Moriarty et al. 1992). Schuknecht pointed out that cupulolithiasis hypothesis fails to explain the usual characteristic latency and burst pattern of BPPV nystagmus as well as remissions (Schuknecht et al. 1973). Rather, cupulolithiasis should result in a constant nystagmus. This pattern is sometimes seen (Smouha et al. 1995). Cupulolithiasis might theoretically occur in any canal -- horizontal, anterior or vertical, each of which might have it's own pattern of positional nystagmus. Some authors hold that both the cupulolithiasis and canalithiasis hypotheses may be correct (Brandt et al. 1994). If cupulolithiasis is suspected, it seems logical to treat with either the Epley with vibration, or alternatively, use the Semont maneuver. There are no studies of cupulolithiasis to indicate which strategy is the most effective.
Vestibulolithiasis is a hypothetical condition in which debris is present on the vestibule-side of the cupula, rather than being on the canal side. For this theory, there is loose debris, close to but unattached to the cupula of the posterior canal, possibly in the vestibule or short arm of the semicircular canal. Pathologic studies of BPPV have found roughly equal amounts of fixed debris on either side of the cupula (Moriarty et al. 1992), suggesting that loose debris might also be found on either side. For the vestibulolithiasis mechanism, when the head is moved, stones or other debris might shift from vestibule to ampulla, or within the ampulla, impacting the cupula. This mechanism would be expected to resemble cupulolithiasis, having a persistent nystagmus, but with intermittency because the debris is movable. Very little data is available as to the frequency of this pattern, and no data is available regarding treatment.
Multicanal patterns. If debris can get into one canal, why shouldn't it be able to get into more than one ? It is common to find small amounts of horizontal nystagmus or contralateral downbeating nystagmus in a person with classic posterior canal BPPV. While other explanations are possible, the most likely one is that there is debris in multiple canals.
WHERE ARE BPPV EVALUATIONS AND TREATMENTS DONE?
The Vestibular Disorders Association (VEDA) maintains a large and comprehensive list of doctors who have indicated a proficiency in treating BPPV. Please contact them to find a local treating doctor.
MORE INFORMATION
Literature-and DVDs
- DVD illustrating Brandt-Daroff, Home-Epley and log roll
- VEDA has recently published a patient-oriented book on BPPV.
REFERENCES CONCERNING BPPV:
Click here for very recent, but possibly less relevant references.
Published literature referred to above:
- Amin M, Giradi M, Neill M, Hughes LF, Konrad H. Effects of exercise on prevention of recurrence of BPPV symptoms. ARO abstracts, 1999, #774
- ATACAN E, Sennaroglu L, Genc A, Kaya S. Benign paroxysmal positional vertigo after stapedectomy. Laryngoscope 2001; 111: 1257-9.
- Bertholon, P., A. M. Bronstein, et al. (2002). "Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis." J Neurol Neurosurg Psychiatry 72(3): 366-72.
- Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 1980 Aug;106(8):484-485.
- Brandt T, Steddin S, Daroff RB. Therapy for benign paroxysmal positioning vertigo, revisited. Neurology 1994 May;44(5):796-800.
- Buckingham RA. Anatomical and theoretical observations on otolith repositioning for benign paroxysmal positional vertigo. Laryngoscope 109:717-722, 1999
- Epley JM. The canalith repositioning procedure: For treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992 Sep;107(3):399-404.
- Fife TD. Recognition and management of horizontal canal benign positional vertigo. Am J Otol 1998 May;19(3):345-351.
- Fujino A and others. Vestibular training for benign paroxysmal positional vertigo. Arch Otolaryngol HNS 1994:120:497-504.
- Froehling DA, Silverstein MD, Mohr DN, Beatty CW, Offord KP, Ballard DJ. Benign positional vertigo: incidence and prognosis in a population-based study in Olmsted County, Minnesota. Mayo Clin Proc 1991 Jun;66(6):596-601.
- Gacek RR. Technique and results of singular neurectomy for the management of benign parodxysmal positional vertigo.l Acta Oto-laryngologica 1995 115(2) 154-7
- Gacek RR, Gacek MR. The three faces of vestibular ganglionitis. Ann ORL 111:2002, 103-113
- Hain TC, Helminski JO, Reis I, Uddin M. Vibration does not improve results of the canalith repositioning maneuver. Arch Oto HNS, May 2000:126:617-622
- Harvey SA, Hain TC, Adamiec LC. Modified liberatory maneuver: effective treatment for benign paroxysmal positional vertigo. Laryngoscope 1994 Oct;104(10):1206-1212.
- Herdman SJ. Treatment of benign paroxysmal vertigo. Phys Ther 1990 Jun;70(6):381-388.
- Herdman SJ, Tusa RJ, Zee DS, Proctor LR, Mattox DE. Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 1993 Apr;119(4):450-454.
- Ishiyama A, Jacobson KM, Baloh RW. Migraine and benign positional vertigo. Ann Otol Rhinol Laryngol. 2000;109:377-380
- Jen JC and others. Spinocerebellar ataxia type 6 with positional vertigo and acetazolamide responsive episodic ataxia. J. Neuro Neurosurg Psych 1998:65:565-568
- Korres S and others. Occurrence of semicircular canal involvement in Benign Paroxysmal Positional Vertigo. Otol Neurotol 23:926-932, 2002
- Lanska DJ, Remler B. Benign paroxysmal positioning vertigo: classic descriptions, origins of the provocative positioning technique, and conceptual developments. Neurology 1997 May;48(5):1167-1177.
- Lempert T, Wolsley C, Davies R, Gresty MA, Bronstein AM. Three hundred sixty-degree rotation of the posterior semicircular canal for treatment of benign positional vertigo: a placebo-controlled trial. Neurology 1997 Sep;49(3):729-733.
- Lim DJ (1984). The development and structure of otoconia. In: I Friedman, J Ballantyne (eds). Ultrastructural Atlas of the Inner Ear. London: Butterworth, pp 245-269.
- Massoud EA, Ireland DJ. Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. J. Otolarynglogy 25(2):121-5, 1996
- Moriarty, B., et al. (1992). "The incidence and distribution of cupular deposits in the labyrinth." Laryngoscope 102(1): 56-9.
- Nunez RA, Cass SP, Furman JM. Short and long-term outcomes of canalith repositioning for benign paryxosmal positional vertigo. Otol HNS, May 2000:122:647-52
- Oghalai, J. S., et al. (2000). "Unrecognized benign paroxysmal positional vertigo in elderly patients." Otolaryngol Head Neck Surg 122(5): 630-4.
- Parnes LS, McClure JA. Posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 1990 May;99(5 Pt 1):330-334.
- Parnes LS. Update on posterior canal occlusion for benign paroxysmal positional vertigo. Otolaryngol Clin North Am 1996 Apr;29(2):333-342.
- Parnes LS, Price-Jones RG. Particle repositioning maneuver for benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 1993 May;102(5):325-331.
- Radtke, A., et al. (1999). "A modified Epley's procedure for self-treatment of benign paroxysmal positional vertigo." Neurology 53(6): 1358-60.
- Rizvi SS, Gauthier MG. Unexpected complication of posterior canal occlusion surgery for benign paroxysmal positional vertigo. Otol and Neurotol 23:938-940, 2002
- Schuknecht, H. F. (1969). "Cupulolithiasis." Arch Otolaryngol 90(6): 765-78.
- Schuknecht, H. F., et al. (1973). "Cupulolithiasis." Adv Otorhinolaryngol 20: 434-43.
- Semont A, Freyss G, Vitte E. Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 1988;42:290-293.
- Smouha EE. Time course of recovery after Epley maneuvers for benign paroxysmal positional vertigo. Laryngoscope 1997 107(2) 187-91
- Welling DB, Barnes DE. Particle Repositioning maneuver for benign paroxysmal positional vertigo. Laryngoscope 1994 Aug;104(8 Pt 1):946-949.
(c) 1997-2005 Timothy C. Hain, thain@dizziness-and-balance.com
2010年9月10日 星期五
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新生兒聽損率 高於代謝疾病
新生兒聽損率 高於代謝疾病
2010-08-09 15:33:48 中央社記者陳麗婷台北9日電
先天性聽力損失發生率約千分之6，比先天性代謝異常疾病還高。醫師今天表示，只要新生兒出生後36小時進行聽力篩檢，就算是雙側聽力受損，經過治療也能擁有幾近正常聽語發展。
馬偕醫院耳鼻喉科主任林鴻清受訪表示，新生兒先天性單側、雙側聽力損失發生率為千分之6，比先天性代謝異常疾病，如甲狀腺低下症、先天性腎上腺增生症、苯酮尿症等高很多。
林鴻清說，國內外研究顯示，只要新生兒出生後36小時內進行聽力篩檢，例如雙側先天性聽力損失的嬰兒，如果能在出生後3個月內確診，並在1個月內配戴合適的聽能輔具，且6個月內積極開始接受聽能復健，未來可以擁有幾近正常的聽語發展。
林鴻清說，先前收治1名陳小妹就是在新生兒聽力篩檢，發現雙耳聽損問題，在5個月大時裝上助聽器，並在11個月大時開始接受語言治療，現在陳小妹已經5歲，也上了幼稚園，聽語發展及學習狀況和正常小孩一樣。
他說，早期發現聽力受損多數都可以藉由助聽器改善，而少數聽損嚴重者也能以植入人工電子耳等方式積極復健，因此，提醒家長千萬不能忽略新生兒接受聽力篩檢的重要性。
新生兒聽損比率偏高 早篩檢早治療
2010-08-10 中國時報 張翠芬／台北報導
新生兒聽力異常不容小覷，馬偕醫院研究發現，新生兒先天性聽力損失的發生率高達千分之六，比先天性代謝異常疾病還高，醫師建議，新生兒出生後卅六小時應進行聽力篩檢，三個月內確診，即使雙側聽力受損，經過治療也能有良好的聽語發展。
陳小妹妹在馬偕醫院出生後即接受新生兒聽力篩檢，發現有雙耳聽損問題，經過評估確診，五個月大時裝上助聽器，十一個月開始接受語言治療，現在陳小妹妹已經五歲，在幼稚園裡活蹦亂跳、載歌載舞，適應良好，聽語發展及學習情況與正常小孩無異。
陳媽媽說，家族中沒有聽損的病例，所以並沒有注意需要做聽力篩檢，還好醫院工作人員告知可免費為小朋友檢查，及早發現讓孩子及早接受良好的治療。
馬偕醫院耳鼻喉科主任林鴻清表示，新生兒先天性單側、雙側聽力損失發生率為千分之六，比先天性代謝異常疾病，如甲狀腺低下症、先天性腎上腺增生症、苯酮尿症等高很多。林鴻清說，早期發現聽力受損多數都可以戴助聽器改善，嚴重者可以植入人工電子耳積極復健，他呼籲，政府應把聽力篩檢納入必要檢驗項目，以免孩子錯失黃金治療期，若超過三歲以後才開始矯正，可能造成永久性中樞聽覺發展異常，家長要特別注意。
每千名新生兒 約六人有聽損
【聯合報╱記者陳惠惠／即時報導】2010.08.09 11:13 pm
馬偕醫院耳鼻喉科主任林鴻清指出，雙側先天性聽力損失的嬰兒，如果能在出生後三個月內確診，且在一個月內配戴合適的聽能輔具，六個月內積極接受聽能復健，未來就能擁有幾近正常的語言發展。
林鴻清說，先天性單、雙側聽力損失發生率為千分之六，比甲狀腺低下、先天性腎上線增生症，以及苯酮尿症等先天性代謝異常疾病高出許多，國內、外研究顯示，新生兒只要在出生後卅六小時內，就能進行聽力篩檢。
陳小妹妹家族裡並沒有聽損個案，出生後接受新兒生聽力篩檢，卻發現雙耳都有聽損問題，經評估、診斷，五個月大就裝上助聽器，十一個月開始接受語言治療。如今，陳小妹妹已經五歲了，陳媽媽說，她在幼稚園的適應情況非常好，聽語發展及學習情況跟正常小孩沒兩樣。
新生兒聽損 早期篩檢早治療
更新日期:2010/08/10 04:11 記者鍾麗華／台北報導
5歲陳小妹妹有雙耳聽損的問題，所幸在出生後接受新生兒聽力篩檢時被發現，5個月大時裝上助聽器，11個月大時開始接受語言治療，現在她在幼稚園裡活蹦亂跳、載歌載舞，聽語發展及學習情況與正常小孩無異。
馬偕紀念醫院耳鼻喉科主任林鴻清表示，新生兒聽損發生率千分之6，遠高於先天性代謝異常疾病，如甲狀腺低下症、先天性腎上腺增生症、苯酮尿症等，政府早在74年全面補助先天性代謝異常疾病篩檢，卻遲未把聽力納入必要檢驗項目，導致許多孩子錯失了黃金治療期。
林鴻清指出，國內外研究均顯示，新生兒出生後36小時內即可進行聽力篩檢，若雙耳先天性聽損者，在出生後3個月內確診，並在1個月內配戴合適的輔具，且於6個月內復健，未來可擁有幾近正常的聽語發展。若超過3歲以後才開始矯正，可能造成永久性中樞聽覺發展異常，影響後天語言及社會技巧發展，提醒家長記得讓新生寶寶接受聽力篩檢。
林鴻清指出，新生兒聽力篩檢，過去採用耳聲傳射檢查（OAE），但因易受羊水、皮膚分泌的胎脂影響，檢測時約有5％的偽陽性，近年來全面改採自動聽性腦幹反應檢查（aABR），可測得周邊至腦幹聽覺系統，篩檢成效良好，偽陽性降低至1％。
2010年7月14日 星期三
『耳聲傳射發明者 讚台灣新生兒聽篩』
小嬰兒不會表達，怎麼樣才能知道聽力有沒有問題呢，現在全世界通用兩種工具，其中一種--耳聲傳射的發明者--大衛‧坎伯日前特地前來台灣演講，他對台灣推動新生兒聽篩有什麼看法，一起來看下面的報導。貼上電極片，好記錄聲音刺激下腦部電波反應，這是自動聽性腦幹反應檢查，傳統的新生兒聽力篩檢工具， 檢查需要幾分鐘，費用比較高，但結果比較不容易出錯，不過有個缺點。
不想弄醒寶寶，還有一個安靜的檢查方法-耳聲傳射。
只要耳塞插進耳朵，幾秒鐘就能偵測負責聽力傳導的耳朵毛細胞有沒有問題。
大衛‧坎普 在32年前發現內耳也會產生聲音，不過剛開始沒人相信他的理論，經過十年努力才研發出測量的機器。
坎普的發明不只證實了新生兒聽篩的重要性、，而且操作方便，對提高篩檢率有很大的貢獻，歐美好幾個國家都超過90%。不過台灣從1998年推廣到現在，篩檢率只有60.45%。
現在全台接生醫院402家中只有243家有篩檢工具，負責推動的台北馬偕醫院林鴻清醫師說好在重視聽篩的觀念慢慢發芽，今年二月國健局開始補助全台低收入戶新生兒免費做，而台北市和嘉義縣市更跑在中央前面，全面實施新生兒免費聽篩。
坎普說聽篩只是早期發現，更重要的是接下來的聽語療育。台灣最大優勢就是聽能早療系統很完善，看看這一個個經過早期療育的聽損兒表現，真的只要把握黃金治療期，他們的未來可期。
990714公視--耳聲傳射發明者 讚台灣新生兒聽篩
2010年5月25日 星期二
『婦聯聽障文教基金會』
簡介:
將近二十年前，當我知道聽損孩子戴上助聽器之後，也可以和一般孩子一樣開口說話時，心裡真有說不出的驚喜，由此而展開了我與聽損孩子們不解之緣。當時我想，聽損孩子需要用手語和別人溝通，但是一般人不會使用手語，溝通就不容易，如果聽損孩子也能使用口語，那麼他們融入社會生活的可能性就會大大地提高，也因此可以減少社會成本的付出，於是就在婦聯會附設的惠幼托兒所裡，開辦了教導三到六歲聽損孩子說話的聽障班。當時只是一個很單純的念頭，沒想到竟能像一粒落入土中的麥子一樣，成長、繁衍，成了國內聽損早期療育的濫觴。那時候正值婦聯會衡量社會需求，亟思調整社會服務內容的當口。看著聽損事工得推廣已見成效，有愈來愈多的聽損家庭到婦聯會求助，於是我們決定開辦「天聽專案」，將婦聯會原本為國軍縫製征衣的縫衣工場，改為聽語訓練教室，將正規教育體制中所缺乏的零至三歲聽損幼兒教育納入，讓零到六歲的聽損孩子都有機會接受聽損教育，學習「聽」和「說」，真正落實「早期發現、早期治療」精神。
聽損教育若要在一個穩健、紮實的基礎上發展，師資的養成是一個極為關鍵的課題。所以民國八十四年，婦聯會特地邀請加拿大聽覺口語法專家茱蒂‧辛塞來台講習一年，以提昇國內聽損早療教師的專業水準，同時率先將聽覺口語法有系統地引進台灣。此舉在當時的聽損教育界引起了極大的迴響，也讓更多人瞭解到「聽損」不是「不能」，「聽損者也有機會可以聽見全世界」。
婦聯會在民國八十五年捐資成立了婦聯聽障文教基金會，正式以專責機構來推廣服務。我們在基金會裡建置了符合國際標準的聽力室，聘請受過嚴謹訓練的聽力師執行專業服務。這是國內第一個有聽力師專業介入的聽損教育單位，將聽損教學與聽力學管理密切結合，讓我們的老師能夠隨時掌握孩子的聽覺狀況，並據以調整教學計畫及提供適切的諮詢。
隨著灑下的種子日漸茁壯，基金會也陸續成立了二個教學中心，讓遠道的聽損家庭可以就近接受服務；此外，更在振興醫院裡成立了聽覺醫學中心，建立台灣第一個跨領域整合的專業服務團隊，同時將服務層面擴及成年聽損族群，使當初成立基金會的用意，得到具體而有深廣的延伸。
近年來電子科技的進步，研究方法的改進，讓我們瞭解到聽損孩子的教學，不能再以「開口說話」為滿足，而是要提昇他們學習和解決問題的能力，與主流社會適切地融合在一起，成為真正的獨立個體才是聽損早療教育的最終目標。因此，基金會跟著科學進展的腳步，不斷地改進教學方法，從而提出發展多元智慧的概念，應用於聽損教育中。這個在十年前提出的觀念，近年來普遍獲得特教界的認同，而我們也在孩子們進入小學和各個求學階段後，看到了顯著的成效。我們深感欣慰。
付出本身就是一種收穫，身為基金會董事長，每次和夥伴們一起回顧歷史時，總是心波蕩漾，一方面有喜悅，另一方面又有一股力量推動我們繼續向前，為聽損孩子們全心付出。我們並不以服務人次已超過幾千人感到滿足，因為我們有更大的願望，我們對所有聽損孩子們抱持希望，我們要為他們築夢，一個可以實現的美麗的夢。
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- 舉辦聽損教學及親職教育研討會
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文章內容引述婦聯基金會網站
2010年5月23日 星期日
新生兒聽力篩檢工具之認識:OAE v.s AABR
本文經財團法人 兒童聽語文教基金會同意
轉錄自 雅文兒童聽語文教基金會 第21期聽語期刊
http://www.chfn.org.tw/theway_3_4.aspx?CID=P_00000015
醫師專欄
新生兒聽力篩檢工具之認識：OAE vs. AABR
經歷：
中山醫學大學 兼任講師、助理教授、副教授
國立台北護理學院 兼任助理教授、副教授
台北馬偕紀念醫院 耳鼻喉科 主任
2009 10月攝於太平洋吉里巴斯 國際醫療義診
撰文/台北馬偕紀念醫院耳鼻喉科林鴻清主任
前言
因 2009 年聽障奧運在台北舉行的緣故，聽力損失的議題得到政府及社會大眾的注意，也因此自2009年起多個縣市陸續推行免費新生兒聽力篩檢計劃嘉惠國民。本會此次特別邀請林鴻清醫師為我們撰文介紹新生兒聽力篩檢工具。林鴻清醫師自1998年起致力推廣新生兒聽力篩檢，目前也是行政院衛生署國民健康局新生兒聽力篩檢計劃主責醫師。
耳聲傳射(OAE)之原理與發展背景
在1990年代之前，只能使用傳統聽性腦幹反應(Conventional ABR)作為新生兒聽力篩檢工具，因為較耗人力、物力，故只能針對約高危險群新生兒(約佔10%之新生兒)施行，這僅能篩檢出約一半的先天聽力障礙患者。耳聲傳射(Otoacoustic emission，OAE)之生理現象早於1978年被英國倫敦大學David Kemp教授發現，當刺激音由外耳道傳入，經由中耳傳到內耳，刺激了內耳的外毛細胞，產生行波，當行波的振動波反射回外耳道，再由麥克風接收此回音，可藉此評估內耳外毛細胞的功能，進而協助聽力診斷。
1988年Kemp研發出第一台商品臨床應用的OAE儀器，與ABR檢查相比，有著不用貼導極、操作方便、施行迅速、簡易判讀的優點。故迅速廣泛為臨床應用。美國由猶他大學Karl White教授與倫敦大學David Kemp教授合作，於1990年代初期，在美國羅德島州(Rhode Island)推行全面性的新生兒聽力篩檢計畫，結果證實TEOAE作為新生兒聽力篩檢工具是可行的，可以早期診斷先天性聽障，於是美國開始廣泛使用TEOAE作為新生兒聽力篩檢之第一線工具，這是OAE最發揚的年代。
OAE雖然操作方便快速，且儀器、耗材較AABR便宜，但因測試過程容易受到新生兒外耳道胎脂影響，易造成偽陽性較高，亦即無聽力異常之新生兒卻沒有通過篩檢，造成家人巨大的焦慮與心理壓力。另外針對較特殊的聽力損失疾病，例如：聽神經病變 (auditory neuropathy，約佔10%之先天性聽障患者)，OAE無法提供診斷，亦即會出現偽陰性(新生兒聽力異常但OAE篩檢通過)。
自動聽性腦幹反應(AABR)之原理與發展背景
在OAE儀器問世的前後，美國Natus公司研發出ALGO第一代的自動聽性腦幹反應(Automated auditory brainstem response，AABR，目前已經研發至第四代) 。其原理和傳統ABR相同，由耳機放出35 dB click刺激音，評估聽神經與腦幹功能，藉由導極接收新生兒大腦對刺激音的腦波反應，但比起傳統ABR，AABR最大的好處在於電腦可自動判讀測試結果，顯示「通過」（Pass）或「應轉介」（Refer）。AABR不受外耳道胎脂影響，偽陽性較低，所以轉介率也較低，唯獨AABR設計上因為需貼導極紀錄腦波，較容易驚嚇受測新生兒，操作上也比OAE稍微複雜、較耗時間，且儀器比OAE昂貴。唯針對可能的聽神經病變(auditory neuropathy)新生兒，AABR是可以偵測到，因此針對高危險群，如加護病房的新生兒，一定建議施行AABR。而日前越來越多的研究指出，AABR最大的強項是偽陽性較低，讓家人感到最焦慮的莫過於新生兒的健康，過高的偽陽性結果不但造成新生兒雙親無謂的焦慮和心理壓力，往後耗費在追蹤聽力檢查上的金錢、時間以及人力，更是相當龐大。（轉介率(Referral rate)的定義：未通過篩檢而需要轉診進行更進一步檢查的比率。）
馬偕紀念醫院之經驗
雅文兒童聽語文教基金會與台北馬偕紀念醫院於1998年合作推廣台灣新生兒聽力篩檢計畫，一開始採用的聽力篩檢工具是短暫音誘發之耳聲傳射(Transient evoked otoacoustic emission, TEOAE)，它具有操作方便性、高準確性及價格便宜等優點；回顧之前的研究結果，接受TEOAE後而需要轉診進行更進一步檢查的轉介率為6.4%，本院一直到2004年，才修改成TEOAE搭配AABR進行聽力篩檢，而這種二階段的篩檢方式的確把聽力異常轉介率，由原先的5.8%降至1.8%。於是在2005年，因篩檢技術人員對AABR的熟稔度增加，也為了嘗試是否能進一步改善偽陽性與降低轉介率，本院全面實施以AABR當作唯一的篩檢工具，結果也已證實再次降低轉介率至0.9%，使其更有效率的篩檢出聽力異常的新生兒。
如何選擇適當的第一線聽力篩檢工具
綜合篩檢工具之優缺點，建議選擇AABR作為新生兒聽力篩檢工具。其主要原因為可以有效降低聽篩偽陽性，減少家人的焦慮。並可以篩出聽神經病變(auditory neuropathy)新生兒，減低偽陰性。然而鑒於AABR儀器設備較貴的考量，國內部分醫院仍採用OAE作為聽篩工具，從馬偕醫院多年臨床操作之心得顯示，OAE著重在清潔外耳道、耳塞與探頭，以及改進放置篩檢儀器耳塞技巧。有經驗者也可以適當改善未通過率。臨床上發現當OAE重複進行到第三次測試，可以把轉介率由17.3%降到5%(仍然偏高)。
國民健康局於2008編寫<台灣新生兒聽力篩檢共識>文件中，也明文建議指出：自動聽性腦幹反應(AABR)為最合適的新生兒聽力篩檢工具。其主要根據請見下表AABR與OAE之比較：
耳聲傳射
OAE 自動聽性腦幹反應
AABR
儀器設備與耗材 較便宜 J 較貴
測試時間 較短 J 較長
偽陽性率 較高 較低 J
轉介造成產婦壓力 很高 很低 J
聽神經病變 無法偵測 可以偵測 J
單次初步篩檢費用 較低 J 較高
總費用（初篩與複檢） 較高 較低 J
結語
從以上介紹我們知道目前 AABR 的偽陽性及轉介率較低，相對的也減少家人不必要的焦慮及壓力，不過 OAE 檢查也並不是沒有優點，例如：OAE檢查對於發現輕度聽損或是中耳異常較AABR敏感。因此不管您的寶寶接受哪一種檢查方法，應記得新生兒聽力篩檢只是一個開始，重要的是若寶寶未通過新生兒聽力篩檢，爸爸媽媽應儘早帶孩子回門診追蹤。若確實有聽力損失儘早接受療育才能確實預防孩子因聽力損失而語言發展遲緩，進而影響孩子的學習能力。
2010年3月26日 星期五
SCI-me co-author
論文著作:SCI-me co-author
| 編號 | 論文題目 | 下載 |
| 1 | CI |  |
| 2 | Progress towards early detection of hearing loss | |
| 3 | ||
| 4 |
2010年3月5日 星期五
FM 無線調頻
http://www.hearingaid.com.tw/FM/FM1-1.htm
各教育階段應向哪些單位申請FM？ | |
1. | 國中小（含縣市立高中職）： |
由各縣市政府負責，特教資源中心於評估後提供輔具。 | |
2. | 高中職： |
由教育部中部辦公室負責，暫時由教育部委辦之三個大專輔具中心提供服務。 | |
3. | 大專校院： |
由教育部特教小組負責，由教育部委辦之三個大專輔具中心提供服務。（視障：淡江大學、聽障：高雄師範大學、肢障：中山醫學大學附設復健醫院）。 | |
欲申請 FM 請洽各縣市特教 電話：(03)9312464 地址：260宜蘭市民權路一段36號 | 台中市特教資源中心 電話：(04)2121293 地址：401台中市東區樂業路60號 |
電話：(02)24243752 地址：202基隆市中正區中船路36巷4號 | 電話：(04)7273173 地址：500彰化市泰和路二段145巷1號 |
電話：(02)25924446 地址：103台北市大同區重慶北路三段 320號 | 電話：(049)2562609 地址：南投縣草屯鎮中正路568-23號 (旭光高中) |
電話：(02)29438252 地址：220臺北縣板橋市中山路1段161號21樓 | 電話：(05) 6361859 地址：632雲林縣虎尾鎮民主路36號 |
電話：(03)4629991 地址：320桃園縣中壢市育英路55號 | 電話：(05)2283781 地址：600嘉義市垂楊路241號(崇文國小第三棟一樓) |
電話：(037)337811 地址：360苗栗市縣府路100號 | 電話：(07)3133940 地址：807高雄市三民區十全一路一號 |
電話：(03)5216121#264 地址：300新竹市中正路120號 | 電話：(06)9274400 地址：880澎湖縣馬公市治平路32號 |
電話：(03)5572346 地址：304新竹縣新豐鄉新興路291號 | 資源教室電話: 07-7172930分機1633 |
以上內容轉述http://www.ear.com.tw/FM/FM1.htm網站，若不便 惠予告知！
特教法、身心障礙者生活輔助器具費用補助標準表
◎特教法規
◎臺北市身心障礙者生活輔助器具費用補助標準表(980501修正適用)
◎臺北市身心障礙者生活輔助器具費用補助標準表(980501修正適用)
71、 助 聽 器 | 單耳 | １０,０００ | ５,０００ | ３ | 聽障者、語障者或具聽障、語障之多重障礙者。 ＊需由身心障礙鑑定醫院耳科醫師診斷證明及經醫療機構內之聽力檢查人員評估檢查。雙耳聽力皆損失在55dB~110dB之間補助兩只；優耳聽力在55dB~110dB之間，劣耳聽力110dB以上補助1只；聽力損失認定標準為氣導聽力檢查頻率500Hz~4000Hz之間平均值。 | 一、檢附文件:1、由耳科醫師開立註明症狀需要該項輔具之診斷證明書。2、臺北市助聽器評估/檢測表(第1次向本局申請助聽器補助者，需符合配戴前聽力評估檢查補助標準及配戴後效益檢測合格標準；第2次(含)以上向本局申請者，需符合配戴前聽力評估檢查補助標準，得免作配戴後效益檢測)。3、輔具買賣契約書影本(註明助聽器廠牌、型號、序號)。 二、18歲以下者，最高補助金額單耳為10,000元，雙耳為28,000元，補助使用年限為2年；18歲至20歲以下者檢附在學證明文件(指教育部立案之學校但不含空大、高中以上進修學校、在職班、學分班、僅夜間或假日上課、遠距教學之學校)，補助金額及補助使用年限比照辦理。 三、12歲以下兒童補助使用年限為1年。 |
雙耳 | ２０,０００ | １０,０００ | ||||
72、人工電子耳 | ６００, ０００ | 一般戶 最高補助額度 ２００,０００ | 終身乙次 | 詳見臺北市人工電子耳補助計畫 | ||
中低收入戶 最高補助額度 ４００,０００ | ||||||
73、人工電子耳耗材（含長線、短線、線圈、麥克風及磁鐵…等項目）(單次補助金額) ☆ | ５,０００ | ４,０００ | ２ | 申請者需接受人工電子耳植入手術滿3年，始可提出補助申請。 | 一、第1次向本局申請人工電子耳耗材補助者，需檢附由醫師開立註明人工電子耳植入日期之診斷書，以證明植入手術已滿3年，第2次(含)向本局申請者可免附診斷書。 二、各項耗材項目需同批1次提出申請。 三、12歲以下兒童補助使用年限為1年。 | |
補助對象 | １. 設籍並實際居住本市，且領有本市核發、換發、補發或註記之身心障礙手冊者。 ２. 申請補助項目未獲政府其他醫療補助、社會保險給付或其他相同性質(輔具器具)補助者。 ３. 曾申請輔具補助者，須已超過輔助器具之補助年限。 ４. 其他：詳見「臺北市身心障礙者生活輔助器具費用補助標準表」有關規定。 | |||||
◎地方社會局
機關名稱 | 地址 | 電話 | 傳真 |
台北市信義區市府路1號 | (02)27208889 | (02)27206552 | |
高雄市四維三路2號2樓 | (07)3373365 | (07)3333565 | |
台北縣板橋市中山路一段161號25樓 | (02)29603456 | (02)29693894 | |
宜蘭縣宜蘭市同慶街95號 | (03)9328822 | (03)9328522 | |
桃園市縣府路1號 | (03)3375900 | (03)3362942 | |
新竹縣竹北市光明六路10號 | (03)5519058 | (03)5554694 | |
苗栗市縣府路100號 | (037)328841 | (037)355329 | |
台中縣豐原市陽明街36號 | (04)25263100 | (04)25264411 | |
彰化縣彰化市中與路100號 | (04)7264150-2 | (04)7238243 | |
南投縣南投市中興路660號 | (049)2222106-9 | (049)3204188 | |
雲林縣斗六市雲林路二段515號 | (05)5323395 | (05)5348530 | |
嘉義縣太保市祥和一路東段1號 | (05)3620123 | (05)3620348 | |
台南縣新營市民治路36號 | (06)6322231 | (06)6321592 | |
高雄縣鳳山市光復路2段120號 | (07)7460050 | (07)7100057 | |
屏東縣屏東市自由路527號 | (08)7320415 | (08)7334046 | |
台東縣台東市中山路276號 | (089)326141 | (089)3345451 | |
花蓮市府前路17號 | (03)8227171 | (03)8230840 | |
澎湖縣馬公市治平路32號 | (06)9274400 | (06)9264067 | |
基隆市中正區義一路1號 | (02)24201122 | (02)24258637 | |
新竹市中正路120號 | (03)5216121 | (03)5261409 | |
台中市中區自由路二段53號 | (04)22289111 | (04)22291810 | |
嘉義市中山路160號 | (05)2254321 | (05)2292835 | |
台南市永華路2段6號 | (06)2991111 | (06)2991764 | |
金門縣金城鎮民生路60號 | (082)325551 | (082)320105 | |
連江縣馬祖南竿鄉介壽村76號 | (0836)22485 | (083)622209 |
以上內容為轉述，如果不便 惠予告知！
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