摘自：天下雜誌群 康健雜誌6月號
採訪記者：天下雜誌群 康健雜誌 李佳欣記者
2011年7月5日 星期二
2011年6月2日 星期四
讓愛聽得見-馬偕人工電子耳基金
林鴻清醫師著作 "教會公報"_3091期_第17版(2011.05.26)
註:投稿內容網址:http://weekly-pctpress.org/2011/3091.html
讓愛聽見，人工電子耳
馬偕紀念醫院耳鼻喉科林鴻清主任
「如果沒有這樣走過一回，我不會知道人的心是這麼的善良，社會是這麼的美，有這麼多人一直在不求回報的做善事，大家對我的幫助讓我覺得我真的一點也不可憐，而是很幸運！」，這是一對雙胞胎姊妹的媽媽在「馬偕電子耳」部落格的留言。2005年，雙胞胎因為聽力上的障礙而需要植入電子耳，但沉重的經濟負荷卻讓母親的眉頭始終深鎖著，雖然如此，母愛的強韌讓她克服了重重難關，唯獨堅持著要雙胞胎同一天開刀，只為給她們同等的愛！如今，一家人已經漸漸走向光明人生，得到 神最大的恩賜與祝福。
「我的心渴望加入你的歌唱，但擠不出一點聲音來。我要說話，而言語不能開放成歌聲。」（泰戈爾）
人工電子耳手術（人工耳蝸植入手術），是治療極重度聽損程度至90分貝以上的感音神經聽力障礙的病人。手術後輔以「聽能復健」和「語言訓練」，就可使重度或極重度聽障患者重回有聲世界。然而「最單純的曲調，需要最艱苦的練習。」。對於聽力障礙的幼童，如果在植入人工耳蝸後配合語言治療師及聽障老師的教導，就可以讓他們開始辨識新的語音訊息，並開始學習口語（說話）。一般來說，學語前失聰的幼童，平均要6個月以上的訓練才會有較明顯的效果，經過1年的努力，便可以開口講話了。相對於學語後失聰（5歲後才失聰者）的病人（可以是大人或小孩），他的聽語復健的時間則比較快，常常在數個星期內，就可得到滿意的效果。手術後的孩童在生長發育及互動上的進展，對家屬而言是多麼大的感動與祝福啊！
因為人工電子耳的植入經費龐大，光是耗材就需要80-90萬台幣，造成許多父母經濟上的負擔，故政府每年定額補助近60個名額（依經濟狀況補助20、40、60萬），造福了無數民眾，但多數的病童只能申請到20萬，與手術的開支仍有一段距離。「孩子是不能等的！」，在本院徐銘燦醫師發起下，我們成立了『馬偕人工電子耳基金』，匯集善心人士的小額捐款及其他民間慈善團體幫忙，讓涓涓細流匯聚成河，共同幫助需要的聽障家庭。目前我們開刀植入電子耳的100多個個案中，多數請領政府補助，並由馬偕社工師評估提供部份院內補助款，至今所幫助的弱勢電子耳病友已經近壹千萬元。當中孩子的童言童語、及家屬欣慰的笑容，是我們最大的動力。
「我雖然行過死蔭的幽谷、也不怕遭害，因為你與我同在，你的杖、你的竿、都安慰我。」（詩經23：4）
聽得到母親的呼喚，是聽障兒最大的幸福！長達10多年的人工電子耳手術經驗，讓我們看見聽障幼童家庭的徬徨與無助，也喜樂於透過「馬偕人工電子耳基金」與病友團體的成立，為他們所帶來的改變。真愛能彌補缺憾，由於各界無私、真誠的付出，得以讓這些弱勢病人得到最大的扶持與幫助。一切感謝 主的恩典，期望各界教友能繼續支持我們，一齊陪伴他們走過人生幽谷，完成這美好的事工。
2011年5月26日 星期四
林鴻清下苦心聽損童 終會說笑幼兒聽篩推手
林鴻清下苦心聽損童終會說笑幼兒聽篩推手
2011/05/22 06:30 蘋果日報不論是生老病死，你我都得接觸醫生，《蘋果》每逢周六、日推出名醫專欄，由各大醫院推薦各個領域的名醫，讓讀者一窺他們白袍下的寫實人生。
十多年前，不少孩子上學才發現聽損，錯失及早治療的機會；現在多數聽損兒能在一歲前發現、介入治療，如同一般孩子學習講話與上學，主因是新生兒聽力篩檢的推動，其幕後重要推手，正是台北馬偕醫院耳鼻喉科主任林鴻清。
台灣每1000個新生兒，有4、5個寶寶單側或雙側聽力損傷。1998年，在雅文兒童聽語文教基金會與台北馬偕醫院支持下，林鴻清率先為該院出生寶寶執行免費新生兒聽力篩檢，到去年底，全台有276家接生的醫療院所提供自費或免費聽力篩檢，佔國內全年出生總人數的5、6成。
在林鴻清多年奔走下，台北市2年前全面免費提供新生兒聽篩，新北市、嘉義縣市與金門縣也跟進。林鴻清說：「過去很多孩子因為聽不到，只能學手語，變成不會說話的瘖啞人，無法融入社會。有了聽篩及助聽器、電子耳的發明，加上早期療育，他們再怎麼聾，也絕不會變成啞巴，人生完全不同。」他曾遇到一對瘖啞夫妻，生下聽損的女兒，在阿嬤積極協助復健下，兩歲的小女孩現妙語如珠，還很會說笑話。
奔走全台不喊苦推動歷程艱辛，旁人形容林鴻清如苦行僧。認識他逾15年的雅文基金會聽覺口語老師王文惠就說，「他全台跑透透，向官員、醫界推廣，不以為苦。」儘管受惠人數持續增多，林鴻清卻不滿足，「部分縣市仍只有不到半數寶寶受檢。仍有孩子上小學後，老師叫他卻慢半拍，才被發現。」他說，紐澳、新加坡、香港都是政府免費提供新生兒聽力篩檢。
為聽篩衝鋒陷陣十幾年，林鴻清遺憾政府過去未積極介入，如今僅宣導自費篩檢，唯低收入戶免費，「仍有家長不知要篩檢或因自費需1200元而卻步。」他指「政府應全方位照顧孩子，不要排富，應全面免費提供。因為越晚發現，孩子的語言、學習發展會越差。」
林鴻清說，國內推動聽篩團隊已做好基礎建設，台北市府更把篩檢價格壓低到每人500元。若一年出生20萬人，衛署1年只需花1億元，即可找到600個聽損寶寶，「重點是政府要不要做。」
爭全國免費聽篩
林鴻清下一步希望面見衛生署長邱文達，爭取全面免費聽篩。林鴻清笑說，早有心理準備，未必會成功，「儘管再困難、再辛苦，只要是對的事，都應堅持做下去。」
2010年12月27日 星期一
2010年10月17日 星期日
衛教:耳石脫落
參考來源:http://www.tchain.com/otoneurology/disorders/bppv/bppv.html
BENIGN PAROXYSMAL POSITIONAL VERTIGO
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Causes 
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
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.
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.
SURGICAL TREATMENT OF BPPV
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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