BACKGROUND:  We aimed to explore the role of comprehensive vestibular rehabilitation based on virtual reality (VR) technology in residual symptoms after canalith repositioning procedure.
METHODS:  A total of 124 patients, who were diagnosed with benign paroxysmal positional vertigo from September 2020 to July 2023 and had residual symptoms 24 hours after the canalith repositioning procedure, were selected as the subjects. They were randomly divided into a normal control (NC) group, a Cawthorne-Cooksey exercise group (n=41), a Brandt-Daroff exercise group (n=41), and a VR group (n=42). The NC group received no intervention, the Cawthorne-Cooksey exercise group underwent Cawthorne-Cooksey exercise, the Brandt-Daroff exercise group was subjected to Brandt-Daroff exercise, and the VR group was given comprehensive vestibular rehabilitation based on VR technology.
RESULTS:  After treatment, the Dizziness Handicap Inventory (DHI) and vestibular symptom index (VSI) scores of the virtual reality (VR), Cawthorne-Cooksey exercise, and Brandt-Daroff exercise groups were significantly lower than those of the NC group (P <.05). The scores of the VR group were lower than those of the Cawthorne-Cooksey exercise and Brandt-Daroff exercise groups (P < .05). The abnormality rates of ocular vestibular evoked myogenic potentials (oVEMP) and cervical vestibular evoked myogenic potentials (cVEMP) in VR, Cawthorne-Cooksey exercise, and Brandt-Daroff exercise groups were lower than those of the NC group (P <05). The rates of the VR group were lower than those of the Cawthorne-Cooksey exercise and Brandt-Daroff exercise groups (P <05).
CONCLUSIONS:  Comprehensive vestibular rehabilitation based on VR technology can cure the residual symptoms after the canalith repositioning procedure, reduce the abnormality rates of oVEMP and cVEMP, and reconstruct the balance ability.

BACKGROUND: Vertigo is the most common clinical complaint, misdiagnosed patients are not rare, so it is very important to exclude and identify vertigo. For vertigo caused by multiple causes, including cervical vertigo with atlantoaxial rotation fixation combined with benign paroxysmal positional vertigo (BPPV), tuina can correct joint misalignment. The reduction technique will return the fallen otolith to the correct position. The use of massage and reduction can improve clinical symptoms and improve quality of life and may be a simple, safe, and effective treatment strategy for this disease.
METHODS: We report on a patient with both cervical vertigo due to atlantoaxial rotational fixation and BPPV, including his imaging examination, clinical manifestations, and treatment methods.
METHODS: Cervical vertigo (atlantoaxial rotatory fixation) and BPPV.
METHODS: Tuina combined with atlantoaxial directional inverted reduction technique and reduction manipulation.
RESULTS: The patient\'s vertigo symptoms improved significantly, nystagmus disappeared, cervical occipital pain, nausea, head distension, and other symptoms disappeared, and cervical motion rotation reached 60°.
CONCLUSIONS: This study proved the effectiveness of massage combined with a reduction in the treatment of cervical vertigo and BPPV, as well as the importance of vertigo diagnosis and differential diagnosis, and provided a new treatment idea for the future diagnosis and treatment of vertigo caused by a variety of causes.

UNASSIGNED: This study aimed to investigate the characteristics of positional nystagmus in patients with cupulolithiasis of the posterior semicircular canal-benign paroxysmal positional vertigo (PC-BPPV-cu) to improve clinical diagnostic accuracy.
UNASSIGNED: This study retrospectively analyzed 128 cases of PC-BPPV-cu and 128 cases of canalolithiasis of BPPV (PC-BPPV-ca). General data, intensity, distribution, and the correlation of positional nystagmus were compared between the two groups.
UNASSIGNED: Compared to the PC-BPPV-ca group, more cases from the PC-BPPV-cu group initially presented in the emergency department (P < 0.05). The most frequent positional nystagmus induced by PC-BPPV-cu was torsional-upbeat nystagmus, characterized by the upper pole of the affected eye beating toward the lower ear and vertically upward (387 cases, 59.7%). It was followed by torsional-downbeat nystagmus, characterized by the upper pole of the unaffected eye beating toward the lower ear and vertically downward (164 cases, 25.3%). The former represented posterior canal excitatory nystagmus (PC-EN), while the latter represented posterior canal inhibitory nystagmus (PC-IN). In the PC-BPPV-cu group, PC-EN was most easily caused by the Half Dix-Hallpike (HH) maneuver on the affected side, while PC-IN was most easily induced by a face-down position (FDP) on the unaffected side at approximately 45° angle (45° FDP). The vertical slow phase velocity (v-SPV) of positional nystagmus was more potent in the affected HH than in other positions with PC-EN (all P < 0.05); the v-SPV of positional nystagmus was greater in the 45° FDP than in different positions with PC-IN (all P < 0.05); the v-SPV of the affected Dix-Hallpike (DH) maneuver in the PC-BPPV-ca group was significantly greater than that of the affected HH maneuver in the PC-BPPV-cu group (P < 0.05). The a priori analysis showed that the strongest correlation with HH positional nystagmus was observed in the affected side roll test, followed by the DH maneuver.
UNASSIGNED: In the PC-BPPV-cu group, the HH maneuver most easily induced PC-EN on the affected side, and PC-IN was most easily induced by the 45° FDP. In some cases of PC-BPPV-cu, significant nystagmus was not observed to be induced in the DH position on the affected side; however, vertical rotation nystagmus was induced in the roll-test position on the affected side. In such cases, PC-BPPV-cu diagnosis should be considered, and HH and 45° FDP tests should be conducted to support the diagnosis.

BACKGROUND: To analyze the risk factors for benign paroxysmal positional vertigo (BPPV) and to construct a predictive nomogram model.
METHODS: In this retrospective study, 312 participants were enrolled, including 164 BPPV patients and 148 healthy subjects without BPPV. Risk predictors for BPPV were identified using univariate and multivariate analyses, and a clinical nomogram was constructed. The predictive accuracy was assessed by unadjusted concordance index (C-index) and calibration plot.
RESULTS: Univariate and multivariate regression analysis identified stroke (95% CI, 0.575-5.954; P=0.022), hyperlipidemia (95% CI, 0.471-4.647; P=0.003), chronic suppurative otitis media (95% CI, 1.222-45.528; P=0.005), cervical spondylosis (95% CI, 1.232-3.017; P=0.005), and osteoporosis (95% CI, 1.130-3.071; P=0.001) were the independent risk factors for BPPV. These risk factors were used to construct a clinical predictive nomogram. The regression equation was: logit (P) = -6.820 + 0.450 * stroke + hyperlipidemia * 0.312 + chronic suppurative otitis media * 0.499 + cervical spondylosis * 0.916 + osteoporosis * 0.628. The calibration curves demonstrated excellent accuracy of the predictive nomogram. Decision curve analysis showed that the predictive model is clinically applicable when the threshold probability was between 20% and 60%.
CONCLUSIONS: Stroke, hyperlipidemia, chronic suppurative otitis media, cervical spondylosis and osteoporosis are independent risk predictors for BPPV. The developed nomogram is useful in predicting the risk of BPPV.

Objective: To investigate the disease composition, clinical features, diagnosis, and treatment characteristics of vertigo in children. Methods: A total of 120 children with vertigo diagnosed and treated in the Department of Otorhinolaryngology, Children\'s Hospital, Capital Institute of Pediatrics in Beijing from February 2018 to February 2022 were retrospectively analyzed to explore the clinical characteristics of common peripheral vertigo in children and to summarize the experience of diagnosis and treatment. Results: The etiological composition of 120 cases of vertigo in children are as follows: 63 (52.5%) cases of vestibular migraine of childhood (VMC), 19 (15.8%) of recurrent vertigo of childhood (RVC), 11 (9.2%) of probable vestibular migraine of childhood (PVMC), 10 (8.3%) of secretory otitis media (SOM), 6 (5.0%) of persistent postural-perceptual dizziness (PPPD), 4 (3.3%) of benign paroxysmal positional vertigo (BPPV), 2 (1.7%) of vestibular neuritis (VN), 2 (1.7%) of Meniere\'s disease (MD), 2 (1.7%) of inner ear malformation (IEM), and 1 (0.8%) of vestibular paroxysmal syndrome (VP).The major cause of vertigo in children of different ages was different. SOM was the most important cause in preschool children, followed by RVC and VMC; VMC was the most important cause in school-age children, followed by RVC; and MD and BPPV were exclusive found in adolescents. The incidence rate of PPPD was higher in adolescents than in preschool and school-age children. Children with vertigo had good prognosis in general. Conclusions: VMC, RVC and SOM are the most common causes in vertigo in children, and their proportion was different in different aged children. Transforming abstract feelings into specific information is the skill required for collecting medical history of children with vertigo. Considering the age and cooperation of children, appropriate hearing and vestibular examination techniques are recommended. We should pay more attention to the mental health of children with vertigo and their parents.
目的： 了解儿童眩晕的病因构成、临床表现及诊疗特点。 方法： 病例系列研究。回顾性分析2018年2月至2022年2月首都儿科研究所附属儿童医院耳鼻喉科诊治的120例眩晕患儿的临床资料，探讨儿童常见眩晕的临床特点、总结诊疗经验。 结果： （1）120例儿童眩晕的病因构成：儿童前庭性偏头痛（VMC）63例（52.5%）、儿童复发性眩晕（RVC）19例（15.8%），可能性前庭性偏头痛（PVMC）11例（9.2%），分泌性中耳炎（SOM）10例（8.3%），持续性姿势-感知性头晕（PPPD）6例（5.0%）、良性阵发性位置性眩晕（BPPV）4例（3.3%），前庭神经炎（VN）2例（1.7%），梅尼埃病（MD）2例（1.7%），内耳先天性发育畸形2例（1.7%）、前庭阵发症（VP）1例（0.8%）。（2）不同的年龄阶段，儿童眩晕的病因构成不同，学龄前儿童最主要的是SOM，之后是RVC和VMC；学龄儿童则主要是VMC，之后是RVC；相较于其他年龄段，青少年期MD、BPPV，尤其是PPPD发病率更高。（3）眩晕患儿的整体预后较好。 结论： 眩晕患儿病因以VMC、RVC、SOM为主，在不同的年龄阶段病因不同。采集眩晕患儿病史的技巧是将抽象的感受转化为具体的事项。根据儿童的年龄和配合度，选择适合的听力和前庭检查，并关注眩晕患儿及家长的心理健康，将有助于临床诊治。.

机体代谢异常可通过对耳石膜的结构及耳石正常生理代谢过程产生一定的影响，进而作用于良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）的发生、发展和预后。本文就代谢异常与BPPV相关的基础研究和临床研究做一总结，探究代谢异常在BPPV中的影响。.

Objective:To explore the clinical value of supine median³ nystagmus in the accurate diagnosis of horizontal semicircular canal benign paroxysmal positional vertigo（HC-BPPV）. Methods:A total of 187 patients with HC-BPPV admitted to the First Affiliated Hospital of Xi\'an Jiaotong University from June 2020 to March 2021 were selected. Among them 42 cases of Cupulolithiasis and 145 cases of Canalithiasis. The nystagmus parameters of patients left and right supine position and supine median³ position were recorded in detail by RART. According to the direction of supine median³ nystagmus, patients were divided into three groups: group A（nystagmus to weak side）, group B（nystagmus to strong side）, group C（negative nystagmus）. The canalith repositioning manoeuvres（CRM） was carried out by utility of an automatic vestibular function diagnosis and therapy system（SRM-IV）. The cure rate of CRM in three groups of HC-BPPV patients was compared, Multivariate logistic regression analysis was performed to analyze the influencing factors of CRM for HC-BPPV. Results:The cure rates of group A, group B and group C were 81.58%, 16.13% and 56.25%, respectively. The difference among the three groups was statistically significant. Then a pairwise comparison of group A, B and C, the difference was statistically significant（χ²A-B=40.294,P<0.001,χ²B-C=14.528, P<0.001,χ²A-C=11.606, P=0.001）; the results of multivariate logistic regression analysis showed that the direction of supine median³ nystagmus and BMI were the influencing factors of CRM for HC-BPPV. Conclusion:The direction, intensity and duration of supine median³ nystagmus play an important role in determining the responsibility semicircular canal of HC-BPPV.
目的：探讨仰卧正中位³眼震特征在水平半规管良性阵发性位置性眩晕（horizontal canal benign paroxysmal positional vertigo，HC-BPPV）责任半规管准确判定及疗效预估中的临床价值。 方法：选取2020年6月至2021年3月就诊于西安交通大学第一附属医院耳鼻咽喉头颈外科并确诊为HC-BPPV的患者187例，其中嵴顶结石症42例，管石症145例。采取快速轴位滚转试验（rapid axial roll test，RART）并详细记录患者在双耳下及仰卧正中位³引出的眼震参数，按照仰卧正中位³眼震方向分为3组：A组（眼震向弱侧）、B组（眼震向强侧）、C组（眼震阴性）。通过全自动前庭功能诊治系统（SRM-Ⅳ）进行复位治疗，比较3组HC-BPPV患者的复位治愈率，并进行多因素logistic回归分析HC-BPPV复位疗效的影响因素。 结果：A组治愈率81.58%（62/76），B组治愈率16.13%（5/31），C组治愈率56.25%（45/80），3组治愈率比较，差异有统计学意义（χ²=40.038，P<0.001），3组两两比较，患者治愈率差异均有统计学意义（χ²A-B=40.294，P<0.001，χ²B-C=14.528，P<0.001，χ²A-C=11.606，P=0.001）。多因素logistic回归分析结果显示：仰卧正中位³眼震方向及BMI是HC-BPPV复位疗效的影响因素。 结论：仰卧正中位³眼震的方向、强度及持续时间在判定HC-BPPV责任半规管中有重要意义。.

UNASSIGNED: The association between benign paroxysmal positional vertigo (BPPV) and various mental disorders is still controversial. This study used the Mendelian randomization (MR) method to clarify the correlation between BPPV and seven mental disorders (bipolar disorder, depression, anxiety disorder, schizophrenia, suicidality, neuroticism, and mood swings) to aid in the exploration of BPPV complications and prevention and early treatment of mental disorders.
UNASSIGNED: The datasets for BPPV and seven mental disorders were obtained from genome-wide association studies (GWASs). Two-sample MR was used to analyze the correlation between exposure (BPPV) and various outcomes (bipolar disorder, depression, anxiety disorder, schizophrenia, suicidality, neuroticism, and mood swings). A reverse MR study was also performed. The inverse variance weighting (IVW) method, the MR-Egger method, the simple mode method, the weighted mode method, and the weighted median method were selected.
UNASSIGNED: The MR analysis and the reverse MR analysis results did not reveal significant associations between BPPV and bipolar disorder, depression, anxiety disorder, schizophrenia, suicidal tendencies, neuroticism, and mood swings. Interestingly, neuroticism (IVW: OR = 1.142, 95% CI: 1.059-1.231, P = 0.001; P-MR-PRESSO adjustment = 0.0002) and mood swings (IVW: OR = 3.119, 95% CI: 1.652-5.884, P = 0.0004) may have a significant association with BPPV. After MR-PRESSO adjustment, there was no horizontal pleiotropy or heterogeneity, and a significant association between neuroticism, mood swings, and BPPV has still been suggested.
UNASSIGNED: We conducted MR analysis on genetic data from European populations and discovered a causal relationship between BPPV and the seven mental disorders. Our research findings suggest that BPPV may not have a significant causal relationship with bipolar disorder, depression, anxiety disorder, schizophrenia, or suicidal tendencies. However, neuroticism and mood swings may be risk factors for BPPV.

Objective: To compare the clinical efficacy of personalized vestibular rehabilitation and otolith reposition in treating atypical benign paroxysmal positional vertigo (BPPV). Methods: A randomized controlled trial was carried out. Fifty patients diagnosed with atypical BPPV in the Vertigo Clinic of the First Affiliated Hospital of Shandong First Medical University from October 2022 to September 2023 were recruited and randomly divided into manual reduction group (25 cases) and vestibular rehabilitation group (25 cases) according to the random number table. All patients were given flunarizine. Patients in the manual reduction group were treated by Epley maneuver and (or) Barbecue maneuver, while the vestibular rehabilitation group was given personalized vestibular rehabilitation therapy. After two weeks\' treatment, the clinical symptoms (positional vertigo/nystagmus) and total dizziness handicap inventory (DHI) score, DHI physical (DHI-P), DHI emotional (DHI-E), and DHI functional (DHI-F) of the two groups were evaluated and compared. Results: A total of 50 patients diagnosed with atypical BPPV were included, including 23 males and 27 females, with an average age of (48.8±14.5) years. There was no statistically significant difference between the two groups in age, gender, disease severity, Romberg, position test abnormality ratio (Dix-hallpike/Roll test), temperature test, and video head impulse test baseline test results (all P>0.05). After 2 weeks of treatment, the effective rates of the treatment in the manual reduction and vestibular rehabilitation groups were 56.0% (14/25) and 88.0% (22/25), respectively, with a statistically significant difference (P=0.025). The total DHI score, DHI-P, DHI-E, and DHI-F scores in both groups were significantly decreased after treatment (all P<0.001). Compared with the manual reduction group, the total DHI score (23.2±2.7 vs 36.4±15.7, P=0.002), DHI-P (10.2±4.6 vs 13.7±5.3, P=0.016) and DHI-F (6.5±6.4 vs 13.0±7.2, P=0.002) in the vestibular group were lower, however, there was no significant difference in DHI-E score between the two groups (6.6±4.8 vs 9.6±7.3, P=0.087). Conclusion: Compared with otolith reposition, personalized vestibular rehabilitation therapy plays a better role in improving the symptoms and decreasing DHI score for patients with atypical BPPV.
目的： 比较个性化前庭康复和耳石复位对不典型良性阵发性位置性眩晕（BPPV）的疗效。 方法： 随机对照试验。纳入2022年10月至2023年9月就诊于山东第一医科大学第一附属医院眩晕门诊的50例不典型BPPV患者，根据随机数字表法分为耳石复位组（25例）和前庭康复组（25例）。在常规口服用药基础上，耳石复位组根据症状和体征分别给予Epley和（或）Barbecue复位法，前庭康复组则予以制定个性化前庭康复方案进行治疗。于治疗后2周进行随访，对两组患者的临床疗效、眩晕残障量表（DHI）总分及躯体（DHI-P）、情感（DHI-E）、功能（DHI-F）三个维度评分进行比较。 结果： 50例不典型BPPV患者中，男23例，女27例，年龄（48.8±14.5）岁。耳石复位组和前庭康复组患者年龄、性别、DHI评分、Romberg试验分级、位置试验异常比例、双温试验异常比例、视频头脉冲试验（vHIT）基线结果比较差异均无统计学意义（均P>0.05）。治疗2周后耳石复位组、前庭康复组的眩晕治疗有效率分别为56.0%（14/25）和88.0%（22/25），差异有统计学意义（P=0.025）。两组患者治疗后DHI总分及DHI-P、DHI-E、DHI-F三个维度评分均较治疗前改善，差异均有统计学意义（均P<0.001）。与耳石复位组比较，前庭康复组患者治疗2周后DHI总分［（23.2±2.7）分比（36.4±15.7）分，P=0.002］以及DHI-P［（10.2±4.6）分比（13.7±5.3）分，P=0.016］、DHI-F［（6.5±6.4）分比（13.0±7.2）分，P=0.002］评分均更低，但DHI-E评分两组差异无统计学意义［（6.6±4.8）分比（9.6±7.3）分，P=0.087］。 结论： 个性化前庭康复治疗可以改善不典型BPPV的眩晕残障程度，且临床疗效优于耳石复位治疗。.

Objective:To analyze the related factors that may affect the onset of benign paroxysmal positional vertigo（BPPV）. Methods:Fifty BPPV patients treated in Department of Otolaryngology Head and Neck Surgery, Shanxi Provincial People\'s Hospital from May to September 2023 were selected as the case group, and 50 healthy adults were selected as the control group. Relevant information was collected by means of questionnaire survey and medical history inquiry. The two groups were compared in terms of sleep time, night sleep duration, wake times, underlying diseases（hypertension, diabetes, coronary heart disease, etc.） and negative emotional impact. Results:The proportion of male and female in the case group was 16% and 84%, and that in the control group was 20% and 80%. The mean age of the case group was（54.66±13.39） years old, and the mean age of the control group was（54.42±12.55） years old, ranging from 27 to 80 years old. The sleeping time of the case group was significantly later than that of the healthy group, and the difference was statistically significant（P<0.05）. The night sleep duration of the case group was shorter than that of the healthy group, the difference was statistically significant（P<0.05）. There was no significant difference in awakening times between the case group and the healthy group（P>0.05）. There were more patients in the case group with underlying diseases（54%） and affected by negative emotions（70%） than in the healthy group, and the difference was statistically significant（P<0.05）. Conclusion:Late sleep time, short sleep duration at night, accompanied by underlying diseases and negative emotions can affect the onset of BPPV.
目的：分析可能影响良性阵发性位置性眩晕（BPPV）发病的相关因素。 方法：选取2023年5-9月就诊于山西省人民医院耳鼻咽喉头颈外科的BPPV患者50例作为BPPV组，选取健康成年人50例作为对照组，采用问卷调查及病史询问的方式采集相关信息。比较2组人群在入睡时间、夜间睡眠时长、觉醒次数、有无基础性疾病（高血压、糖尿病及冠心病等）及受负面情绪影响等方面是否存在差异。 结果：BPPV组男、女比例分别为16%和84%，对照组男、女比例分别为20%和80%；BPPV组年龄27～80岁，平均（54.66±13.39）岁，对照组年龄26～80岁，平均（54.42±12.55）岁。BPPV组入睡时间明显晚于对照组，差异有统计学意义（P<0.05）；BPPV组夜间睡眠时长偏短，显著低于对照组，差异有统计学意义（P<0.05）；BPPV组觉醒次数与对照组比较，差异无统计学意义（P>0.05）；BPPV组伴有基础性疾病（54%）和受负面情绪影响（70%）者多于对照组，差异有统计学意义（P<0.05）。 结论：入睡时间偏晚、夜间睡眠时长过短、伴有基础性疾病及存在负面情绪等均可影响BPPV发病。.