Benign dizziness in children. Benign Paroxysmal Purchase Dizziness: Nature of the occurrence and principles of treatment

One of the most frequent reasons System dizziness is a pathology that called "benign paroxysmal positional dizziness" (DPPG). Instant manifestation of signs of this disease is observed during squats and slopes, as well as when performing other exercise.

The patient's condition diagnosed with DPPG is characterized by short dizziness attacks that are provoked by the change of body position in space, its movement (sometimes quite sharply turn the head so that it began to be spinning). Such an organism reaction is called orthostatic hypotension.

The presence of ololytiasis may be due to the following reasons:

• middle ear infections;
• CMT (cranial trauma);
• compliance with prolonged beddown;
• outlook Operational Interventions;
• meniere disease;
• the action of certain antibacterial drugs (gentamicin);
• permanent attacks of migraine, provoked by dystonic and spasmodic phenomena in the arteries running in the labyrinth.

For the elderly, DPPG becomes more likely after a labyrinth infarction. In half cases, the cause of the occurrence of the disease remains unidentified. Women face such pathology 2 times more often than men.

Characteristic feature clinical picture In DPPG is Kupaulolithiasis (crystallized Calcium Circuit). The pressure exerted by them affects an ampular receptor responsible for the perception of angular acceleration.

For this reason, the positional dizziness is fixed when the head and torso are in a certain position. Under the influence of gravity, the fragments of the ololytes are moved to the semicircular channel (Coupulolyatiasis) or settle on the ampular receptor. The most often clutches are localized in the rear semi-currency channel of the labyrinth, since these areas are in the plane of gravity.

The beginning of the attack of DPPG occurs during the latent period lasting 10 seconds. First, dizziness will be strong. It is accompanied by various vegetative symptoms. This sensation lasts only 1 minute, and if not turning the head, it quickly passes.

After a few shifts, PDPG disappears, but a long rest leads to its re-occurrence, nevertheless no additional symptoms are noted.

Differential diagnosis

In order for the treatment to be effective, it is required to assign it only after you managed to make a diagnosis as accurately as possible. There are several diseases that are similar in their manifestations with DPPG or accompany him, creating an improper idea of \u200b\u200bthe state of the person.

Benign positional dizziness can resemble a migraine aura (one of the symptoms of osteochondrosis) or infectious pathology. Make the right conclusions in such cases helps differential diagnosiswhich is the most detailed and accurate.

Typical signs of DPPG:

• bredity (dizziness occurs without any visible reasons and ends similarly);
• the duration of the attack is no more than a day;
• there is vegetative symptoms (feeling of nausea, pallor skin Pokrov, hyperhydrosis, heat);
• at the end of the attack, the condition becomes completely ordinary and quite acceptable;
• unlikely appearance of noise in the ears, deafness and headaches.

The restoration of the body after overcoming the disease occurs very quickly, and no more than 30 days are required for treatment.

Diagnostics (in case of damage to the rear semicircular channel)

Diagnose in the patient canalolytiasis of the rear semicircular channel can be using a special test. When checking the right labyrinth of the patient, they ask to turn the head about 45˚ left.

After performing the conditions supplied, the specialist as quickly as possible, but gently stacked the patient to the right side and waits for 10 seconds of the latent period. Further, the subject is noted the emergence of dizziness and nystagms (twitching) aimed towards the right ear.

After the manifestation of symptoms becomes the maximum, their severity will go to the decline. As soon as all unpleasant sensations disappear, the patient will ask again quickly change the situation and sit down.

Usually, the signs of violations appear again, although with a smaller force, and Nistagm is sent to the opposite direction from the right ear.

Checking the left labyrinth channel is carried out according to a similar principle. This procedure is called sample of the positional dizziness Dix-Holpayka. In addition to her, it will be necessary to do:

• MRI brain;
• x-ray of the cervical spine;

If horizontal semicircular channels are affected, then the patient's status check method will be slightly different.

Diagnostics (with damage to the horizontal semicircular channel)

This variant of the disease is detected much less frequently, only 10-20% of cases. At the same time, various semicircular channels can be amazed on the ears (for example, on the left - horizontal, on the right - vertical), in addition, because of the actions of specialists, they can move one to another.

If the horizontal semicircular channel suffers, then the patient usually feels dizziness, having an attacking character when tilts his head in different directions, lying on the back. Notable only to this sign after a complete rest and when you turn the face towards the patient's ear.

Such diagnostics is convenient because it can be performed independently.

The latent period of the DPDG during the defeat of the horizontal semicircular channel of the brief (5 seconds), and the attack itself has a greater duration. Often, pathology is accompanied by vomiting.

Treatment

At the moment, the therapy of ololytiasis often appear, the actions that contribute to the extraction of the otolith from the semicircular channel back on the eve of the sieve. This allows you to remove the already existing symptoms, but does not guarantee that the attack will not happen again.

In situations where the excavation is impossible to eliminate, experts resort to a multiple vertigation provocation method, which allows to reduce the severity of symptoms (or even get rid of them) due to central compensation.

After the attending physician will make the necessary actions, it is usually necessary to reduce vestibular excitability. For this purpose, special vestibulolitic drugs are applied.

Most often, experts are prescribed by patients Betagistina Dihydrochloride (Betaderk). The medication has an impact on the inland ear histamine receptors and vestibular cores of the central nervous system.

Betaderk improves blood flow and normalizes the lymphatic pressure inside the snail and the labyrinth. In addition, the drug contributes to raising serotonin levels, which also makes vestibular kernels less active. The optimal dosage of the medication is 24 mg twice during the day.

In addition, the doctor may appoint additional meansthat will help eliminate nausea, dizziness and emotional stress, and will also contribute to the normalization of blood circulation as a whole.

One of the most significant moments relating to overcoming the disorder of the vestibular system is associated with the implementation of exercise complexes, which are a special vestibular gymnastics.

It is equally important to proceed to treatment as early as possible, as well as provide rational psychotherapy, because in some cases (as, for example, with phobic fatigue dizziness), the main cause of the disease may become psychological disorders, without the elimination of which the whole process will be meaningless. It should also be borne in mind that the patient may require not only drug, but also operational treatment.

Health gymnastics

First of all, we are talking about rotator (facing patient's ear) head slopes. The lying or leaning person holds the accepted pose for 10-15 seconds. After he sits down, at the same time turning his head to the side opposite to the sick area.

You can also turn turns with vertical swings back and forth. The necessary result is already per day after 75% of patients.

• Maneuver epipe.

You need to sit on the couch in the sitting position and turn your head about 45 ° to the side of the patient's ear. The specialist fixes the resulting posture and stacked the patient on the back, also throwing his head to 45 °. After that, it is necessary to deploy it in the opposite direction, and the whole body is entirely on the side where a healthy ear.

The last step is to take a starting position, tilt your head and turn to where dizziness is felt. Repeat the entire complex 3-4 times.

In a position sitting legs to hold perpendicular to the surface of the earth. Face unfold 45 ° in the direction of that ear that does not hurt. Pose to fix with the help of hands and lie on the side opposite to the side that the face turned.

In this position it is necessary to be until the attack is completely passed, and after the doctor will fly to the other side without changing the position of the head. Re-wait for the completion of the attack, then take the starting position. Repeat as needed.

Sitting on a couch, turn the head to the standard angle for such exercises to the side where the pathological area is located. The doctor must hold the patient's head throughout the maneuver. A person needs to be put on the back and turn his face in the opposite direction. Then turn the head to where the ear is great.

Further, the human body who came to the reception, turn around so that he lay down on the stomach. The head must be rotated so that the nose indicates perpendicularly down. Turn the patient to other sideways, and put the head so that her sick side is drawn down. Back to its original position through a healthy side.

Such techniques are usually quite enough to overcome the disease, so you should not resort to independently received folk recipes Treatment of dizziness, especially without receiving the approval of a specialist.

Outcome

Clearing DPPG should be necessary, since this will not be afraid in excessive depth or height, where strong pressure drops are recorded, and it will also be possible to minimize the probability of recurrence. The only thing that is required from the patient in this case is to consult a doctor in a timely manner so that he prescribes the necessary medicines, exercises or operation (if it is needed).

Benign paroxysmal positional dizziness (DPPG) ranks first among all the causes of Vertigo.

It occurs when changing the position of the body, sometimes in the most unforeseen moments.

The nature of this symptom, methods of diagnosis and treatment methods will be considered further in the article.

The positional circles of the head may arise after the occurrence of the cranial injury or transferred viral infection.

May also appear after incorrect surgical treatment or as complications from treatment with antibiotics (gentamicin).

The disease is always benign.

Periods of exacerbation can be repeated daily, but then the long period of remission comes, which can last several years. The disease may begin at any age.

Causes of positional dizziness

In the inner ear there is a vestibular apparatus that is responsible for the orientation of a person in space. In anticipation inner ear There are special receptors that are attached to the otolitis and transmit information about all changes in the spatial location of the body.

A benign positional dizziness is associated with the displacement of the otoliths, as a result of which, when the position of the head changes, a feeling of dizziness appears. The particles of the otolitis take off and fall into the rear channel of the inner ear, where do they choose themselves because of the low location of the channel at any position of the human body.

If you notice the appearance of new symptoms uncharacteristic for you - do not tighten the visit to the doctor. Dizziness can be both an easily solved problem and the symptom of heavier diseases.

Symptoms

When visiting a positional nature, the attacks usually appear suddenly and are short-term. Perhaps the cost of nausea and vomiting. The course of the attacks is tolerated by a person hard, significantly reducing the quality of his life.

The suddenness of the appetifies may be less dangerous due to the likelihood of falling and injury or, for example, the emergence of attacks when driving a car. Stronger symptoms Manifested in the morning in the lying position or when turning into bed.

Distinctive features of positional dizziness:

• the head is not constantly spinning, the symptoms appear by attacks;
• short-term;
• nistagm - Fast involuntary eye movements;
• accompany the symptoms of violations vegetative system - pallor, throwing in heat, increased sweating, nausea attacks;
• during the absence of an attack of a complaint, the patient is absent, well-being good;
• after the disease, the body quickly comes to normal;
• when dizziness, there is often no noise in the ears and a sense of deafness, the headache is rare.

Forms of the disease

In DPPG, or ololytiasis, 2 forms are distinguished:

1. Canalolyatiaz - Cuchkin Fragments of Otolitis is located in a smooth part of the channel.
2. Capulolyatiaz - fragments entrenched in the ampoule of one of the channels.

When making a diagnosis, an affected side and a semicircular channel is always indicated.

The suddenness of your symptoms should be alarmed. Try to find a pattern to then tell a doctor about this - a certain time for the position of the body provoking the factor.

Diagnostics

The diagnosis is quite simple and is based mainly on the complaints of the patient himself.

To confirm the diagnosis, special tests are carried out.

For example, Dix-Holpike's sample. Clinically significant is that when a patient's dizziness, an involuntary movement of the eyes is observed.

It is very important to carry out the correct diagnosis of dizziness. There are cases when the patient found osteochondrosis cervical departments Spine or vascular problems in the brain and these factors were classified as the main cause of dizziness. At the same time, these were only accompanying diseases, since dizziness was caused by the wrong arrangement of the ololytes and the turns of the head.

Diagnostics - the most important stage on the path to treatment. Be careful to the feelings of your body so that the doctor can correctly determine the cause of dizziness.

Principles of treatment of positional dizziness

The main place in the treatment of benign positional dizziness is allocated to conduct special position maneuvers.

At the same time, the doctor conducts a series of slopes and head turns in such a way as to complete the symptom.

For example, when maneuver, epipe, the particles of ololytes move from the fields of the inner ear in which they cause dizziness to other areas.

The maneuver can be conducted as a doctor and a patient on his own home. The maneuver scheme is quite simple - you need to change your location five times, while tilting the head at a certain angle.

Medicase treatment is ineffective. Existing drugs are not able to eliminate acute attack. In severe cases, in the absence of results after medical Menevrov, surgery can be shown.

In general, the prognosis of the treatment of benign dizziness is favorable, and the effectiveness of treatment in most cases is high.

Permanent I. strong dizziness It may indicate the presence of pathological processes in the body, which are difficult to diagnose independently. Here is a list of diseases that are inherent in this symptom.

Are there any vestibular exercises?

Effective with positional dizziness will be rehabilitation maneuvers, when conducting the disappearance of rolled sediments from the field of the inner ear channel.

Vestibular exercises will help get rid of dizziness.

In this position or lying the patient is about 15 seconds, and then returns to the sitting position, but turns his head to the other side. Such exercises give 75% positive effect.

Treatment of positional dizziness in most cases depends on you. Regular performance of the exercise and doctor's prescriptions - and you will forever get rid of this problem.

With benign positional dizziness, the main thing is to diagnose it correctly, so as not to start erroneous therapy. Further recovery depends in most cases from the patients themselves - regular fulfillment of special exercises and practically no financial spending.

Age changes in the operation of the vestibular apparatus can lead to dizziness. Assist to remove an unpleasant symptom. See a list of recommended drugs.

Should I turn to the doctor if a light dizziness occurs periodically? Consider the main causes of this syndrome.

Video on the topic

Benign paroxysmal positional dizziness (DPPG) is a vestibular disorder that occurs when changing the position of the body and head. The reasons for this pathology are not fully clarified. It is believed that the DPPG is based on structural changes in the inner ear maze as a result of any external influences. Women suffer from DPPG more often than men. The frequency of occurrence of this type of dizziness is sufficiently high and up to 50% of all vestibular peripheral dips.

Development mechanisms for subscribing PTP

Currently, scientists suggest two basic theories of the origin of the DPPG associated with the destruction of the inner ear of the olion membrane. This is a dupleolithiasis and canalolyatiasis. In the first case, easily moving particles of the olion membrane are fixed on the dome of one of the channels, and in the second - in its cavity. These particles have a small mass and strive for precipitation, but any head movement leads to their movement and cause dizziness attack. The best period for the sedimentation of the olhed particles is the phase of night sleep, when they form the so-called clots, which, after waking, cause hydrostatic changes in the semiccur. At the same time, on the opposite side, these changes are absent.

The resulting asymmetry in the state of vestibular receptors and leads to the development of pathological symptoms. It is believed that the basis of all these disorders is a violation of calcium metabolism. At the same time, provoking factors for the development of DPPGs may be:

• card and brain injury;
• surgical interventions;
• infections;
• reception of differentoxic antibacterial drugs (for example, antibiotics from the aminoglycoside group);
• neurocirculatory dystonia, migraine, etc.

Over time, freely moved particles dissolve in endolymph or shifted in the bags of the inner ear and the patient recovering.

Clinical manifestations

Dizziness with this pathology occurs when the position of the head changes, for example, after lifting the bed.

DPPG is characterized by typical repetitive dizziness attacks with a feeling of rotation of surrounding items. Most often they arise in the morning after awakening or at night at the moment of turning in bed. Provocates the attack of moving the head from one position to another. In this case, dizziness has a greater intensity, but no more than one minute continues. Often the attack is accompanied by nausea, vomiting and common concern. With a long-term course of the disease in individuals suffering from the DPPG, an equilibrium function disorders may appear.

In addition, during dizziness in patients, another specific feature appears - Nistagm (oscillatory involuntary movements eye apples). It can have a different direction depending on the location of the affected semicircular channel. More often, DPPG occurs when the location of pathological changes in the rear semicircular canal.

A distinctive feature of this pathology from other forms of dizziness is the absence of others. neurological symptoms and normal rumor.

Diagnostics

DPPG diagnosis is based on clinical manifestations Diseases. With an objective and additional examination of pathological changes, it is usually not detected. Help the doctor to confirm the diagnosis of special positioning samples. For example, Dix-Hallpayka test. Before it is conducted, the subject is in the sitting position and turns his head in some direction at 45 degrees. Then the doctor fixes his head and quickly moves it to the position lying down (while the head hangs from the edge of the couch), and then observes the movement of the eyes of the patient and its condition. The arising from this nistagm and the attack of dizziness indicates the presence of DPPG in the patient.

Differential diagnosis is required with the pathology of the rear cranial fossa, the central positional nastagm, multiple sclerosis and vertebro-basilar insufficiency.

Conservative therapy

The treatment of DPPG is aimed at relieving dizziness attacks in the shortest possible time. To do this, the method of therapeutic effects can be used using special maneuvers contributing to the mechanical movement of free particles in semicircular channels. Maneuvers are a set of exercises that can be performed independently or with the participation of the attending physician. It should be noted that the latter are more efficient (the cure occurs in 95% of cases).

At home, such patients can use the Brandt Daroff technique. Its essence lies in the exercise 3 times a day at five slopes in each direction.

• To carry out a maneuver, after waking up, it is necessary to sit in the center of the bed, lowering the legs.
• After that, you need to turn your head at an angle of 45 degrees to the left (or right) and lie on the same side.
• It is recommended to be in this position within 30 seconds or until the end of the attack (if any).
• The very best is recommended to repeat the head to the other side.

The duration of similar therapy is determined individually, its effectiveness is about 60%. With a high vegetative sensitivity for the period of maneuvers, Betagistin and anti-anemic means can be assigned to the patient.

Other medical maneuvers are conducted under the control of the attending physician, as they can cause severe vegetative attacks and are technically more complex. An example of such an impact may be the method of lemplete.

• For his implementation, the patient sits on the couch towards along it.
• The doctor fixes his head at the time of the procedure and first turns it at 45 degrees towards the lesion in the horizontal plane.
• Then the patient moves to the back and turns the head to the other side.
• Next, the patient turns over to healthy side by ear.
• Then - on the stomach and then on the opposite side, while the head is shifted along the rotation.
• At the end of the maneuver of the patient sitting on a couch through a healthy side.

Surgery

If the effect OT. conservative treatment DPPG is absent, surgical intervention is necessary.

With ineffectiveness conservative methods And too long adaptation is possible surgical treatment of DPPG. The most efficient and safe procedure is a fill with the affected bone chips.

Other surgical interventions can also be used (the removal of the affected labyrinth, the intersection of the vestibular nerve), but they have a number of complications and lead to the destruction of the structures of the inner ear.

In part of patients (in 6% of cases), recurrences of the disease are possible, in which case it is necessary to limit the movement in space and access to the doctor as early as possible.

Conclusion

The emergence of DPPG may violate the normal vital activity of patients and even deprive of their working capacity. But therefore, these disorders and are named benign that their characteristic feature is the sudden disappearance of all symptoms. DPPG treatment is assigned if it is seriously transferred to patients and persists for a long time. And in most cases, the results do not make themselves waiting.

The otorinolaryngologist A. L. Guseva presents a presentation on the topic "DPPG":

Neurologist Kinzersky A. A. talks about benign pompaksismal positional dizziness:

Repeated transient short-term attacks of system dizziness, which are stored by changing the position of the head. Associated with the presence of floating in endolymph or fixed on Kupaul Otolites. In addition to nausea and sometimes vomiting, paroxysmal dizziness attacks are not accompanied by any other symptomatic. The diagnosis is based on patient complaints, a positive sample of Dix-Hallpike, the results of the rotational test. Treatment consists in conducting special medical techniques of epipe or Semomt, performing vestibular gymnastics.

General

Paroxysmal positional dizziness (PPG) is a benign paroxy system dizziness, a duration of several seconds to 0.5 min, which occurs when the head moves is more often in the horizontal position of the body. Described in 1921 by Robert Barurance. In 1952, Dix and Hallpikes suggested the connection of the disease in the balance of equilibrium and proposed a provocative diagnostic sample to clinical use, which still uses specialists in the field of neurology and vestibular. Since paroxysmal positional dizziness is not associated with the organic lesion of the inner ear, but is due only to a mechanical factor, "benign" is often added to its name. PPG is more common in women. The incidence is about 0.6% of the population per year. People over 60 years of age are 7 times more often than younger. The most affected by the PPG age period is from 70 to 78 years.

Causes of paroxysmal positional dizziness

The vestibular apparatus is formed by 3 semicircular channels and 2 bags. The channels are filled with endolymph and sent by hairsmaps - vestibular receptors that perceive angular accelerations. From above, the hair cells covers the membrane computers, on the surface of which the olitis (otokonia) are formed - calcium bicarbonate crystals. In the course of the livelihoods of the body, the spent rigs are destroyed and utilized.

In disruption of metabolism (hyperproduction or weakened recycling), their parts are freely floating in the endolymph of semicircular channels, the most often accumulating in the rear channel. In other cases, the ololytes fall into the ampoules (extensions) of the channels and stick there to the Capula covering receptor cells. During the heads of the head, the inference moves in the endolymph of the channels or shift to the Coupul, thereby annoyingly affecting the hair cells and causing dizziness. After the end of the movement, the ololyta is settled on the bottom of the channel (or stop moving to the Coupul) and the dizziness stops. If the otokonia is located in the lumen of the channels, then they say about Canalolyatiasis if they are deposited on Kupaul, then Coupulolytiasis.

Despite the detailed learned mechanism for the occurrence of PPG, the causes of the formation of free otokonii in most cases remain not clear. It is known that in a number of patients, the oliths are formed due to traumatic damage to the olion membrane during crank-brain injury. To the etientifactors, which also belongs to the previously transferred maze of viral etiology, the Menietor's disease, the spasm of the blood supply to the artery (for migraine), surgical manipulations on the inner ear, receiving a heotoxic pharmaceutical pharmaceuticals (first and foremost, gentamicine-row antibiotics). In addition, PPGs can act as a concomitant pathology with other diseases.

Symptoms of paroxysmal positional dizziness

The basis of the clinical picture is a transient system dizziness - a sense of movement of objects in a horizontal or vertical plane, as if rotating around the patient's body. Such dizziness paroxysm is provoked by head movements (turns, folding). Most often occurs in the lying position, when turning into bed. Therefore, the majority of PPG attacks fall in the morning when patients lie in bed after waking up. Sometimes dizziness paroxysms occur in a dream and lead to the awakening of the patient.

On average, the PPG attack lasts no more than 0.5 minutes, although patients seem to be longer in their complaints, in their complaints they often indicate that dizziness lasts for several minutes. It is characteristic that the attack is not accompanied by noise in the ears, headache, falling hearing (hearing loss). Possible nausea, in some cases vomiting. For several hours after the attack or periodically in the intervals between them, some patients note the presence of non-systemic dizziness - sense of shaking, instability, "fools". Sometimes the PPG attacks are of one character, but in most cases during the exacerbation period they arise several times a week or a day. Then follows the period of remission at which there are no dizziness paroxysms. It can last up to several years.

The attacks of positional dizziness are not dangerous for the patient's life or health. The exceptions are cases when paroxysism occurs when a person is at high height, underwater immersion or driving vehicle. In addition, repeating attacks may adversely affect the psycho-emotional state of the patient, provoking the development of hypochondria, depressive neurosis, neurosis.

Diagnosis of paroxysmal positional dizziness

The diagnosis of PPG is based mainly on clinical data. In order to confirm his confirmation, the neurologist or the vestibular is carried out by Dix-Holpayka's sample. Initially, the patient sits, turning his head at 45 degrees in the affected side and fixing a look at the doctor's bridge. Then the patient is sharply transferred to the lying position, thusing his head on 30 degrees. After latent period (1-5 seconds), a systemic dizziness occurs, accompanied by rotator nistagm. For registration of the latter, video philosophone or electronistagmography is needed, since peripheral Nistagm is suppressed when fixing the gaze and visually not be fixed. After the disappearance of the nystagma, the patient is returned to the sitting position, which is accompanied by a slight dizziness and rotator nistagm, directed in the opposite direction relative to the previously caused.

Provocative sample is performed from 2 sides. The bilateral positive Dix-Hallpayka test is usually found at the PPG traumatic origin. If during the sample there was no dizziness and nystagm, it is considered negative. If dizziness was noted without Nistagma, the sample is considered positive, diagnosed by T.N. "Subjective PPG". After repeated repetition of samples, the nystagm is depleted, dizziness does not occur, since as a result of repeated movements, the otoliths are dissipated along the semicircular channel and the cluster does not form capable of affecting the receptor apparatus.

An additional diagnostic breakdown is the rotational test, which is carried out in the position lying with the head of 30 degrees. With a positive sample after a sharp turn of the head, the latent interval arises horizontal Nistagm, which is well registered with visual observation. In the direction of Nistagma, you can distinguish canalolytiasis from Kupaulolithiasis and diagnose which semicircular channel is amazed.

Differential diagnosis of PPGs must be carried out with a positional dizziness in arterial hypotension, a vertebral artery syndrome, Barre-Leu syndrome, Meniery disease, vestibular neuronitis, labyrinth fistula, CNS diseases (multiple sclerosis, rear cranial jams). The foundation of the diffidosis is the absence along with the positional dizziness of others, characteristic of these diseases, symptoms (hearing loss, "darkening" in the eyes, pain in the neck, headaches, ear noise, neurological disorders, etc.).

Treatment of paroxysmal positional dizziness

Most patients are recommended conservative therapy, which depends on the type of PPG. Thus, under Kupaulolithiasis, the vestibular gymnastics of Semomt is used, and in Canalolyatiasis - special therapeutic techniques aimed at changing the location of the movement. With residual and light symptoms, exercises are recommended for training vestibular apparatus. Pharmacotherapy may make sense during periods of exacerbation. Its foundation contains such drugs such as cinnarizin, ginkgo biloba, betahastin, flunarizin. but medical therapy It can serve only an addition to the treatment with special techniques. It should be said that some authors express great doubts about her expediency.

The most common therapeutic techniques include taking EPILE, consisting in consistent head fixing in 5 different positions. The reception allows you to move the oscillates from the channel to the oval pouch of the labyrinth, which leads to the relief of the SPG symptoms in 85-95% of patients. When taking the patient's semon, from the position of sitting with turned into a healthy side, the head is transferred to the position lying on the affected side, and then, without changing the turn of the head, through the position sitting in the position lying on the healthy side. Such a quick change of the position of the head allows you to free the Coupuli from the otoliths on it.

In severe cases with frequent attacks of positional dizziness, not a binding application of the techniques of epipe and Semont, the issue of surgical treatment is considered. Operational intervention can consist in filling of the affected semicircular channel, selective intersection of individual vestibular fibers,

For the first time, what subsidiary DPPG was described by Robert Baruran in 1921. It is believed that this type of work disorder of the peripheral part of the vestibular analyzer occurs in 17-35% of patients who appeal to the doctor with a complaint about dizziness. People aged 50-60 years (40% of cases) are most susceptible to him. In women, a benign positional paroxysmal dizziness is diagnosed 2 times more often than in men.

The reasons

The causes of benign positional paroxysmal dizziness are not installed. Presumably, it can result in:

• brain injury;
• viral infection, affected inner ear (labyrinth);
• meniere diseases;
• taking antibiotics with a isotoxic effect;
• operations on the ear;
• spasm of the labyrinth artery.

At the same time, doctors believe that in more than half of the cases, the causes of the occurrence of DPPG are not pathological. There are several theories explaining the mechanism of benign positional dizziness. The main one is Coupulolyatiasis.

The vestibular analyzer responsible for maintaining equilibrium consists of two departments - the central, in the brain, and the peripheral, located in the inner ear. In the peripheral department includes semicircular channels and the rund.

At the ends of the channels there are extensions - ampoules, in which receptor hairs cells are located, their clusters are called the cules (dampers). The cavities of the inner ear are filled with liquids - perilimph and endolymph. When moving, the pressure of the liquids changes, and the receptor irritation occurs, as a result, a signal of a change in the position of the body or head comes into the brain.

On the eve of the inner, there are two bag - urticulus and sacculus communicating with semicircular channels. They have accumulations of lime cells - the tag apparatus. The processes of nerve cells are shipped to the otolitis. According to the theory of Coupulolytiasis, the causes of DPPG are in the fact that the smallest particles come off from the otolitis when the head turns, which are then sticking to the Kupaul, it is pulled out and deviates, causing dizziness. With the reverse movement, the particles disappear from receptor cells, and the attack passes.

This theory is confirmed by the fact that in the pathology of patients suffering from positional dizziness, the basophil substance was found. Doctors believe that the high frequency of DPPG in older people is explained by the degeneration of ololytes in the aging process.

Symptoms

What is a DPPG diagnosis? What signs does he show? The main symptom of DPPG is short-term dizziness when changing the position of the head. Most often, the attacks happen when a person lies and turns sharply either thumps his head. Duration of dizziness is not more than a minute, then some time may notice the feeling of instability. Sometimes DPPG occurs during sleep, it can be so strong that a person wakes up from unpleasant sensations.

Other symptoms of benign positional paroxysmal dizziness - nausea and vomiting, but they are rarely observed. Headache And the reduction of hearing for this state is not characteristic.

As a rule, DPPG proceeds benign: periods of exacerbations, during which attacks often happen, will change to a steady long remission - up to 2-3 years. In rare patients, the disease is accompanied by regular dizziness episodes and severe vegetative disorders.

In general, a benign positional paroxysmal dizziness is well-dangerous for a person, but it can lead to fatal consequences if the attack occurs during management vehicle, when finding at height, in water and so on.

Diagnostics

Benign positional paroxysmal dizziness is diagnosed based on patient complaints. Confirmation of the diagnosis is the positive test of Dix-Holpayka. It is carried out so. The patient sits on a couch and focusing the look at the forehead of the doctor. The doctor turn the head of the patient to the right to 45 °, sharply puts it on his back and throws his head to 30 °. If a person has dizziness and nystagm (oscillatory movements of the eyes), the trial is estimated as positive. Then she repeats on the other side. Nistagm appears not always.

DPPG is differentiated from vestibular neuronit, labyrinth fistulas and vestibular type Meniere disease.

Additional diagnostic methods:

• test using a stabilometric platform;
• MRI brain;
• CT or x-ray cervical.

Treatment

How is the DPPG? In the past, doctors advised patients to avoid head provisions in which dizziness arises, as well as take medicines as symptomatic therapy. As a rule, Meklozin was prescribed - a drug with antihistamine and anticholinergic properties. But practice shows low efficiency medicines In the treatment of DPPG.

IN last years The treatment of benign paroxysmal dizziness (DPPG) is practiced using various exercises that contribute to the return of particles of the ololytes in their place - in the bags. Most. effective way Recovery of the mechanics of the inner ear and the normalization of equilibrium control is considered to be the technique of epipe. Its algorithm:

• The patient sitting on the couch directly and turns his head toward the patient's ear at 45º, then falls on his back, lingering in this position for 2 minutes.
• The doctor turns the patient's head in the opposite direction (90º) and fixes it for 2 minutes.
• The patient slowly turns the body towards the head of the head, directing the nose down and lingering in such a posture for 2 minutes, then returns to the starting point.

Throughout the exercise, a person can feel dizziness. Typically, 3 repetitions are required, after which there is a steady improvement in the state. The number of procedures is determined by the doctor. Recurrements arise in 6-8% of cases.

Another method of treating benign paroxysmal positional dizziness is the vestibular gymnastics according to the Semomt method. Its essence consists in consecutive sharp changes in the position of the patient's head and body. As a rule, it causes severe dizziness, many doctors consider it too aggressive and rarely prescribed.

With the ineffectiveness of conservative treatment and the serious course of the disease, a neurosurgical operation is carried out in the inner ear.

Forecast

Forecast for DPPG is favorable: In most cases, adequate treatment leads to a resistant.

Prevention

DPPG prevention measures are not developed, since the causes of the disease are not established.

Video: Exercises for DPPG according to the technique of epipe