This document summarizes benign paroxysmal positional vertigo (BPPV), a common cause of positional vertigo. It describes the pathophysiology of BPPV, involving debris accumulating in the posterior or horizontal semicircular canals, causing vertigo when the head is moved into certain positions. It outlines diagnostic tests like the Dix-Hallpike maneuver and treatments including the Epley maneuver and particle repositioning maneuvers, which aim to move the debris out of the affected canal.

1. Benign Paroxysmal Positional Vertigo
300 Formosan J Med 2023 Vol.27 No.3
‫ؼ‬
‫ؼ‬‫܄‬ତว‫܄‬Տ࿼‫੾܄‬ཀྵ
ဨσ୉
ᄔ
ᄔाǺ‫ؼ‬‫܄‬ତว‫܄‬Տ࿼‫੾܄‬ཀྵ(benign paroxysmal positional vertigo, BPPV)ࢂᓐཀྵനத‫ـ‬‫ޑ‬ੰӢǶ
Dix-Hallpike maneuver ёບᘐऊ՞Ըҡੱ 8 ԋ‫ࡕޑ‬ъೕᆅԸҡੱ(posterior canal BPPV, PC-BPPV)Ǵ஻Ը‫ޑ‬
ԸҡӢख़ΚϐࡺǴ஥୏ϣరЃనࢬ୏Ǵठ൙ဎ(ampulla)‫ޑ‬ഗ൰(cupula)ୃ౽Ǵᇨวрӛ΢‫ٳ‬㥲௽‫܄‬౳ਁǴ
Epley maneuver ‫ک‬ Sémont maneuver ฻ԸҡൺՏೌࢂ‫ݯ‬ᕍ२ᒧǶѳ፴ΠѰѓୁ፴ᔠࢗ(supine to head-lateral
test)ёບᘐऊ՞Ըҡੱ 2 ԋ‫ޑ‬НѳъೕᆅԸҡੱ(horinzotal canal BPPV, HC-BPPV)Ǵр౜ӛӦ౳ਁࣁᆅԸ
ҡࠠНѳъೕᆅԸҡੱǴр౜଍Ӧ౳ਁࣁഗ൰؈ҡࠠНѳъೕᆅԸҡੱǶ‫ݯ‬ᕍБԄԖ࡭ុ࠮༈‫(ݤ‬forced
prolonged position, FPP)Ǵջᡣੰ஻፴ӛ౳ਁၨ১ୁೱុ 10-12 λਔǴᜤа‫ߏڙ܍‬ਔ໔ୁ፴‫ޣ‬ё௦Ҕ‫ځ‬Ѭ
ൺՏೌ‫ݯ‬ᕍǴӵ barbecue maneuver ‫ک‬ Gufoni maneuverǶ߻ъೕᆅԸҡੱ(anterior canal BPPV, AC-BPPV)
നࣁ‫ـش‬ǴDix-Hallpike maneuver ևӛΠ౳ਁǴ‫ݯ‬ᕍБԄЙ໪Եቾ஻ԸࣁՖୁǴ֡௦ᓐһᝌൺՏೌ(deep
head hanging maneuver)Ƕ
ᜢ
ᜢᗖຒǺ‫܄ؼ‬ତว‫܄‬Տ࿼‫੾܄‬ཀྵǴ౳ਁǴъೕᆅǴᆅԸҡǴഗ൰؈ҡǴԸҡൺՏೌ
(Ѡ᡼ᙴᏢ Formosan J Med 2023;27:300-11) DOI:10.6320/FJM.202305_27(3).0007
߻
߻ ‫ق‬
‫ق‬
列⿏昋䘤⿏ỵ伖⿏䛑㘰(benign paroxysmal
positional vertigo, BPPV)⍰䧙俛䞛䕯炻㗗䛑㘰攨姢
㚨ⷠ夳䘬䕦䕭ˤỵ㕤⇵⹕ℏ䘬㨊⚻♲(utricle)䘬俛
䞛⚈㓭㺪句军ᶱ⋲夷䭉ᷕㆾ湷旬㕤⋲夷䭉⢢儡䘬
枪ⷥ嗽炻㓭侴婀䘤䛑㘰ˤBPPV 䘬冐⸲堐䎦䁢䔞䕭
か柕悐廱≽⇘㝸ᶨỵ伖㗪炻↢䎦䞕㙓䘬昋䘤⿏䛑
㘰ˤ㬌䕯⤥䘤㕤 50-60 㬚䘬侩⸜Ṣᶼ⤛⿏庫⣂炻䓂
⮹䘤䓇㕤⬑䪍ˤ
ὅ䕭⚈⎗↮䁢䈡䘤⿏␴临䘤⿏炻⍇⚈ᶵ㖶䘬
䈡䘤⿏ BPPV Ỽ 50%ẍᶲ炻⸜䲨ˣ橐岒䔷檮ˣ䵕䓇
䳈 D 仢᷷䕯ˣ檀埨⡻ˣ檀埨傪ˣ檀⯧愠ˣῷ柕䖃
䫱悥⎗傥㚱䚠斄ˤ临䘤⿏ BPPV ⣂临䘤㕤⇵⹕䤆䴻
䀶ˣ㠭⯤䇦㮷䕯ˣ䨩䘤⿏倥≃晄䣁ˣ俛䥹ㇳ埻␴柕
悐⢾ 䫱ˤ晾婒䕭か⣂⎗冒埴䶑妋炻Ữ㚱ṃ䕭か䓂
军天㔠㚰⼴炻䓇㳣ㇵ傥《⽑㬋ⷠ炻喍䈑⮵㬌䕯䃉栗
叿䗪㓰炻㚱䞼䨞㊯↢⽆䘤ἄ⇘㱣䗪炻℞䕭䦳⎗忼
18 ᾳ㚰ᷳᷭ炻㓭 BPPV ᷎朆ℐ䃞㗗ᶨ冒旸⿏䕦䕭炻
⺢嬘ṵ暨䧵㤝㱣䗪[1]ˤ
BPPV 䕭か⣂ᷣ姜℞䛑㘰㚫⚈幢ᶳˣ⸲ᶲⶎ⎛
侣幓ˣᾗ幓␴ẘ柕㗪婀䘤炻䓇㳣ᷕ媠⤪崟⸲ˣ㰸㴜
㲿柕ˣἄ⚺喅ˣ䚳䈁慓ㆾἄ伶⭡㗪䘤䓇ˤ侴⛐昋䘤
⿏䛑㘰 㬊⼴䘬㔠⮷㗪⇘㔠⣑炻㚱ṃ䕭かṎ㚫㉙⿐
⸛堉嬲ⶖˣ㕳廱デˣ埴崘⚘暋ˣ柕㖷ˣ◩⽫ˣ▼⎸ˣ
⁦㕄デˣ↢㯿ˣ㺪㴖デˣ夾≃㧉䱲ˣ␴夾䈑嶛≽䫱ˤ
昋䘤⿏ỵ伖⿏䛤㋗䓙媦居䇦䋶⼿ᷣ Barany[2]
㕤 1921 ⸜椾⃰㍸↢炻Ṿ㍷徘Ḯ 1 ỵ 27 㬚⤛⿏䕭か
⍵央䘤ἄ䛑㘰 2 忙炻ᶼ⎒䘤ἄ㕤⎹⎛“幢ᶳ㗪炻䕭
か↢䎦⻟䁰䛑㘰᷎⎗夳㕳廱ㆸấ⎹⎛ˣ✪䚜ㆸấ⎹
ᶲ䘬䛤㋗炻⎹⎛䚳㗪↢䎦╖䲼䘬㕳廱䛤㋗炻⎹ⶎ䚳
㗪↢䎦╖䲼䘬✪䚜⎹ᶲ䛤㋗ˤDix ␴ Hallpike[3]ℵ
㕤 1952 ⸜ἄ忚ᶨ㬍斉慳炻娵䁢枰䫎⎰ᶳ↿⸦枭㡅
ẞㇵ㗗 BPPV 䘬℠✳䛤㋗烉
ᶨ.ġ ⎗䓙柕ỵ嬲㎃㗪婀䘤烊
Ḵ.ġ か“俛㛅ᶳἄ Dix-Hallpike maneuver 柕ỵ嬲
⊾㩊㞍㗪炻䛤㋗⏰⺣㕳⎹⛘⿏烊
ᶱ.ġ ⛐柕ỵ嬲⊾⼴㚫㚱⸦䥺䘬⺞怚ㇵ䓊䓇烊
⚃.ġ ㊩临㗪攻⣂⮷㕤 20 䥺炻䁢ᶨ䞕㙓⿏䛤㋗烊
冢⣏慓昊㕘䪡⎘⣏↮昊俛滣┱悐
忂妲ἄ侭倗䴉嗽烉叱⣏῱炻冢⣏慓昊㕘䪡冢⣏↮昊俛滣┱悐炻㕘䪡ⶪ䴻⚳嶗1㭝442⶟25嘇ˤ
E-mail: yehdawei@gmail.com
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੫ᒮ! 眩暈：從周邊到中樞ġ

2. 列⿏昋䘤⿏ỵ伖⿏䛑㘰
⎘䀋慓⬠ 2023 ⸜ 27 ⌟ 3 㛇 301
Ḽ.ġ ⍵⎹柕ỵ㓡嬲㗪炻㚫↢䎦微⎹䛤㋗烊
ℕ.ġ ⍵央䘬柕ỵ嬲⊾㩊㞍炻
㚫ἧ婀䘤䘬䛤㋗⻟⹎㷃
⻙␴㗪攻㷃⮹ˤ
䛤㋗⎰᷶ᶲ徘⭂佑䘬昋䘤⿏䛑㘰䕭か炻ㇵ塓姢
㕟䁢列⿏昋䘤⿏ỵ伖⿏䛑㘰炻ᶵ⬴ℐ䫎⎰ᶲ徘㡅
ẞ炻Ữ㕤柕ỵ嬲㎃㚫䓊䓇昋䘤⿏䛑㘰侭炻℞䛤㋗⇯
㬠栆䁢ᶵ℠✳䛤✳ˤ
1980 ⸜ John Epley[4]椾⃰㍸↢俛䞛⽑ỵ埻
(canalith repositioning procedure, CRP)㚦怕⬠埻䓴
岒䔹炻䃞侴䴻忶 10 检⸜䘬冐⸲䴻槿炻俛䞛⽑ỵ埻
⶚㗗 BPPV 椾怠㱣䗪㕡⺷ˤ1994 ⸜ Welling ␴
Barres[5] ᾖ 㓡 䘬 俛 䞛 䰺 ⫸ ⽑ ỵ 埻 (particle
repositioning maneuver, PRM)炻㑵ἄ㕡㱽㚜䁢䯉
╖炻ㆸ≇䌯檀忼 8ˣ9 ㆸẍᶲˤ
BPPV ठੰᐒᙯ
䚖⇵㚱ℑ䧖䎮婾Ἦ妋慳 BPPV 䘬冐⸲堐䎦烉
ᶨ.ġ 枪 ⷥ 㰱 䞛 䎮 婾 (cupulolithiasis) 烉 1969 ⸜
Schuknecht[6]⛐㚱 BPPV 忶⼨⎚䘬䕭か炻䘤䎦
㚱⣏慷▄渤⿏柮䰺旬叿㕤⼴⋲夷䭉䘬枪ⷥ炻娵
䁢㗗俛䞛䳸㘞旬叿㕤枪ⷥ⡆≈Ḯ℞⭮⹎炻䔞柕
ỵ㓡嬲㗪枪ⷥ⚈㬌↢䎦ῷ䦣炻⚈㬌婀䘤↢䛑㘰
␴䛤㋗ˤ⬫䘬䈡溆㚱烉(ᶨ)か侭䦣≽军婀䘤橼
ỵ㗪炻䛑㘰䩳⇣䘤䓇炻䃉㼃ặ㛇烊(Ḵ)䛑㘰␴
䛤㋗⎴㗪↢䎦烊(ᶱ)䕭か柕悐ᾅ㊩⛐婀䘤橼
ỵ炻䛑㘰␴䛤㋗⯙㚫㊩临↢䎦ˤ枪ⷥ㰱䞛⺽䘤
䘬 BPPV 䚠⮵⮹夳ˤ
Ḵ.ġ 䭉俛䞛䎮婾(canalithiasis)烉1979 ⸜ Hall 䫱[7]
椾⃰㍸↢炻䕭か䘬⼴⋲夷䭉ℏ炻㚱僓暊冒⇵⹕
俛䞛☐䘬㺪㴖柮䰺炻柕ỵ䨩䃞㓡嬲㗪炻忁ṃ俛
䞛㚫ⷞ≽ℏ㵳⶜㳩≽炻⚈侴婀䘤↢䛑㘰␴䛤
㋗ˤ1992 ⸜ Parnes ␴ McClure[8]㕤⼴⋲夷䭉
攱⠆ㇳ埻㗪炻䘤䎦Ḯ⼴⋲夷䭉㵳⶜ℏ㚱㺪㴖柮
䰺侴嫱⮎㬌婒ˤ⬫䘬䈡溆㚱烉(ᶨ)か侭䦣≽军
婀䘤橼ỵ㗪炻㚱㔠䥺军㔠 10 䥺䘬㼃ặ㛇ㇵ㚫
䛑㘰䘤ἄˤ(Ḵ)䛑㘰䘬㼃ặ㛇冯䛤㋗㼃ặ㛇䚠
⎴ˤ(ᶱ)䛑㘰␴䛤㋗䘬⻟⹎㚫㻠㫉⡆⻟侴⼴㷃
⻙炻⣂⛐ 1 ↮揀ℏ㴰⣙炻ᶼ␴枪ⷥῷ䦣䘬䦳⹎
䚠斄ˤ䭉俛䞛⺽䘤䘬 BPPV 庫䁢ⷠ夳ˤ
ᶱ䧖⋲夷䭉ᷕ炻⼴⋲夷䭉㕤Ṣ橼䚜䩳㗪ỵ㕤㚨
Ỷ嗽炻㚨㖻⚈慵≃ᷳ㓭㹹僓军㬌嗽炻㓭⼴⋲夷䭉俛
䞛䕯(PC-BPPV)Ỽ㚨⣂㔠炻䲬 8 ㆸ烊㯜⸛⋲夷䭉俛
䞛䕯(HC-BPPV)㫉ᷳ炻䲬 2 ㆸ烊⇵⋲夷䭉俛䞛䕯
(AC-BPPV)㚨䁢份夳ˤ↮⇍婒㖶⤪ᶳ烉
ࡕъೕᆅԸҡੱ(PC-BPPV)
Dix-Hallpike maneuver (⚾ᶨ) 䓐ẍ姢㕟 PC-
BPPV炻嬻䕭か⛸⛐姢䗪⸲ᶲ炻⮯䕭か柕廱⎹か“
45°炻幢⌏ᶼ柕ㆠỵ⼴ẘ㯜⸛朊ᶳ䲬 30°炻奨⮇䛤㋗
↢䎦⏎ˤ⎛俛 PC-BPPV ⏰⎹ᶲ微㗪揀徜㕳⿏䛤㋗
(upward counterclockwise rotatory nystagmus)炻ⶎ俛
PC-BPPV ⏰ ⎹ ᶲ 枮 㗪 揀 徜 㕳 ⿏ 䛤 ㋗ (upward
კ΋ǺDix-Hallpike maneuverǶᡣੰ஻֤ӧບᕍ‫׉‬΢(A)Ǵஒੰ஻ᓐᙯӛ஻ୁ 45°(B)Ǵ፴㣺ЪᓐᝌՏࡕһНѳय़Π
ऊ 30°Ǵᢀჸ౳ਁр౜ց(C)ǶѓԸ PC-BPPV ևӛ΢଍ਔដ଑௽‫܄‬౳ਁ(D)Ƕ

3. Benign Paroxysmal Positional Vertigo
302 Formosan J Med 2023 Vol.27 No.3
clockwise rotatory nystagmus)炻崟幓⼴⇯⎗奨⮇⇘
䚠⍵㕡⎹䘬䛤㋗ˤ㩊㞍⎗⛐ᶨ凔攨姢䑘⠫忚埴炻㛒
⽭⼿ἧ䓐 Frenzel glasses(↠德掉)ㆾ䲭⢾䶂䛤㋗
₨炻ょ℞⎗㴰昌⚢夾㈹⇞(fixation suppression)炻庫
傥奨⮇⇘ᶵ㖶栗䘬䛤㋗ˤ
俛䞛䕯䘬䛤㋗堐䎦
炻
⎗䓙 Ewald 㮷ᶱ⣏⭂⼳妋
慳(⚾Ḵ)烉(ᶨ)ℏ俛㝸㡅⋲夷䭉⍿⇢㽨㗪炻䛤䎫㚫
ὅ娚⋲夷䭉䘬⸛朊䓊䓇廱≽烊(Ḵ)ẍ㯜⸛⋲夷䭉侴
妨炻⎹⢢儡㳩≽(ampullopetal flow)䘬ℏ㵳⶜㵚炻㭼
崟暊⢢儡㳩≽(ampullofugal flow)
炻
㚫䓊䓇庫⻟䘬⇢
㽨烊(ᶱ)⼴⋲夷䭉␴⇵⋲夷䭉〘␴䫔Ḵ⭂⼳䚠⍵炻
⎹⢢儡㳩≽䘬ℏ㵳⶜㵚炻㭼崟暊⢢儡㳩≽炻㚫䓊䓇
庫⻙䘬⇢㽨ˤ
䓙㕤⼴⋲夷䭉⢢儡ⴜ(crista)ℏ㮃䳘傆枪䪗䘬
举㮃㌺↿㕡⺷炻㗗庫攟䘬≽举㮃(kilocilia)ỵ㕤䭉
“炻庫䞕䘬朄举㮃(stereocilia)ỵ㕤♲“炻㇨ẍ䔞幢
ᶳ㗪か“俛䞛怈暊⢢儡
炻
ὅ Ewald 㮷䫔ᶱ⭂⼳㚫䓊
䓇冰⤖⿏⇢㽨ˤ㬌㗪䓙㕤俛䞛䘬㳩≽炻农暁“⇵⹕
⻝≃ᶵ⸛堉炻婀䘤↢✪䚜㕡⎹䘬䛤䎫ㄊ忇ῷ䦣␴⍵
⮬⿏㌫夾
ˤ
か俛䘬䛤㋗ㄊ䚠(slow phase)Ἦ冒⎴“ᶲ
㕄倴ˣ⮵“ᶳ䚜倴㓞䷖炻䓊䓇✪䚜⎹ᶳˣ㈕廱⎹‍
“䘬ㄊ忇䛤䎫忳≽烊侴⼴ᷕ㧆┇≽⍵⮬⿏㌫夾䘬⾓
䚠(quick phase)炻⇯㗗Ἦ冒⎴“ᶳ㕄倴ˣ⮵“ᶲ䚜
倴䘬ἄ䓐ˤ⽑⚈䛤䎫䘬ᶲ㕄倴ˣᶳ㕄倴ᷣ天≇傥↮
⇍㗗ℏ㕳ˣ⢾㕳炻ᶳ䚜倴ˣᶲ䚜倴ᷣ天≇傥↮⇍㗗
⎹ᶳˣ⎹ᶲ炻㇨ẍ⛐䛤㋗₨(videonystagmography)
ᶳ⎗奨⮇⇘か俛“䘬䛤㋗庫㈕廱ṃˣ‍俛“䘬䛤㋗
庫✪䚜ṃ[9]炻Ữ劍⎒㗗墠䛤㩊夾炻⇯ᶵ⣒⭡㖻奨
⮇↢ℑ䛤ᷳ攻䛤㋗䘬䳘⽖ⶖ䔘ˤ
Epley maneuver(⚾ᶱ)㱣䗪 PC-BPPV炻ᷫ啱䓙
⦧⊊㓡嬲嬻俛䞛枮⇑䦣↢⼴⋲夷䭉彼⚆㨊⚻♲ˤ⍇
⥳䇰㛔䘬俛䞛⽑ỵ埻㚫⃰ἧ䓐ᶨᾳ橐暯≽☐⛐ḛ
䨩嗽炻ⶴ㛃㱦湷⛐⼴⋲夷䭉⡩䘬俛䞛㚜㖻檮≽炻ḇ
㚫⺢嬘㍍⍿⽑ỵ埻⇵ 1 ⮷㗪炻⃰⎋㚵捖⭂∹喍䈑炻
䃞⼴攳⥳⽑ỵˤ⛐㬌➢䢶ᶳ映临㚱姙⣂⬠侭㍸↢Ḯ
⎬䧖㓡列㕡⺷炻⊭㊔ᶵἧ䓐暯≽☐ˣᶵ暨⎋㚵捖⭂
∹炻⽑ỵ忶䦳㚜䁢䯉ὧ炻䘮䧙ᷳ䁢㓡列⺷俛䞛⽑ỵ
埻(modified Epley maneuver) [10]ˤ
忚埴⽑ỵ埻㱣䗪䘬䕭か⃰天㍍⍿⬴㔜䘬䕭⎚
娊⓷ˣ幓橼㩊㞍炻᷎ὅ Dix-Hallpike manuever 姢㕟
↢か俛“炻嬻䕭か⛸⛐姢䗪⸲ᶲ炻慓ⷓ⛐䕭か⼴
㕡炻⮯䕭か柕廱⎹か“ 45°炻Ẍ℞幢ᶳ⏰柕ㆠỵ
30°ˤℵ⮯䕭か柕廱⎹‍“ 90°炻两临⮯䕭か柕廱⎹
‍“ 90°炻⼊ㆸ“再ỵ炻⌛朊㛅ᶳ炻滣⫸冯ẘ再ỵ
⏰ 135°⣦奺ˤ㚨⼴嬻䕭か⛸崟炻柕廱军ᷕỵᶳ⶜
Ỷ⏰ 20°ỵ伖ˤ㭷ᾳỵ伖⛯䵕㊩ 30-60 䥺炻ㆾ䚜⇘
䕭かᶵℵデ奢䛑㘰ˣ䛤㋗㴰⣙䁢㬊炻ㇵ忚埴ᶳᶨᾳ
ỵ伖ˤ⽑ỵ埻⼴ 24-48 ⮷㗪ℏ䃉暨柕悐♜㟤ᾅ㊩䚜
䩳炻ょ⊧ἄ⣏ⷭ⹎䘬㎾柕ˣ溆柕䫱柕ỵ嬲⊾≽ἄˤ
1988 ⸜ Sémont 䫱[11]㍸↢Ḯ䭉䞛妋僓㱽
(liberatory maneuver)(⚾⚃)炻嬻䕭か⛸㕤⸲⇵炻柕
⎹‍俛“廱 45°⼴炻嬻䕭か幢⎹か俛“⏰共㛅⣑炻
⼭䛤㋗㴰徨⼴朄῁ 1-2 ↮揀ˤ⾓忇⮯䕭か幓橼 180°
“幢㕤‍“炻⼭䛤㋗㴰徨⼴朄῁ 1-2 ↮揀炻ℵ嬻䕭
か⛸崟ˤEpley maneuver 㗗⇑䓐慵≃(gravity)嬻俛
䞛㕤㭷ᾳ⦧⊊嬲⊾㗪㳩⎹Ỷỵ嗽炻Sémont maneuver
⇯㗗⇑䓐ㄋ⿏(inertia)⍲⃳㚵慵≃䘬≃⬠⍇䎮Ἦ䦣
≽俛䞛炻㇨ẍ 180°廱⎹‍“㗪忇⹎ᶵ傥忶ㄊ炻ẍ
⃵俛䞛㛒傥⎹ℙ⎴儛(common crus)㕡⎹㳩ℍˤ
䓙 㕤 BPPV ẍ 侩 ⸜ Ṣ ⯭ ⣂ 炻 ⁛ 䴙 ᶲ ὅ
Dix-Hallpike maneuver 㩊㞍暨㈕廱柠悐␴ᾅ㊩柕ㆠ
ỵ炻1994 ⸜ Steddin ⍲ Brandt ㍸↢“幢㩊㞍
(side-lying test) [12]炻䈡⇍怑⎰侩⸜Ṣㆾ柠悐㚱䕦䕭
侭ˤ⸛幢ᶳ攟㗪攻“幢⽑ỵ埻(supine to prolonged
lateral position maneuver, SPLP maneuver) [13]㚜㗗
㹓␴䘬⼴⋲夷䭉俛䞛䕯⽑ỵ㕡⺷炻⃰嬻䕭か⛸㕤⸲
კΒǺEwald М‫ࡓۓ‬ҢཀკǶᠼЛനߏ‫୏ࣁޣ‬ᠼЛǴၨ
อ‫ࣁޣ‬ᓉᠼЛǶϣరЃనӵጂᓐ‫܌‬ҢӛѰ౽୏ਔǴ཮٬
ᓉᠼЛ໼ॹӛ୏ᠼЛǶϣరЃనӵጂᓐ‫܌‬Ңӛѓ౽୏
ਔǴᓉᠼЛό৒ܰ໼ॹǶѰԸΟঁъೕᆅ൙ဎ೽΢‫ߏޑ‬
อጕӚԾჹᔈ୏ᠼЛǵᓉᠼЛ࣬ᜢՏ࿼ǴጂᓐБӛҢཀ
Нѳъೕᆅևӛ൙ဎࢬ୏ਔǵ߻ъೕᆅ‫ࡕک‬ъೕᆅևᚆ
൙ဎࢬ୏ਔǴё٬ᓉᠼЛӛ୏ᠼЛ໼ॹǴౢғᑫᏟ‫ڈ܄‬
ᐟǶ

4. 列⿏昋䘤⿏ỵ伖⿏䛑㘰
⎘䀋慓⬠ 2023 ⸜ 27 ⌟ 3 㛇 303
ᶲ炻䃞⼴ẘ幢㕤⸲ᶼᾅ㊩㬌橼ỵ㊩临 3 ↮揀炻ℵ嬻
䕭か柕悐␴幓橼⎴㗪“幢⎹‍“炻ᾅ㊩㬌橼ỵ军⮹
30 ↮揀炻俛䞛⎗䴻䓙ℙ⎴儛㳩彼㨊⚻♲ˤ
НѳъೕᆅԸҡੱ(HC-BPPV)
⸛幢ᶳⶎ⎛“幢㩊㞍(supine to head-lateral test)
䓐Ἦ姢㕟䲬Ỽ俛䞛䕯 2 ㆸ䘬 HC-BPPV炻嬻䕭かẘ
კΟǺEpley maneuverǶᡣੰ஻֤ӧບᕍ‫׉‬΢(A)Ǵᙴৣӧੰ஻ࡕБǴஒੰ஻ᓐᙯӛ஻ୁ 45°(B)Ǵз‫ځ‬፴ΠևᓐᝌՏ
30°(C)Ƕӆஒੰ஻ᓐᙯӛ଼ୁ 90°(D)Ǵᝩុஒੰ஻ᓐᙯӛ଼ୁ 90°Ǵ‫׎‬ԋୁޮՏǴջय़රΠǴሷηᆶһޮՏև 135°֨
‫(ف‬E)Ƕനࡕᡣੰ஻֤ଆǴᓐᙯԿύՏΠЃեև 20°Տ࿼(F)Ƕ
კѤǺSémont maneuverǶᡣੰ஻֤‫߻׉ܭ‬Ǵᓐӛ଼Ըୁᙯ 45°(A)ࡕǴᡣੰ஻፴ӛ஻ԸୁևᖍරϺ(B)Ǵࡑ౳ਁ੃ଏࡕ
ᓉং 1~2 ϩដǶ‫ז‬ೲஒੰ஻‫ي‬ᡏ 180°ୁ፴‫(ୁ଼ܭ‬C)Ǵࡑ౳ਁ੃ଏࡕᓉং 1~2 ϩដǴӆᡣੰ஻֤ଆǶ

5. Benign Paroxysmal Positional Vertigo
304 Formosan J Med 2023 Vol.27 No.3
幢⦧⊊ᶳ柕悐⠲檀 30°炻⃰⽆㬋ᷕỵὅ⸷⮯柕⎹ⶎ
⎹⎛⎬廱 90°ẍ奨⮇䛤㋗㚱䃉(⚾Ḽ)ˤ劍↢䎦㯜⸛
䘬⎹⛘䛤㋗(geotropic nystagmus)ㆾ㯜⸛䘬微⛘䛤
㋗(apogeotropic nystagmus)⌛姢㕟䁢 HC-BPPV炻↮
⇍姀抬䁢 ˣ 炻╖䭕柕堐䣢庫⻙“
䛤㋗炻暁䭕柕堐䣢庫⻟“䛤㋗ˤ㍐婾ℑ侭䘬农䕭㨇
廱 ↮ ⇍ 䁢 䭉 俛 䞛 (canalithiasis) ␴ 枪 ⷥ 㰱 䞛
(cupulolithiasis)炻HC-BPPV ↮栆䁢䭉俛䞛✳㯜⸛⋲
夷䭉俛䞛䕯(canalithiasis of HC-BPPV, HC-Can)⍲
枪ⷥ㰱䞛✳㯜⸛⋲夷䭉俛䞛䕯(cupulolithiasis of
HC-BPPV, HC-Cup)ˤ
䁢ỽ HC-Can ⏰⎹⛘䛤㋗ᶼ䛤㋗庫⻟“䁢か
俛“(⚾ℕ)烎ὅ㒂 Ewald 㮷䫔Ḵ⭂⼳炻䔞俛䞛ỵ㕤
㯜⸛⋲夷䭉⼴兪炻䕭か幢ᶳᶼ柕悐⠲檀 30°炻廱柕
⎹か俛炻俛䞛㛅⎹か俛⢢儡(ampullopetal)㺦≽炻忈
ㆸ冰⤖⿏⇢㽨炻枪ⷥ⎹♲“ῷ䦣炻枪ⷥῷ䦣䘬㕡⎹
䁢䛤㋗ㄊ䚠炻㓭婀䘤㛅⎹か俛䘬庫⻟⎹⛘䛤㋗ˤ廱
柕⎹‍俛炻俛䞛怈暊か俛⢢儡(ampullofugal)㺦≽炻
忈ㆸ㈹⇞⿏⇢㽨炻枪ⷥ⎹䭉“ῷ䦣炻枪ⷥῷ䦣䘬㕡
⎹䁢䛤㋗ㄊ䚠炻㓭婀䘤㛅⎹‍俛䘬庫⻙⎹⛘䛤㋗
[14]ˤ
1985 ⸜ McClure[15]椾㫉䘤堐㬌䕦䕭炻㓞普Ḯ
7 ἳ䘮㗗㕤⸛幢⦧⊊㗪炻柕⎹⎛“ㆾⶎ“⛯⎗婀䘤
↢㯜⸛⎹⛘䛤㋗炻ᶼ⛐㝸ᶨ“Ἕ㚱庫⻟䘬䛑㘰デ␴
䛤㋗ˤ䛤㋗庫⻟“ⷠỜ㚱冒䘤⿏䘬䛤㋗⍵廱䎦尉
(nystagmus inversion)炻⌛廱柕⎹䛤㋗庫⻟“䘬か俛
“㗪炻ᶨ攳⥳㚫⏰⎹⛘䛤㋗炻Ữᶨ㭝㗪攻⼴䛤㋗㚫
廱䁢庫⻙䘬微⛘䛤㋗烊Ữ㗗䔞柕廱⎹‍俛“㩊㞍
㗪炻⇯䃉㬌䎦尉ˤ⚳ℏ椾ἳ HC-Can 䓙㛶⍲恙[16]
㕤 1999 ⸜䘤堐ˤ
კϖǺѳ፴ΠѰѓୁ፴ᔠࢗǶᡣੰ஻һ፴࠮༈Πᓐ೽პଯ 30°ǴӃவ҅ύՏ٩‫ׇ‬ஒᓐӛѰӛѓӚᙯ 90°аᢀჸ౳ਁԖ
คǶ
კϤǺᆅԸҡ‫ޑ‬ᐒᙯǶр౜Нѳ‫ޑ‬ӛӦ౳ਁࣁ HC-Can( ) ǴЪ౳ਁၨமୁࣁ஻ԸǶᙯᓐӛ஻(Ѱ)ԸǴԸҡරӛѰԸ
൙ဎᄾ୏ǴࡺᇨวරӛѰԸ‫ޑ‬ၨமӛӦ౳ਁǶᙯᓐӛ଼(ѓ)ԸǴԸҡᇻᚆ஻Ը൙ဎᄾ୏ǴࡺᇨวරӛѓԸ‫ޑ‬ၨ১ӛӦ
౳ਁǶ

6. 列⿏昋䘤⿏ỵ伖⿏䛑㘰
⎘䀋慓⬠ 2023 ⸜ 27 ⌟ 3 㛇 305
1994 ⸜ Lempert 䫱[17]ㇵ攳⥳㍸↢㱣䗪㕡⺷炻
Lempert maneuver ⎗㱣䗪 HC-Can炻℞㬍樇䁢嬻䕭
か⸛幢炻柕⎹‍“ὅ⸷廱 3 ᾳ 90°炻㭷廱ᶨᾳ 90°
悥嬻䕭かᾅ㊩㬌⦧⊊ 1 ↮揀炻䚜⇘䛤㋗㴰⣙ㇵ两临
ᶳᶨᾳ≽ἄ(⚾ᶫ)炻⍰䧙 barbecue maneuverˤ1996
⸜ Meilleure 䫱 [18] ㍸ ↢ Meilleure liberatory
maneuver炻⃰嬻䕭か幢⎹か“炻䃞⼴⾓忇 180°廱⎹
‍“炻ⶴ㛃⋲夷䭉ℏ䘬俛䞛忂忶朆⢢儡䪗䘬攳⎋彼
⚆㨊⚻♲ˤ1997 ⸜ Vannucchi 䫱[19]嬻䕭か㊩临幢
⎹‍“ 12 ⮷㗪炻ᾳṢ㱣䗪䴻槿Ṏẍ㬌㊩临⦧⊊㱽
(forced prolonged position, FPP)㚨䁢䯉╖㚱㓰炻⍰
ᶵ便屣攨姢㗪攻[20]炻暋ẍ㈧⍿攟㗪攻“幢侭炻⎗
㍉℞⬫⽑ỵ埻㱣䗪ˤ
枪ⷥ㰱䞛✳㯜⸛⋲夷䭉俛䞛䕯(cupulolithiasis
of HC-BPPV, HC-Cup)䘬䛤㋗炻ᷫ⚈僓句䘬俛䞛旬
叿⛐⢢儡䘬枪ⷥᶲ炻䔞柕ỵ嬲⊾㗪炻俛䞛ㆾ⛐枪ⷥ
ᶲ㕡ᶳ⡻炻ㆾ⛐枪ⷥᶳ㕡㉱㈗炻⚈㬌↢䎦㗪攻㊩临
1 ↮揀ẍᶲ䘬䛤㋗ˤὅ俛䞛旬叿⛐枪ⷥ䘬㨊⚻♲“
(utricle-sided) ㆾ ⋲ 夷 䭉 “ (canal-sided) ỵ 伖 䘬 ᶵ
⎴炻HC-Cup ⍰↮栆䁢♲“(Cup-U)␴䭉“(Cup-C)ˤ
䁢ỽ HC-Cup ⏰微⛘䛤㋗(⚾ℓ)烎廱柕⎹か
俛炻俛䞛ἧ枪ⷥ⎹䭉“ῷ䦣炻忈ㆸ㈹⇞⿏⇢㽨炻枪
ⷥῷ䦣䘬㕡⎹䁢䛤㋗ㄊ䚠炻㓭婀䘤㛅⎹‍俛䘬微⛘
䛤㋗ˤ廱柕⎹‍俛炻俛䞛ἧ枪ⷥ⎹♲“ῷ䦣炻忈ㆸ
冰⤖⿏⇢㽨炻枪ⷥῷ䦣䘬㕡⎹䁢䛤㋗ㄊ䚠炻㓭婀䘤
㛅⎹か俛䘬微⛘䛤㋗ˤ
1995 ⸜ Baloh[21]䘤堐 3 ἳ PC-BPPV 㱣䗪⼴
↢䎦ℑ“㯜⸛微⛘䛤㋗炻㍐婾㗗俛䞛䓙⼴⋲夷䭉䦣
↢⼴炻䴻䓙㨊⚻♲ℵ湷旬㕤㯜⸛⋲夷䭉枪ⷥ䘬♲
“ˤ1996 ⸜ Steddin 䫱[22]䘤堐 2 ἳ HC-BPPV炻㕤
▿娎㕘㱽㱣䗪㗪炻䛤㋗䓙⍇㛔ℑ“㯜⸛⎹⛘䛤㋗廱
䁢㊩临⿏ℑ“㯜⸛微⛘䛤㋗炻㍐婾㗗俛䞛䓙䭉ℏ䦣
≽旬叿军㯜⸛⋲夷䭉枪ⷥ䘬䭉“ˤ⚳ℏ椾ἳ Cup-U
␴ Cup-C 䓙哉ˣ㛶⍲恙[23]㕤 2002 ⸜䘤堐ˤ
㛔Ἦ劍ὅ Ewald 㮷䫔Ḵ⭂⼳(ẍ㯜⸛⋲夷䭉侴
妨炻⎹⢢儡㳩≽䘬⇢㽨⻟忶暊⢢儡㳩≽䘬⇢㽨)炻
HC-Can か俛䁢䛤㋗庫⻟“炻HC-Cup か俛䁢䛤㋗
庫⻙“ˤỮ㗗 Baloh 䫱[21]娵䁢 Cup-U ␴ Cup-C ⺽
崟䘬䛤㋗⻟ᶵ⎴炻廱柕⎹か俛“㗪炻Cup-U ⡻従枪
ⷥ怬≈ᶲ冒幓慵慷炻㚫㚱庫⻟䛤㋗炻Cup-C ㉱㈗枪
ⷥ怬⎗傥㚱悐ấ俛䞛僓句炻㚫㚱庫⻙䛤㋗ˤ廱柕⎹
‍俛“㗪炻Cup-C ⡻従枪ⷥ怬≈ᶲ冒幓慵慷炻㚫㚱
庫⻟䛤㋗炻Cup-U ㉱㈗枪ⷥ怬⎗傥㚱悐ấ俛䞛僓
句炻㚫㚱庫⻙䛤㋗ˤ
ὅᶲ徘䎮婾⼿䞍
炻
ˬ⎛俛 Cup-C ␴ⶎ俛 Cup-U˭
悥㚫⏰ⶎ“俛庫⻟䘬微⛘䛤㋗( )炻
ˬⶎ俛
Cup-C ␴⎛俛 Cup-U˭
ḇ㚫⏰⎛“俛庫⻟䘬微⛘䛤
㋗( )炻⌛冐⸲ᶲ䃉㱽䓙䛤㋗⻟⻙“㍐婾⎗
傥䘬か俛“ˤ⍵ᷳ炻HC-Can 䘬䛤㋗庫⻟“⌛䁢か
俛“ˤ嬻䕭か幢⎹䛤㋗庫⻙“䘬㊩临⦧⊊㱽炻⎗⋼
≑揹⇍姢㕟か俛“䁢ỽ“烎劍㗗 Cup-U炻⚈俛䞛⶚
彼⚆㨊⚻♲炻㩊㞍㗪ᶵℵ↢䎦䛤㋗炻䕯䉨䶑妋ˤ劍
კΎǺLempert maneuverǶᡣੰ஻ѳ፴Ǵᓐӛ଼ୁ٩‫ׇ‬ᙯ 3 ঁ 90°Ǵ‫؂‬ᙯ΋ঁ 90°೿ᡣੰ஻ߥ࡭Ԝ࠮༈ 1 ϩដǴ‫ډޔ‬౳
ਁ੃ѨωᝩុΠ΋ঁ୏բǴΞᆀ barbecue maneuverǶ

7. Benign Paroxysmal Positional Vertigo
306 Formosan J Med 2023 Vol.27 No.3
㗗 Cup-C 㚫廱䁢⎴“俛䘬 HC-Can炻㬌㗪ℵᶨ㫉㊩
临⦧⊊㱽幢⎹䛤㋗庫⻙“⌛㗗ˤ⃀䭉 HC-BPPV 㚱
⣂䧖Ṇ✳炻农䕭㨇廱䓂䁢⣂㧋炻Ữ⎗㬠䲵䁢幢⎹䛤
㋗庫⻙“䘬㊩临⦧⊊㱽(⚾ḅ)䁢℞㱣䗪⍇⇯炻䃉枰
侫ㄖか俛䁢ỽ“[20]ˤ
1998 ⸜ Gufoni 䫱[24]㍸↢ Gufoni maneuver炻
㬌㱽⎗㱣䗪 HC-Can ␴ Cup-C(Ữᶵ怑⎰䓐㕤㱣䗪
Cup-U)ˤ㱣䗪⎹⛘✳䛤㋗(⚾⋩)炻嬻䕭か⛸㕤㩊㞍
⸲ᷕ攻炻㩊㞍侭㈞叿䕭か暁偑朊⮵䕭か炻嬻䕭か“
幢⎹‍“(⎹⛘䛤㋗庫⻙“)⼴炻ᾅ㊩㬌⦧⊊ 2 ↮
揀炻㩊㞍侭暁ㇳ廱㈞军か侭柕悐炻⾓忇⎹ᶳ廱柕
45° ⼴ᾅ㊩㬌⦧⊊ 2 ↮揀炻䃞⼴⛸崟ˤ
㱣䗪微⛘✳䛤㋗(⚾⋩ᶨ)炻嬻䕭か⛸㕤㩊㞍⸲
ᷕ攻炻㩊㞍侭㈞叿䕭か暁偑朊⮵䕭か炻嬻䕭か“幢
კΖǺഗ൰؈ҡ‫ޑ‬ᐒᙯǶр౜Нѳ‫ޑ‬଍Ӧ౳ਁࣁ HC-CupǴ஻Ըёૈࢂ౳ਁၨமୁ‫ޑ‬ Cup-U( )‫܈‬౳ਁၨ১ୁ‫ޑ‬
Cup-C( )Ǵջ‫ٿ‬Ըࣣёૈࣁ஻ԸǶ
კΐǺ፴ӛ౳ਁၨ১ୁ‫࠮ុ࡭ޑ‬༈‫ݤ‬ǶѰԸ HC-Can( )ǵCup-U( )‫ޑ‬Ըҡ‫ޔ‬ௗ߇ӣᐍ༝៶ǴѓԸ Cup-C( )‫ޑ‬Ըҡ
཮ᙯࣁӕୁԸ‫ޑ‬ HC-CanǶ

8. 列⿏昋䘤⿏ỵ伖⿏䛑㘰
⎘䀋慓⬠ 2023 ⸜ 27 ⌟ 3 㛇 307
⎹か“(微⛘䛤㋗庫⻙“)⼴ᾅ㊩㬌⦧⊊ 2 ↮揀炻㩊
㞍侭暁ㇳ廱㈞军か侭柕悐炻⾓忇⎹ᶲ廱柕 45° ⼴
ᾅ㊩㬌⦧⊊ 2 ↮揀炻䃞⼴⛸崟ˤ䔞䃞炻㬌㗪⼿`姕
微⛘䛤㋗㗗Ⱄ Cup-C 侭ˤ
⾓忇廱柕㱽(Rapid Head Rotation)⣂䓐㕤㱣䗪
枹⚢䘬 HC-Cup[25]炻ἄ㱽㗗嬻䕭か⸛幢⦧⊊ᶳ柕
悐⠲檀 30°炻⮯柕䶑ㄊ⛘廱⎹䛤㋗庫⻙“ 90° ⼴炻
⾓忇⛘ 180°⎹⮵“㕳廱ˤ劍㗗 Cup-U炻俛䞛塓䚜
㍍䓑⚆㨊⚻♲烊劍㗗 Cup-C炻俛䞛⇯塓䓑䁢⎴“
HC-Can炻ℵὅ䭉俛䞛✳⽑ỵ㕡⺷㱣䗪⌛⎗ˤ㚱㗪
HC-Cup ᶵ㖻⇌㕟䛤㋗⻟⻙“炻⇯⎒枰ἄ 180°⾓忇
廱柕⌛㗗炻ᶵ⽭侫ㄖ䓙ỽ“廱崟炻䚖䘬⯙⎒㗗天啱
⾓忇廱柕炻嬻㱦湷忶䵲䘬枪ⷥ㰱䞛⼿ẍ僓暊ˤ
HC-Cup 㭼崟 HC-Can 㚜㖻㚱䃉㱽↮彐䛤㋗⻟
⻙“䘬䩀⠫炻侴ῷῷ⎬䧖⽑ỵ埻炻悥枰枸⃰`姕か
俛“ㇵ傥㍍临㬋䡢㱣䗪炻㕤㗗㚱Ḯ⎬䧖庼≑柕ỵ㩊
㞍炻ẍ䡢⭂姢㕟微⛘䛤㋗䘬か俛“炻⤪㬌⎗㷃⮹婌
娎㱣䗪䘬㫉㔠ˤ
柕⇵⼴⁦㩊㞍(bow and lean test, BLT) [26]⎗
⋼≑姢㕟か俛“炻椾⃰嬻䕭か㍍⍿ supine to
head-lateral test 彐⇍㗗Ⱄ⎹⛘䛤㋗䘬 HC-Can ㆾⰔ
微⛘䛤㋗䘬 HC-Cup烎㍍叿嬻䕭か柕⎹⇵⁦ 90°炻
ℵ⎹⼴ẘ 45°ˤ劍㗗 HC-Can ⇯か俛“䁢⇵⁦㗪䛤
㋗䘬㕡⎹炻⚈㬌㗪䁢⎹⢢儡㳩≽炻㓭䛤㋗⎹か俛“
(⚾⋩Ḵ)ˤ劍㗗 HC-Cup ⇯か俛“䁢⼴ẘ㗪䛤㋗䘬
㕡⎹炻⚈㬌㗪䁢⎹⢢儡㳩≽炻㓭䛤㋗⎹か俛“(⚾
⋩ᶱ)ˤ
幢ᶳ䛤㋗(lying-down nystagmus, nystagmus
კΜǺGufoni maneuver ‫ݯ‬ᕍӛӦࠠ౳ਁǶᡣੰ஻֤‫ܭ‬ᔠࢗ‫׉‬ύ໔Ǵᔠࢗ‫ןޣ‬๱ੰ஻ᚈުय़ჹੰ஻(A)Ǵᡣੰ஻ୁ፴ӛ
଼ୁ(ӛӦ౳ਁၨ১ୁ)ࡕߥ࡭Ԝ࠮༈ 2 ϩដ(B)Ǵᔠࢗ‫ޣ‬ᚈЋᙯ‫ן‬Կ஻‫ޣ‬ᓐ೽Ǵ‫ז‬ೲӛΠᙯᓐ 45°ࡕߥ࡭Ԝ࠮༈ 2 ϩដ
(C)Ǵฅࡕ֤ଆ(D)Ƕ
კΜ΋ǺGufoni maneuver ‫ݯ‬ᕍ଍Ӧࠠ౳ਁǶᡣੰ஻֤‫ܭ‬ᔠࢗ‫׉‬ύ໔Ǵᔠࢗ‫ןޣ‬๱ੰ஻ᚈުय़ჹੰ஻(A)Ǵᡣੰ஻ୁ፴
ӛ஻ୁ(଍Ӧ౳ਁၨ১ୁ)ࡕߥ࡭Ԝ࠮༈ 2 ϩដ(B)Ǵᔠࢗ‫ޣ‬ᚈЋᙯ‫ן‬Կ஻‫ޣ‬ᓐ೽Ǵ‫ז‬ೲӛ΢ᙯᓐ 45°ࡕߥ࡭Ԝ࠮༈ 2 ϩ
ដ(C)Ǵฅࡕ֤ଆ(D)Ƕ
კΜΒǺᆅԸҡ‫ޑ‬ᓐ߻ࡕ໼ᔠࢗǶᡣੰ஻ᓐӛ߻໼ 90°Ǵӆӛࡕһ 45°Ƕऩࢂ HC-Can ߾஻Ըୁࣁ߻໼ਔ౳ਁ‫ޑ‬БӛǴ
ӢԜਔࣁӛ൙ဎࢬ୏Ǵࡺ౳ਁӛ஻ԸୁǶ

9. Benign Paroxysmal Positional Vertigo
308 Formosan J Med 2023 Vol.27 No.3
while recumbent)ˣ⛸ỵỶ柕䛤㋗(head pitch down
nystagmus while sitting) [27]⛯ὅ䚠⎴⍇䎮炻Ỷ柕㗪
䃉婾 Cup-C ㆾ Cup-U ⛯ἧ枪ⷥῷ⎹䭉“侴婀䘤⎹
‍ 俛 䘬 䛤 ㋗ ˤ ‥ 冒 䘤 䛤 ㋗ (pseudo-spontaneous
nystagmus, PSN) [28]㗗⚈㯜⸛⋲夷䭉冯㯜⸛朊⣦
奺⏰ 30°炻⛸ỵ㗪枪ⷥ㰱䞛㚫⡻ㆾ㉱叿枪ⷥῷ⎹♲
“炻侴婀䘤⎹か俛䘬䛤㋗(⚾⋩⚃)ˤNull point 㗗䶑
ㄊ廱⎹か俛“炻䚜⇘か俛枪ⷥ冯⛘朊✪䚜炻㬌㗪
Cup-C ㆾ Cup-U 䘬䛤㋗⛯㚫㴰⣙ˤ
߻ъೕᆅԸҡੱ(AC-BPPV)
AC-BPPV 㚨䁢份夳炻➟埴㝸“ Dix-Hallpike
maneuver 㗪炻⍵侴⇢㽨⮵“⇵⋲夷䭉俛䞛㳩≽ˤ
ἳ⤪➟埴ⶎ“ Dix-Hallpike maneuver炻⎛⇵⋲夷䭉
俛䞛㳩≽㕡⎹⏰暊⢢儡㳩≽炻⎗奨⮇⇘⎹ᶳ䛤㋗
(downbeat nystagmus)
ˤ
䎮婾ᶲㅱἝ㚱⎹か俛“䘬ᶳ
㕳⿏䛤㋗炻Ữ⚈䁢⇵⋲夷䭉冯䞊䉨朊䘬⣦奺⮷㕤⼴
⋲夷䭉冯䞊䉨朊⣦奺炻㓭䛤㋗䘬㕳廱ㆸấ䚠⮵庫
⮹炻墠䛤ᶳᶵ㖻奨⮇⇘㕳廱⿏ˤ㱣䗪㕡㱽㭳枰侫ㄖ
か俛䁢ỽ“炻㍉ Yacovino maneuver 嬻䕭か䓙⛸⦧
幢ᶳ⏰柕ㆠỵ炻ᾅ㊩㬌⦧⊊橼ỵ 30 䥺炻䃞⼴ᶳ⶜
⃀慷⎹傠悐㕡⎹⁦(chin to chest)炻ᾅ㊩㬌⦧⊊橼ỵ
30 䥺炻ℵ嬻䕭か⛸崟(⚾⋩Ḽ)炻⌛柕ẘㆠ⽑ỵ埻
(deep head hanging maneuver) [29]ˤShort CRP 㗗㕤
娚“䘬 Dix-Hallpike maneuver ⼴炻嬻娚“(か俛“)
⇵⋲夷䭉䘬俛䞛⏰暊⢢儡㳩≽炻㍍叿廱⎹‍俛“
90°炻嬻⇵⋲夷䭉䘬俛䞛⎹ℙ⎴儛㕡⎹㳩ℍ炻侴⼴
䚜㍍⛸崟ˤ憅⮵ Yacovino maneuver 㕤ᶳ⶜⎹傠悐
㕡⎹⁦䘬⦧⊊㗪炻⎗傥↢䎦俛䞛㳩ℍ⼴⋲夷䭉炻㓭
㚱⬠侭㍸↢ modified Yacovino maneuver 䔍⍣ᶳ⶜
⎹傠悐㕡⎹⁦䘬⦧⊊炻嬻䕭か䓙⛸⦧幢ᶳ⏰柕ㆠỵ
30 䥺⼴炻䚜㍍⛸崟炻㛇㛃性攳俛䞛婌ℍ⼴⋲夷䭉
䘬⎗傥[30]ˤ
่ ፕ
䛑㘰䕦䕭㩊㞍㚱姙⣂₨☐䧖栆炻⤪⅘㯜㹓㯜㷔
槿 (caloric test) ˣ 䛤 ㋗ ₨ (videonystagmography,
VNG)ˣ㬍ン≽㎾₨(posturography)ˣ柕悐㍐≃娎槿
კΜΟǺഗ൰؈ҡ‫ޑ‬ᓐ߻ࡕ໼ᔠࢗǶᡣੰ஻ᓐӛ߻໼ 90°Ǵӆӛࡕһ 45°Ƕऩࢂ HC-Cup ߾஻Ըୁࣁࡕһਔ౳ਁ‫ޑ‬Б
ӛǴӢԜਔࣁӛ൙ဎࢬ୏Ǵࡺ౳ਁӛ஻ԸୁǶ
კΜѤǺଵԾว౳ਁǶНѳъೕᆅᆶНѳय़֨‫ف‬և 30°Ǵ֤Տਔഗ൰؈ҡ཮ᓸ‫܎܈‬๱ഗ൰ୃӛ៶ୁ(ӵጂᓐ‫܌‬ҢБӛ)
Զᇨวӛ஻Ը‫ޑ‬౳ਁǶ

10. 列⿏昋䘤⿏ỵ伖⿏䛑㘰
⎘䀋慓⬠ 2023 ⸜ 27 ⌟ 3 㛇 309
(video head impulse test, vHIT)ˣᷣ奨夾奢✪䚜䶂
(subjective visual vertical, SVV)␴⇵⹕婀䘤倴暣ỵ
⍵ㅱ㩊㞍(vestibular evoked myogenic potentials,
VEMP)䫱炻䘮㗗䁢Ḯ揹⇍姢㕟⎬枭⎗傥䘬㛓㡊⿏
ㆾᷕ㧆⿏䛑㘰䕦䕭ˤょ姢㕟 BPPV 㭳枰ẍᶲ₨☐炻
⛐姢攻⎒天䯉╖娊⓷䕭⎚㗗䨩䘤⿏䘬ˣ␴柕悐ỵ伖
㓡嬲㚱斄䘬ˣ䛑㘰㗪攻㔠䥺ㆾ㔠↮ℏ侭炻⌛⎗㆟
䔹ˤḰẍ Dix-Hallpike maneuver 冯⸛幢ᶳⶎ⎛“幢
㩊㞍䡢⭂姢㕟炻ℵ㕥ẍ㬋䡢ᷳ㱣䗪ㇳ㱽炻⌛⎗ᶵ喍
侴䗺ˤ
ठ ᖴ
䈡⇍デ嫅㕘䪡⎘⣏↮昊倥≃ⷓ⛀昲昛ὲ᷆ˣ
∱䏔Ḷ⋼≑㉵㓅⽑ỵ埻䚠䇯炻㛙朄₨⋼≑暣儎丒
⚾ˤ
ᖂ ܴ
㛔䞼䨞ᷳ⇑䙲堅䨩烉䃉ˤ䞍ね⎴シ烉䃉ˤ⍿
娎侭㪲䙲烉䃉Ṣ橼ㆾ≽䈑⮎槿ˤ
ୖԵЎ᝘
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ߥ࡭Ԝ࠮༈ᡏՏ 30 ࣾǴӆᡣੰ஻֤ଆǶѓԸ AC-BPPV ‫ܭ‬Ѱୁ Dix-Hallpike maneuver ਔǴևӛΠ౳ਁ(D)Ƕ

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740599.

12. 列⿏昋䘤⿏ỵ伖⿏䛑㘰
⎘䀋慓⬠ 2023 ⸜ 27 ⌟ 3 㛇 311
Benign Paroxysmal Positional Vertigo
Ta-Wei Yeh
Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness. Posterior canal
BPPV (PC-BPPV) accounts for about 80% of all types of BPPV, can be diagnosed by Dix-Hallpike maneuver,
otolith can trigger flow of endolymphatic fluid by gravity, then cause deviation of cupula and induce upward
rotatory nystagmus. PC-BPPV can be treated by canalith repositioning procedure, such as Epley maneuver and
Sémont maneuver. Horizontal canal BPPV (HC-BPPV) accounts for about 20% of all types of BPPV, can be
diagnosed by supine to head-lateral test, geotropic nystagmus means canalithiasis of HC-BPPV, apogeotropic
nystagmus means cupulolithiasis of HC-BPPV. HC-BPPV can be treated by forced prolonged position (FPP), let
the patient lie to the weaker side of nystagmus for 10~12 hours continuously, if the patient cannot endure long
term side lying then choose other methods, such as barbecue maneuver and Gufoni maneuver. Anterior canal
BPPV (AC-BPPV) is very rare, downbeat nystagmus can be induced by Dix-Hallpike maneuver, can be treated
by deep head hanging maneuver no need to consider which side is lesion side.
Key Words: benign paroxysmal positional vertigo, nystagmus, semicircular canal, canalithiasis, cupulolithiasis,
canalith repositioning procedure
(Full text in Chinese: Formosan J Med 2023;27:300-11) DOI:10.6320/FJM.202305_27(3).0007
Department of Otolaryngology, NTU Hsin-Chu Hospital, Hsin Chu, Taiwan.
Address correspondence to: Ta-Wei Yeh, Department of Otolaryngology, NTU Hsin-Chu Hospital, No. 25, Ln. 442, Sec. 1,
Jingguo Rd., Hsinchu, Taiwan. E-mail: yehdawei@gmail.com