BPPV

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