Belafsky P, Gianoli G, Soileau J, Moore D, Davidowitz S
Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana 70112-2699, USA.
Otolaryngol Head Neck Surg. 2000 Feb;122(2):163-7. doi: 10.1016/S0194-5998(00)70233-6.
The current gold standard for diagnosis of benign paroxysmal positional vertigo (BPPV) is the Dix-Hallpike maneuver. However, because of fatigability, the Dix-Hallpike is often falsely normal. The objective of this study was to evaluate the utility of vestibular autorotation testing in the diagnosis of BPPV.
The charts of 210 patients at a tertiary referral center for vertiginous disorders were reviewed. All patients underwent clinical evaluation, Dix-Hallpike testing, audiometry, electronystagmography, and vestibular autorotation testing. The vestibular autorotation results of patients with BPPV were compared with the findings in patients with non-BPPV vestibular disorders. The sensitivity and specificity of vestibular autorotation testing in diagnosing BPPV were calculated.
Ninety-one patients (42.9%) had BPPV, 76 patients (36.2%) had vertigo of uncertain cause, 28 (13.3%) had unilateral vestibular hypofunction, 9 patients (4.3%) had Meniere's disease, and 2 patients (1.0%) had perilymphatic fistula. Patients with BPPV were 3.32 times more likely to have a normal horizontal gain (95% CI = 1.54-7.19). A normal horizontal gain is 85% sensitive but only 36% specific for BPPV. Patients with BPPV were 1.9 times more likely to have vertical phase lead (95% CI = 0.95-3.93). Patients with BPPV were 2.20 times more likely to have both normal horizontal gain and vertical phase lead (95% CI = 1.03-4.69) The sensitivity of the combination of normal horizontal gain and vertical phase lead on vestibular autorotation testing is 87% specific but only 25% sensitive in the diagnosis of BPPV.
A normal horizontal gain or vertical phase lead on vestibular autorotation testing in a vertiginous patient is suggestive of but not exclusive to a diagnosis of BPPV. The combination of a normal horizontal gain and vertical phase lead on vestibular autorotation testing is highly suggestive of the diagnosis of BPPV. Adjuvant use of these parameters in vestibular autorotation testing may prove to be helpful in the diagnosis of BPPV.
目前诊断良性阵发性位置性眩晕（BPPV）的金标准是Dix-Hallpike试验。然而，由于该试验会产生疲劳性，Dix-Hallpike试验结果常出现假阴性。本研究旨在评估前庭自旋转试验在BPPV诊断中的效用。
回顾了一家三级眩晕疾病转诊中心210例患者的病历。所有患者均接受了临床评估、Dix-Hallpike试验、听力测定、眼震电图检查和前庭自旋转试验。将BPPV患者的前庭自旋转试验结果与非BPPV前庭疾病患者的检查结果进行比较。计算前庭自旋转试验诊断BPPV的敏感性和特异性。
91例患者（42.9%）患有BPPV，76例患者（36.2%）眩晕病因不明，28例（13.3%）有单侧前庭功能减退，9例患者（4.3%）患有梅尼埃病，2例患者（1.0%）患有外淋巴瘘。BPPV患者水平增益正常的可能性高3.32倍（95%可信区间=1.54-7.19）。水平增益正常对BPPV的敏感性为85%，但特异性仅为36%。BPPV患者出现垂直相位超前的可能性高1.9倍（95%可信区间=0.95-3.93）。BPPV患者水平增益正常且出现垂直相位超前的可能性高2.20倍（95%可信区间=1.03-4.69）。前庭自旋转试验中水平增益正常和垂直相位超前联合出现对BPPV诊断的特异性为87%，但敏感性仅为25%。
眩晕患者前庭自旋转试验中水平增益正常或垂直相位超前提示可能为BPPV，但并非其特有表现。前庭自旋转试验中水平增益正常和垂直相位超前联合出现高度提示BPPV诊断。在前庭自旋转试验中辅助使用这些参数可能有助于BPPV的诊断。
