Dumas G, Michel J, Lavieille J P, Ouedraogo E
Clinique ORL, Centre Hospitalier Albert Michallon, 38043 Grenoble Cedex, France.
Ann Otolaryngol Chir Cervicofac. 2000 Nov;117(5):299-312.
Nystagmus signaling vestibular dysfunction was observed after vibratory stimulation with a 100 Hz ABC stimulator in a population of 36 patients with unilateral labyrinthine pathology (ULP) (pre and postoperative neuromas, vestibular neurectomies) and 10 patients with vestibular neuritis. The stimulus was applied on 3 bony points of the skull (vertex and 2 mastoids) and 2 muscular points of the neck (right and left posterior cervical region). These results were compared with those in 95 normal subjects and 19 cases of central disease and were correlated on the same day with results of the caloric test and head shaking test (HST). A consistent nystagmus was found in only 6 % of the normal subjects (specificity 94 %) and in 10 % of the central lesions, but in 94 % of the 36 peripheral ULP. The sensitivity of the test was equivalent to the HST. The signal was optimized in 30 patients: stimulus frequency, amplitude, stimulator mass, form of the contact, patient tolerance. The best results were obtained for a frequency of 100 Hz and an amplitude of 0.5 mm (there was no response under 0.1 mm vibration amplitude). Under videoscopy and 3D videonystagmography, the direction or side of the nystagmus was constant, but its axis (horizontal, oblique or rotational) changed according to the location of the stimulator: on the mastoid (elective location of stimulation with responses in 94 % of cases) the axis was most often horizontal or horizontal rotational. On the vertex location (where nystagmus was observed in 60 % of cases) the axis of nystagmus was most often rotational or oblique and sometimes horizontal-rotational. The nystagmus showed short latency (less than 200 ms). It started and stopped as stimulation was initiated and interrupted. Nystagmus persisted for the duration of patient tolerance. This nystagmus generally signifies unilateral vestibular weakness rather than vestibular predominance. It is a good indicator of unilateral vestibular dysfunction and could serve as a useful test in clinical practice. We discuss the origin of the nystagmus which may originate in muscle proprioception (by propagation of the vibration to neck muscles) or in the labyrinth (simultaneous excitation of 3 canals on each side).
在36例单侧迷路病变（ULP）患者（术前和术后神经瘤、前庭神经切除术）和10例前庭神经炎患者中，使用100Hz ABC刺激器进行振动刺激后，观察到了提示前庭功能障碍的眼球震颤。刺激施加于颅骨的3个骨点（头顶和2个乳突）和颈部的2个肌肉点（右和左颈后区域）。将这些结果与95例正常受试者和19例中枢性疾病患者的结果进行比较，并在同一天与冷热试验和摇头试验（HST）的结果相关联。仅6%的正常受试者（特异性94%）和10%的中枢性病变患者出现了持续的眼球震颤，但36例外周ULP患者中有94%出现了眼球震颤。该试验的敏感性与HST相当。在30例患者中优化了信号：刺激频率、振幅、刺激器质量、接触形式、患者耐受性。频率为100Hz、振幅为0.5mm时获得了最佳结果（振动幅度低于0.1mm时无反应）。在视频显微镜和三维视频眼震图检查下，眼球震颤的方向或侧别是恒定的，但其轴（水平、斜向或旋转）根据刺激器的位置而变化：在乳突上（94%的病例中有反应的首选刺激部位），轴最常为水平或水平旋转。在头顶位置（60%的病例中观察到眼球震颤），眼球震颤的轴最常为旋转或斜向，有时为水平旋转。眼球震颤的潜伏期较短（小于200ms）。随着刺激的开始和中断而开始和停止。眼球震颤在患者耐受期间持续存在。这种眼球震颤通常表示单侧前庭功能减弱而非前庭优势。它是单侧前庭功能障碍的良好指标，可作为临床实践中的有用检查。我们讨论了眼球震颤的起源，其可能起源于肌肉本体感觉（通过振动传播到颈部肌肉）或迷路（双侧3个半规管同时兴奋）。
