Funabiki Kazuo, Naito Yasushi
Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan.
Acta Otolaryngol. 2002 Jan;122(1):31-6. doi: 10.1080/00016480252775706.
We compared the results of analysis of vestibulo-ocular reflex (VOR) obtained by manual rotation in routine vestibular clinical practice with that of caloric testing, and examined the validity and limitations of VOR analysis as a test for the estimation of peripheral vestibular function and imbalance. VOR response was recorded in daily vestibular clinical examinations by manually rotating the standard clinical chair for approximately 30 s. VOR gain was slightly, but significantly, correlated with the peak slow phase velocity of caloric response (r = 0.50, p < 0.001). However, 8 out of 12 patients with no caloric response failed to exceed the range of two standard deviations of the mean value of age-matched normal subjects, indicating that it is clinically difficult to use VOR gain alone as a estimate of unilateral vestibular function. VOR directional preponderance (VOR DP%) correlated well with caloric canal paresis (CP) (CP%; r = 0.89, p < 0.001). VOR DP% was within the normal range in patients with caloric CP% < 40 and exceeded the normal range in most cases with caloric CP% > 80. VOR DP% varied widely when caloric CP% ranged between 40 and 80. The effect of vestibular compensation on VOR DP% was examined by plotting VOR DP% divided by caloric CP% (DP/CP) against the number of days since the onset of vertigo in patients with vestibular neuritis or sudden deafness with vertigo. DP/CP was large within 50 days of the onset of vestibular damage, especially when caloric CP% was < 80, and gradually decreased with time. These results indicate that determination of VOR DP% should contribute to the early diagnosis of fresh vestibular imbalance, especially in daily clinical practice, because this type of VOR recording can be performed in < 1 min in routine vestibular clinics. The decay time constant of DP/CP was larger when caloric CP% exceeded 80, indicating that vestibular compensation proceeds more slowly when the vestibular damage is severe.
我们将常规前庭临床实践中通过手动旋转获得的前庭眼反射（VOR）分析结果与冷热试验结果进行了比较，并检验了VOR分析作为评估外周前庭功能和失衡测试的有效性和局限性。在前庭日常临床检查中，通过手动旋转标准临床椅约30秒来记录VOR反应。VOR增益与冷热反应的慢相峰值速度呈轻度但显著的相关性（r = 0.50，p < 0.001）。然而，12例无冷热反应的患者中有8例未超过年龄匹配正常受试者平均值的两个标准差范围，这表明在临床上单独使用VOR增益作为单侧前庭功能的评估指标存在困难。VOR方向优势（VOR DP%）与冷热半规管轻瘫（CP）相关性良好（CP%；r = 0.89，p < 0.001）。冷热CP% < 40的患者VOR DP%在正常范围内，而冷热CP% > 80的大多数情况下VOR DP%超过正常范围。当冷热CP%在40至80之间时，VOR DP%变化很大。通过绘制前庭神经炎或突发性聋伴眩晕患者VOR DP%除以冷热CP%（DP/CP）与眩晕发作后天数的关系图，研究了前庭代偿对VOR DP%的影响。在前庭损伤发作后50天内，DP/CP较大，尤其是当冷热CP% < 80时，并随时间逐渐降低。这些结果表明，VOR DP%的测定有助于早期诊断新鲜的前庭失衡，特别是在日常临床实践中，因为这种类型的VOR记录在常规前庭诊所中可在1分钟内完成。当冷热CP%超过80时，DP/CP的衰减时间常数更大，表明前庭损伤严重时前庭代偿进展更慢。
