Maire Raphaël, van Melle Guy
Clinic of Otolaryngology, Head & Neck Surgery, University Hospital Lausanne, Switzerland.
Otol Neurotol. 2006 Jun;27(4):535-41. doi: 10.1097/01.mao.0000201432.42498.08.
To evaluate the power of various parameters of the vestibulo-ocular reflex (VOR) in detecting unilateral peripheral vestibular dysfunction and in characterizing certain inner ear pathologies.
Prospective study of consecutive ambulatory patients presenting with acute onset of peripheral vertigo and spontaneous nystagmus.
Tertiary referral center.
Seventy-four patients (40 females, 34 males) and 22 normal subjects (11 females, 11 males) were included in the study. Patients were classified in three main diagnoses: vestibular neuritis: 40; viral labyrinthitis: 22; Meniere's disease: 12.
The VOR function was evaluated by standard caloric and impulse rotary tests (velocity step). A mathematical model of vestibular function was used to characterize the VOR response to rotational stimulation. The diagnostic value of the different VOR parameters was assessed by uni- and multivariable logistic regression.
In univariable analysis, caloric asymmetry emerged as the most powerful VOR parameter in identifying unilateral vestibular deficit, with a boundary limit set at 20%. In multivariable analysis, the combination of caloric asymmetry and rotational time constant asymmetry significantly improved the discriminatory power over caloric alone (p<0.0001) and produced a detection score with a correct classification of 92.4%. In discriminating labyrinthine diseases, different combinations of the VOR parameters were obtained for each diagnosis (p<0.003) supporting that the VOR characteristics differ between the three inner ear disorders. However, the clinical usefulness of these characteristics in separating the pathologies was limited.
We propose a powerful logistic model combining the indices of caloric and time constant asymmetries to detect a peripheral vestibular loss, with an accuracy of 92.4%. Based on vestibular data only, the discrimination between the different inner ear diseases is statistically possible, which supports different pathophysiologic changes in labyrinthine pathologies.
评估前庭眼反射（VOR）的各种参数在检测单侧外周前庭功能障碍以及确定某些内耳病变特征方面的效能。
对出现急性外周性眩晕和自发性眼球震颤的连续门诊患者进行前瞻性研究。
三级转诊中心。
74例患者（40名女性，34名男性）和22名正常受试者（11名女性，11名男性）纳入本研究。患者分为三个主要诊断类别：前庭神经炎：40例；病毒性迷路炎：22例；梅尼埃病：12例。
通过标准冷热试验和脉冲旋转试验（速度阶跃）评估VOR功能。使用前庭功能的数学模型来表征VOR对旋转刺激的反应。通过单变量和多变量逻辑回归评估不同VOR参数的诊断价值。
在单变量分析中，冷热试验不对称性成为识别单侧前庭功能缺损最有效的VOR参数，设定的界限值为20%。在多变量分析中，冷热试验不对称性和旋转时间常数不对称性的组合显著提高了相对于单独冷热试验的鉴别能力（p<0.0001），并产生了一个正确分类率为92.4%的检测分数。在区分迷路疾病时，每种诊断获得了不同的VOR参数组合（p<0.003），这支持了三种内耳疾病的VOR特征不同。然而，这些特征在区分病变方面的临床实用性有限。
我们提出了一个强大的逻辑模型，结合冷热试验和时间常数不对称性指标来检测外周前庭功能丧失，准确率为92.4%。仅基于前庭数据，在统计学上可以区分不同的内耳疾病，这支持了迷路病变中不同的病理生理变化。
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