Hong Sung Kwang, Koo Ja-Won, Kim Ji Soo, Park Min-Hyun
Department of Otorhinolaryngology, Seoul National University College of medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Acta Otolaryngol Suppl. 2007 Oct(558):128-31. doi: 10.1080/03655230701625019.
The incidence of ipsilesional beating vibration induced nystagmus (VIN) is significantly higher in Meniere's disease (MD) with lower canal paresis (CP) group on caloric test and the intensity of VIN shows significant positive correlation with CP. Considering previous reports showing predominant loss of type II hair cells in MD and discrepancy of the results between caloric test and head thrust test in MD patients, VIN may provide valuable information regarding the functional reservoir of vestibular type II hair cells in MD.
Clinical presentation of MD is dynamic and nystagmus changes phase to phase, which is attributed to the recovery process in addition to central compensation after active vertigo attack of MD. VIN has been shown to reflect the side difference of peripheral vestibular excitability and is well correlated with the severity of caloric weakness in vestibular neuritis. Aim of this study was to compare the intensity and the direction of VIN with CP in unilateral MD.
52 patients with unilateral definite MD on AAO-HNS guideline (1995) were included. Auditory and vestibular function tests including caloric test, post-head shaking nystagmus (HSN) and VIN were evaluated during symptom free period and cases with spontaneous nystagmus were excluded. Vibratory stimuli (100 Hz) were applied to either mastoid alternatively. Eye movement was recorded using video nystagmography system. The horizontal component of VIN was compared with HSN and caloric test.
37 patients (71%) showed VIN. VIN to ipsilesional side was in 10 and to contralesional side in 27. In patients with CP over 43% (N =23), 2 beated to ipsilesional side, 17 to contralesional side and 4 showed no VIN. In patients with CP of less than 43% (N =29), 8 beated to ipsilesional side, 10 to contralesional side and 11 showed no VIN (p<0.05). 33 patients (63%) showed HSN and 24 patients of them (72%) showed contralesional nystagmus. The intensity of VIN shows significant positive correlation with the degree of CP on caloric test (Spearman's rho =0.340, p<0.05).
在冷热试验中半规管轻瘫（CP）较低的梅尼埃病（MD）患者中，患侧搏动性振动诱发性眼震（VIN）的发生率显著更高，且VIN的强度与CP呈显著正相关。鉴于既往报道显示MD患者中II型毛细胞主要受损，且MD患者冷热试验和摇头试验结果存在差异，VIN可能为MD患者前庭II型毛细胞的功能储备提供有价值的信息。
MD的临床表现是动态变化的，眼震也会逐阶段改变，这除了归因于MD急性眩晕发作后的中枢代偿外，还与恢复过程有关。VIN已被证明可反映外周前庭兴奋性的侧别差异，且与前庭神经炎中冷热试验减弱的严重程度密切相关。本研究的目的是比较单侧MD患者中VIN的强度和方向与CP的关系。
纳入52例符合美国耳鼻咽喉头颈外科学会（AAO-HNS）1995年指南标准的单侧确诊MD患者。在症状缓解期进行听觉和前庭功能测试，包括冷热试验、摇头后眼震（HSN）和VIN，排除有自发性眼震的病例。交替对双侧乳突施加振动刺激（100Hz）。使用视频眼震图系统记录眼动。比较VIN的水平分量与HSN和冷热试验的结果。
37例患者（71%）出现VIN。其中10例VIN指向患侧，27例指向对侧。在CP超过43%的患者（N =23）中，2例VIN指向患侧，17例指向对侧，4例未出现VIN。在CP小于43%的患者（N =29）中，8例VIN指向患侧，10例指向对侧，11例未出现VIN（p<0.05）。33例患者（63%）出现HSN，其中24例（72%）出现对侧眼震。VIN的强度与冷热试验中CP的程度呈显著正相关（Spearman相关系数rho =0.340，p<0.05）。
Zotero 插件