Park HongJu, Shin JungEun, Jeong YongSoo, Kwak HiBoong, Lee YeoJin
Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea.
Otol Neurotol. 2009 Sep;30(6):806-11. doi: 10.1097/MAO.0b013e3181b0ff1b.
Most patients complaining of dizziness seek medical services in the interictal period, which is thought to be a compensated stage. Thus, we wanted to investigate the results of vestibular function tests (VFTs) at a compensated stage in patients with vestibular neuritis to determine the presence and the sides of vestibular hypofunction.
Retrospective case series review.
We analyze the results of VFT including spontaneous nystagmus (SN), caloric, vibration-induced nystagmus (VIN), head-shaking nystagmus (HSN), and subjective visual vertical (SVV) tests in 38 patients (M/F = 23:15; age range, 15-85 yr) with vestibular neuritis observed at around 2 months after the onset of vertigo.
Thirty-seven (97%) of 39 patients showed pathologic results in at least 1 test. Pathologic results, based on caloric, SN, VIN, HSN, and SVV tests, were observed in 29 (76%), 20 (53%), 24 (63%), 33 (87%), and 15 patients (39%). Twenty-nine showed pathologic canal paresis (CP) on the affected side and 9 patients (24%) showed normal CP. There was no patient with pathologic CP on the intact side. In 29 patients with pathologic CP, pathologic results, based on SN, VIN, HSN, and SVV tests, were observed in 16 (55%), 20 (69%), 26 (90%), and 13 patients (45%). Three (10%) of 29 patients showed pathologic VIN or HSN, indicating that the intact side is pathologic. In 9 patients with normal CP, pathologic results, based on SN, VIN, HSN, and SVV tests, were observed in 4 (44%), 4, 7 (78%), and 2 patients (22%). Five (56%) of 9 patients showed pathologic results on the intact side at least in 1 test, and the pathologic sides by each test were not the same.
Our findings suggest that we can detect vestibular imbalance in patients with unilateral vestibular hypofunction through a set of VFTs even when CP is normal at a compensated stage. The CP side indicated by caloric test was the real affected side when CP was pathologic, even if the results of other tests were normal or rarely indicated that the intact side was pathologic. If CP was within reference range, other tests can show the previous presence of vestibular imbalance; however, they could not predict the side of the vestibular hypofunction. These data provide strong support for enrolling a set of VFT when evaluating a dizzy patient.
大多数主诉头晕的患者在发作间期寻求医疗服务，这一时期被认为是代偿期。因此，我们想研究前庭神经炎患者在代偿期的前庭功能测试（VFT）结果，以确定前庭功能减退的存在及部位。
回顾性病例系列研究。
我们分析了38例（男/女 = 23:15；年龄范围15 - 85岁）眩晕发作后约2个月观察到的前庭神经炎患者的VFT结果，包括自发性眼震（SN）、冷热试验、振动性眼震（VIN）、摇头眼震（HSN）和主观视觉垂直线（SVV）测试。
39例患者中有37例（97%）至少在1项测试中出现病理结果。基于冷热试验、SN、VIN、HSN和SVV测试的病理结果分别在29例（76%）、20例（53%）、24例（63%）、33例（87%）和15例（39%）患者中观察到。29例患侧出现病理性半规管轻瘫（CP），9例患者（24%）CP正常。健侧没有患者出现病理性CP。在29例病理性CP患者中，基于SN、VIN、HSN和SVV测试的病理结果分别在16例（55%）、20例（69%）、26例（90%）和13例（4%)患者中观察到。299例患者中有3例（10%）出现病理性VIN或HSN，表明健侧存在病变。在9例CP正常的患者中，基于SN、VIN、HSN和SVV测试的病理结果分别在4例（44%）、4例、7例（78%）和2例（22%）患者中观察到。9例患者中有5例（56%）至少在1项测试中健侧出现病理结果，且每项测试的病理侧不同。
我们的研究结果表明，即使在代偿期CP正常时，通过一组VFT也能检测出单侧前庭功能减退患者的前庭失衡。当CP为病理性时，冷热试验显示的CP侧是真正的患侧，即使其他测试结果正常或很少表明健侧存在病变。如果CP在参考范围内，其他测试可显示既往存在前庭失衡；然而，它们无法预测前庭功能减退的侧别。这些数据为评估头晕患者时采用一组VFT提供了有力支持。
