Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.
Clin Exp Otorhinolaryngol. 2009 Sep;2(3):145-50. doi: 10.3342/ceo.2009.2.3.145. Epub 2009 Sep 23.
Air caloric results are supposed to be influenced by anatomic changes of the middle ear. The aims of our study were to evaluate the incidence and characteristics of abnormal air caloric results in patients with unilateral chronic otitis media and without any history of vertigo, and to compare caloric results with there of other vestibular function tests (VFTs).
Twenty five patients with unilateral chronic otitis media (COM) who were scheduled for surgery underwent VFTs preoperatively. Hearing was assessed using pure-tone audiometry and vestibular function was assessed using a set of VFTs: air caloric, head-shaking nystagmus (HSN), vibration-induced nystagmus (VIN), and subjective visual vertical (SVV) tests.
Six patients (24%) showed pathologic canal paresis (CP) on COM-sided ears. Two patients showed pathologic CP on the contralateral side. However, both of the two showed inverted nystagmus to warm air stimulation on the COM-side and hyperactive nystagmus to cold air stimulation on the COM-side, which means that the COM-sided ear was stimulated too much. There was pathologic HSN in 12 patients (48%), pathologic VIN in 7 (28%), and pathologic SVV in 5 (20%). Overall, 20 (80%) patients showed abnormal findings through a set of VFTs. Patients with an interaural difference of bone-conduction hearing thresholds >/=10 dB tended to show more abnormal VFT results than those for whom the interaural difference of bone-conduction hearing thresholds was <10 dB.
Our data show that one-fourth of patients with unilateral COM show abnormal caloric results on the COM side. However, subclinical latent vestibular imbalances were found to be common, which might be related to the gradual vestibular involvement in inflammatory processes, regardless of the caloric results. Results of a set of VFTs should be referred to when determining vestibular imbalance in patients with COM.
空气热刺激试验的结果可能会受到中耳解剖变化的影响。本研究旨在评估单侧慢性中耳炎（COM）患者且无眩晕病史的患者中异常空气热刺激试验结果的发生率和特征，并将其与其他前庭功能测试（VFT）的结果进行比较。
25 例单侧慢性中耳炎（COM）患者拟行手术治疗，术前均进行了 VFT。纯音测听评估听力，一组 VFT 评估前庭功能：空气热刺激试验、摇头眼震（HSN）、振动眼震（VIN）和主观垂直视觉（SVV）测试。
6 例（24%）患者 COM 侧出现病理性管麻痹（CP）。2 例患者对侧出现病理性 CP。但这 2 例患者 COM 侧对热空气刺激均出现倒向性眼震，对冷空气刺激出现亢进性眼震，这意味着 COM 侧的耳朵受到了过度刺激。12 例（48%）患者出现 HSN 异常，7 例（28%）出现 VIN 异常，5 例（20%）出现 SVV 异常。总体而言，20 例（80%）患者通过一组 VFT 检查发现异常。骨导听阈差值≥10dB 的患者比骨导听阈差值<10dB 的患者更易出现异常 VFT 结果。
我们的数据显示，四分之一的单侧 COM 患者在 COM 侧出现异常的热刺激试验结果。然而，发现亚临床潜在的前庭平衡失调很常见，这可能与炎症过程中逐渐发生的前庭受累有关，而与热刺激试验结果无关。在确定 COM 患者的前庭平衡失调时，应参考一组 VFT 的结果。
