Koide C
Department of Otolaryngology, Niigata University School of Medicine.
Nihon Jibiinkoka Gakkai Kaiho. 1991 Mar;94(3):377-85. doi: 10.3950/jibiinkoka.94.377.
It is well known that inverted caloric nystagmus is seen during air caloric testing in cases of chronic otitis media. The mechanism of inversion and its clinical significance are discussed here. Temperature changes in the tympanic cavity and external ear canal were measured with a microthermister and a digital tester in seventeen ears with tympanic membrane perforation, during bithermal air caloric testing. The tympanic cavity mucosa was cooled by hot stimulation because of the evaporation of heat. When the perforation was closed or humidified air was used, the tympanic cavity mucosa was not cooled by hot stimulation and the inverted caloric nystagmus changed to a normal response. Inverted caloric nystagmus occurred in 30.4% of 335 ears affected by chronic otitis media with perforation. Inverted caloric nystagmus occurred in 90 ears with hot stimulation and in 12 ears with cold stimulation. Inverted caloric nystagmus turned to normal response after myringoplasty in all of 10 ears. The cooling effect caused by evaporation of water from the moist middle ear mucosa during dry air blowing and direct thermal conduction to the vestibulum through a perforation of the ear drum and inversion of the endolymphatic convection seemed to cause the inversion.
众所周知，在慢性中耳炎病例的空气冷热试验中会出现反向冷热眼震。本文讨论了其反向机制及其临床意义。在双温空气冷热试验期间，使用微型温度计和数字测试仪对17例鼓膜穿孔患者的鼓膜腔和外耳道温度变化进行了测量。由于热量蒸发，热刺激使鼓膜腔黏膜冷却。当穿孔闭合或使用加湿空气时，热刺激不会使鼓膜腔黏膜冷却，反向冷热眼震转变为正常反应。335例慢性中耳炎伴穿孔患者中，30.4%出现反向冷热眼震。90耳热刺激时出现反向冷热眼震，12耳冷刺激时出现。10耳鼓膜成形术后，反向冷热眼震均转为正常反应。干燥空气吹拂时，中耳湿润黏膜水分蒸发产生的冷却效应、通过鼓膜穿孔向前庭的直接热传导以及内淋巴对流反转似乎导致了这种反向。
