Guinand Nils, Boselie Frans, Guyot Jean-Philippe, Kingma Herman
Division of Balance Disorders, Department of Otolaryngology-Head and Neck Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
Ann Otol Rhinol Laryngol. 2012 Jul;121(7):471-7. doi: 10.1177/000348941212100708.
Currently, there is no evidence of an effective treatment for patients with bilateral vestibulopathy (BV). Their main complaints are oscillopsia and imbalance. Opinions about the impact of BV on their quality of life are controversial, and their handicap is not always recognized, even among otoneurologists. The aim of this study was to objectively assess the health status of BV patients in order to evaluate the need for pursuing efforts toward the development of new treatments.
The short-form health survey (SF-36), the dizziness handicap inventory (DHI), the short falls efficacy scale-international (short FES-I), and an oscillopsia severity questionnaire were submitted to 39 BV patients. The SF-36 scores were compared to the scores of a general Dutch population. The DHI scores were correlated to the oscillopsia severity scores. The short FES-I scores were compared to scores in an elderly population. Residual otolithic function was correlated to all scores, and hearing to SF-36 scores.
Compared to the general Dutch population, the BV patients scored significantly worse on the "physical functioning", "role physical", "general health", "vitality", and "social functioning" SF-36 variables (p < 0.05). The DHI scores were strongly correlated with the oscillopsia severity scores (r = 0.75; p < 0.000001). The short FES-I scores indicated a slight to moderate increase in the patients' fear of falling. No significant score differences were found between BV patients with residual otolithic function and patients with complete BV. There was no correlation between hearing status and SF-36 scores.
The results correlate with our clinical impression that BV has a strong negative impact on physical and social functioning, leading to a quality-of-life deterioration. There is a clear need for a therapeutic solution. Efforts toward the development of a vestibular implant are justified.
目前，尚无证据表明存在针对双侧前庭病（BV）患者的有效治疗方法。他们的主要症状是视振荡和平衡失调。关于BV对其生活质量的影响，观点存在争议，而且即使在耳神经科医生中，他们的残疾情况也并非总能得到认可。本研究的目的是客观评估BV患者的健康状况，以评估是否需要继续努力开发新的治疗方法。
向39例BV患者发放了简明健康调查量表（SF-36）、头晕残障量表（DHI）、国际简短跌倒效能量表（short FES-I）以及视振荡严重程度问卷。将SF-36得分与荷兰普通人群的得分进行比较。DHI得分与视振荡严重程度得分进行相关性分析。将short FES-I得分与老年人群的得分进行比较。残余耳石功能与所有得分进行相关性分析，听力与SF-36得分进行相关性分析。
与荷兰普通人群相比，BV患者在SF-36量表的“身体功能”“身体角色功能”“总体健康”“活力”和“社会功能”变量上得分显著更低（p < 0.05）。DHI得分与视振荡严重程度得分密切相关（r = 0.75；p < 0.000001）。short FES-I得分表明患者对跌倒的恐惧有轻度至中度增加。在有残余耳石功能的BV患者和完全性BV患者之间未发现显著的得分差异。听力状况与SF-36得分之间无相关性。
这些结果与我们的临床印象相符，即BV对身体和社会功能有强烈的负面影响，导致生活质量下降。显然需要一种治疗方案。开展前庭植入物的研发工作是合理的。
