Chau Allan T, Menant Jasmine C, Hübner Patrick P, Lord Stephen R, Migliaccio Americo A
Neuroscience Research Australia, University of New South Wales , Sydney, NSW , Australia.
Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Front Neurol. 2015 Dec 24;6:268. doi: 10.3389/fneur.2015.00268. eCollection 2015.
Dizziness and imbalance are clinically poorly defined terms, which affect ~30% of people over 65 years of age. In these people, it is often difficult to define the primary cause of dizziness, as it can stem from cardiovascular, vestibular, psychological, and neuromuscular causes. However, identification of the primary cause is vital in determining the most effective treatment strategy for a patient. Our aim is to accurately identify the prevalence of benign paroxysmal positional vertigo (BPPV), peripheral, and central vestibular hypofunction in people aged over 50 years who had experienced dizziness within the past year. Seventy-six participants aged 51-92 (mean ± SD = 69 ± 9.5 years) were tested using the head thrust dynamic visual acuity (htDVA) test, dizziness handicap inventory (DHI), as well as sinusoidal and unidirectional rotational chair testing, in order to obtain data for htDVA score, DHI score, sinusoidal (whole-body, 0.1-2 Hz with peak velocity at 30°/s) vestibulo-ocular reflex (VOR) gain and phase, transient (whole-body, acceleration at 150°/s(2) to a constant velocity rotation of 50°/s) VOR gain and time constant (TC), optokinetic nystagmus (OKN) gain, and TC (whole-body, constant velocity rotation at 50°/s). We found that BPPV, peripheral and central vestibular hypofunction were present in 38 and 1% of participants, respectively, suggesting a likely vestibular cause of dizziness in these people. Of those with a likely vestibular cause, 63% had BPPV; a figure higher than previously reported in dizziness clinics of ~25%. Our results indicate that htDVA, sinusoidal (particularly 0.5-1 Hz), and transient VOR testing were the most effective at detecting people with BPPV or vestibular hypofunction, whereas DHI and OKN were effective at only detecting non-BPPV vestibular hypofunction.
头晕和平衡失调在临床上是定义不明确的术语，影响着约30%的65岁以上人群。对于这些人来说，通常很难确定头晕的主要原因，因为它可能源于心血管、前庭、心理和神经肌肉等方面的原因。然而，确定主要病因对于为患者确定最有效的治疗策略至关重要。我们的目的是准确确定在过去一年中经历过头晕的50岁以上人群中良性阵发性位置性眩晕（BPPV）、外周性和中枢性前庭功能减退的患病率。对76名年龄在51 - 92岁（平均±标准差 = 69 ± 9.5岁）的参与者进行了头部脉冲动态视力（htDVA）测试、头晕障碍量表（DHI）测试，以及正弦和单向旋转椅测试，以获取htDVA评分、DHI评分、正弦（全身，0.1 - 2Hz，峰值速度为30°/秒）前庭眼反射（VOR）增益和相位、瞬态（全身，加速度为150°/秒²至恒定速度旋转50°/秒）VOR增益和时间常数（TC）、视动性眼震（OKN）增益以及TC（全身，以50°/秒的恒定速度旋转）的数据。我们发现，分别有38%和1%的参与者存在BPPV、外周性和中枢性前庭功能减退，这表明这些人的头晕可能是由前庭原因引起的。在那些可能由前庭原因引起头晕的人中，63%患有BPPV；这一数字高于之前在头晕诊所报告的约25%。我们的结果表明，htDVA、正弦（特别是0.5 - 1Hz）和瞬态VOR测试在检测患有BPPV或前庭功能减退的人方面最有效，而DHI和OKN仅在检测非BPPV前庭功能减退方面有效。
