Hearing and Balance Research Unit, Department of Otolaryngology, University of Tampere, Tampere, Finland.
Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.
J Neurol. 2017 Oct;264(Suppl 1):48-54. doi: 10.1007/s00415-017-8452-9. Epub 2017 Mar 20.
The aim of the present study was to evaluate the prevalence and associated factors for syncope among patients with Ménière's disease (MD). An attack of syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously and without a localizing neurological deficit. The study used an across-sectional survey design. Information from a database consisting of 961 individuals was collected from the Finnish Ménière Association. The data contained case histories, general health-related quality of life (HRQoL), and impact measurements of the complaints. In the current study sample, syncope occurred in 12.3% of the patients with MD. It was more prevalent among elderly persons and among those with a longer duration of MD. Syncope was significantly associated with disturbances of otolith function reflected as Tumarkin attacks, gait and balance problems, environmental change of pressure, and physical strain. It was also associated with visual blurring; in fact, patients with otolith dysfunction in MD often experience visual field changes. It was also associated with headache, but not with migraine. Syncope was experienced as frightening and HRQoL was significantly worsened. The patient had higher anxiety scores, and suffered more from fatigue. The results demonstrate that neurally mediated syncope occurs in patients with an advanced form of MD who suffer from Tumarkin attacks due to failure in otolith function. The mechanism seems to be triggered through the vestibular sympathetic reflex when the otolith system fails due to disrupted utricular otolithic membrane mediate erroneous positional information from the otolith organ to the vasomotor centres in the brain stem and medulla.
本研究旨在评估梅尼埃病（MD）患者晕厥的患病率及其相关因素。晕厥发作定义为突然短暂的意识丧失，自发缓解，无局灶性神经缺损。该研究采用横断面调查设计。从芬兰梅尼埃协会的数据库中收集了 961 名个体的信息，该数据库包含病史、一般健康相关生活质量（HRQoL）以及对投诉的影响测量。在当前的研究样本中，MD 患者中有 12.3%出现晕厥。它在老年人和 MD 病程较长的人群中更为常见。晕厥与耳石功能障碍显著相关，表现为 Tumarkin 发作、步态和平衡问题、压力环境变化和体力消耗。它还与视觉模糊有关；实际上，MD 中的耳石功能障碍患者经常会出现视野变化。它也与头痛有关，但与偏头痛无关。晕厥被体验为可怕的，HRQoL 明显恶化。患者焦虑评分更高，疲劳感更严重。结果表明，神经介导性晕厥发生在患有晚期 MD 的患者中，这些患者由于耳石功能障碍而出现 Tumarkin 发作。机制似乎是由于前庭交感反射在耳石系统因椭圆囊耳石膜破裂而功能障碍时被触发，将错误的位置信息从耳石器官传递到脑干和延髓中的血管运动中枢。
