Pyykkö Ilmari, Manchaiah Vinaya, Zou Jing, Levo Hilla, Kentala Erna
Department of Otolaryngology, Hearing and Balance Research Unit, University of Tampere, Finland.
Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, United States; The Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Audiology India, Mysore, Karnataka, India; Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Karnataka, India.
Auris Nasus Larynx. 2018 Apr;45(2):234-241. doi: 10.1016/j.anl.2017.03.023. Epub 2017 May 3.
Experiments in humans and animals indicate that vestibular influx through vestibular sympathetic reflex is an important and vital part of the regulatory system of circulation. The otolith organ adjusts the circulatory responses through the vestibular sympathetic reflex during an upright stance and may trigger a vasovagal attack of syncope. The aim of the present study was to evaluate the prevalence and association of syncope attacks among patients with Ménière's disease (MD). Vestibular syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously in people with vestibular disorders and without localizing neurological deficit.
During clinical interactions, we encountered 5 patients with syncope during a Tumarkin attack of MD. Thereafter we evaluated data from 952 patients collected with a questionnaire from the Finnish Ménière Association (FMA). The data contained case histories with special attention to Tumarkin attacks, participation restriction, migraines, and syncope attacks. The mean age of the subjects participating in the study was 60.6 years (range 25-75 years). The duration of the disease was on average 9.8 years (range 0.5-35 years).
In the current study sample, attacks of syncope were reported by 38 patients (4%) in association with the vertigo attack. Syncope was associated with Tumarkin attacks (X=16.7, p<0.001), migraine (X=7.4, p<0.011), history of ischemic heart disease (X=6.0, p<0.025), and history of cerebrovascular disease (X=11.7, p<0.004). Duration of MD was correlated with syncope. Syncope was provoked by physical strain and environmental pressure, and was associated with impairment of the visual field (i.e., visual blurring). In logistic regression analysis, syncope was significantly associated with Tumarkin attacks (odds ratio 3.2), migraines (odds ratio 2.3) and nausea (odds ratio 1.3). The attack of syncope was experienced as frightening, and general health related quality of life (HRQoL) was significantly worsened. Also, the patients suffered more from fatigue.
The current study indicates that patients with MD who suffer from Tumarkin attacks can suffer from syncope. It confirms the role of the otolith organ in controlling the circulatory homeostasis of the body. The actions are mediated through the vestibular sympathetic reflex.
人体和动物实验表明，通过前庭交感反射的前庭传入是循环调节系统的重要且关键部分。耳石器官在直立姿势期间通过前庭交感反射调节循环反应，并可能引发血管迷走性晕厥发作。本研究的目的是评估梅尼埃病（MD）患者中晕厥发作的患病率及相关性。前庭性晕厥定义为意识突然短暂丧失，在前庭疾病患者中自发缓解且无定位性神经功能缺损。
在临床诊疗过程中，我们遇到5例MD患者在图马尔金发作期间出现晕厥。此后，我们评估了从芬兰梅尼埃病协会（FMA）通过问卷收集的952例患者的数据。数据包含病史，特别关注图马尔金发作、活动受限、偏头痛和晕厥发作情况。参与研究的受试者平均年龄为60.6岁（范围25 - 75岁）。疾病持续时间平均为9.8年（范围0.5 - 35年）。
在当前研究样本中，38例患者（4%）报告在眩晕发作时伴有晕厥发作。晕厥与图马尔金发作（X = 16.7，p < 0.001）、偏头痛（X = 7.4，p < 0.011）、缺血性心脏病史（X = 6.0，p < 0.025）和脑血管病史（X = 11.7，p < 0.004）相关。MD的病程与晕厥相关。晕厥由体力消耗和环境压力诱发，并与视野损害（即视力模糊）相关。在逻辑回归分析中，晕厥与图马尔金发作（比值比3.2）、偏头痛（比值比2.3）和恶心（比值比1.3）显著相关。晕厥发作令人恐惧，与总体健康相关的生活质量（HRQoL）显著恶化。此外，患者更容易疲劳。
当前研究表明，患有图马尔金发作的MD患者可能会出现晕厥。这证实了耳石器官在控制身体循环稳态中的作用。这些作用是通过前庭交感反射介导的。
