Nam Gi-Sung, Jung Chan Min, Kim Ji Hyung, Son Eun Jin
Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Clin Exp Otorhinolaryngol. 2018 Jun;11(2):102-108. doi: 10.21053/ceo.2017.01277. Epub 2018 Jan 9.
Growth of vestibular schwannomas (VS) causes progressive vestibular symptoms and postural instability. Since the tumor grows slowly, compensation of decaying vestibular input may decrease subjective symptoms of dizziness. This study aims to estimate the relationship of subjective vestibular symptoms and objective postural instability in patients with VS.
A retrospective review of 18 patients newly diagnosed with VS and with subjective vertigo symptoms was performed. The results of vestibular function tests including the sensory organization test (SOT) using computerized dynamic posturography, caloric test, and self-report measures of subjective dizziness handicap (Dizziness Handicap Inventory) and visual analogue scale were compared according to the onset of vertigo symptoms.
In VS patients, SOT showed decreased equilibrium score for all vestibular function related conditions, condition (C) 5 and 6, and composite (COMP) score. COMP scores were not correlated with visual analogue scale or Dizziness Handicap Inventory scores. Acute onset group included six patients and insidious onset group, 12 patients. Equilibrium scores for C5 and C6, and COMP scores were lower for insidious onset group, but the difference was not statistically significant.
Our findings confirmed postural instability is prevalent in VS patients. SOT parameters did not differ significantly between acute onset and insidious onset groups, but increased tumor size and canal weakness were noted in the insidious onset group. Clinicians should consider that postural instability is likely present even in patients who do not complain of acute vertigo, and appropriate counseling should be discussed with the patients.
前庭神经鞘瘤（VS）的生长会导致进行性前庭症状和姿势不稳。由于肿瘤生长缓慢，对逐渐衰减的前庭输入的代偿可能会减轻头晕的主观症状。本研究旨在评估VS患者主观前庭症状与客观姿势不稳之间的关系。
对18例新诊断为VS且有主观眩晕症状的患者进行回顾性研究。根据眩晕症状的发作情况，比较前庭功能测试结果，包括使用计算机动态姿势描记法的感觉组织测试（SOT）、冷热试验，以及主观头晕障碍（头晕障碍量表）和视觉模拟量表的自我报告测量结果。
在VS患者中，SOT显示所有与前庭功能相关的条件（条件C5和C6）以及综合（COMP）评分的平衡分数均降低。COMP评分与视觉模拟量表或头晕障碍量表评分无关。急性起病组6例患者，隐匿起病组12例患者。隐匿起病组C5和C6的平衡分数以及COMP评分较低，但差异无统计学意义。
我们的研究结果证实姿势不稳在VS患者中普遍存在。急性起病组和隐匿起病组的SOT参数无显著差异，但隐匿起病组肿瘤大小增加和半规管功能减弱更为明显。临床医生应考虑到即使是没有急性眩晕症状的患者也可能存在姿势不稳，并应与患者讨论适当的建议。
