Marques Pedro Santos, Dias Claudia Camila, Perez-Fernandez Nicolas, Spratley Jorge
Department of Otorhinolaryngology, S. João Hospital Centre, Alameda Prof. Hernâni Monteiro, Porto, Portugal; Department of Surgery and Physiology/Otorhinolaryngology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal.
Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal.
Auris Nasus Larynx. 2018 Oct;45(5):943-951. doi: 10.1016/j.anl.2018.01.001. Epub 2018 May 7.
To estimate how much could intratympanic gentamicin (ITG) interfere with the vestibular-ocular reflex (VOR) parameters on instrumental head impulse test (HIT), either with scleral search coil or video head impulse test and, eventually, foresee the control of vertigo crisis in unilateral intractable Ménière's disease (MD).
A literature search was conducted in PubMed, Scopus, Web of Science and Cochrane search engines. The search terms used were "vestibular ocular reflex", "head impulse test", "gentamicin," and "Meniere's disease". Limitations included text availability to be full text, species to be humans and language to be English. All study types were included. 89 articles were screened identifying four eligible studies were identified. Studies were included after consensus of the authors. Meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data was analysed using Review Manager software.
Instrumental HIT, after ITG for MD, demonstrated, in the treated ear, a decreased gain in the horizontal, posterior and superior semicircular canals (SCC), of 0.36 (0.26; 0.47; 95% CI), 0.35 (0.22; 0.48; 95% CI) and 0.28 (0.21; 0.35; 95% CI), respectively. Gain asymmetry increases between the treated and non-treated ear of 23.78 (7.22; 40.35; 95% CI), 32.01 (12.27; 51.76; 95% CI) and 17.49 (9.99; 24.99; 95% CI), were similarly detected in the horizontal, posterior and superior SCC, respectively. Significantly smaller gain values after the first treatment were observed for a single injection group versus multiple injection group in the horizontal (p=0.002) and superior SCCs (p=0.016).
Instrumental HIT is effective in evaluating the SCC function after ITG for intractable unilateral MD. VOR gain changes in the direction of the treated ear in the three SCC have been clearly registered. An increased reduction of the VOR gain in the horizontal and anterior SCC also seemed to foresee the control of vertigo crisis. Still, after meta-analysis, the small number of patients' data available did not allow to define a treatment end-point value. This review also indicated that further and better-designed studies are warranted.
评估鼓室内注射庆大霉素（ITG）对使用巩膜搜索线圈或视频头脉冲试验进行的仪器化头脉冲试验（HIT）中的前庭眼反射（VOR）参数有多大影响，并最终预测单侧难治性梅尼埃病（MD）眩晕发作的控制情况。
在PubMed、Scopus、Web of Science和Cochrane搜索引擎中进行文献检索。使用的检索词为“前庭眼反射”“头脉冲试验”“庆大霉素”和“梅尼埃病”。限制条件包括文本需为全文、研究对象为人类且语言为英语。纳入所有研究类型。筛选出89篇文章，确定了4项符合条件的研究。经作者共识后纳入研究。使用系统评价和Meta分析的首选报告项目（PRISMA）指南进行Meta分析。使用Review Manager软件分析数据。
对于MD患者，在ITG治疗后，仪器化HIT显示，治疗耳的水平、后半规管和上半规管（SCC）的增益分别降低了0.36（0.26；0.47；95%CI）、0.35（0.22；0.48；95%CI）和0.28（0.21；0.35；95%CI）。在水平、后半规管和上半规管中，治疗耳与未治疗耳之间的增益不对称性分别增加了23.78（7.22；40.35；95%CI）、32.01（12.27；51.76；95%CI）和17.49（9.99；24.99；95%CI）。在水平半规管（p=0.002）和上半规管（p=0.016）中，单次注射组与多次注射组相比，首次治疗后的增益值明显更小。
仪器化HIT可有效评估ITG治疗难治性单侧MD后的半规管功能。已明确记录到三个半规管中VOR增益朝着治疗耳的方向变化。水平半规管和前半规管中VOR增益的进一步降低似乎也预示着眩晕发作得到控制。然而，经过Meta分析，可用的患者数据数量较少，无法确定治疗终点值。本综述还表明需要开展更多设计更好的研究。
