Roberts Richard A
Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Nashville, TN.
Am J Audiol. 2018 Mar 8;27(1):19-24. doi: 10.1044/2017_AJA-17-0090.
This clinical report is presented to describe how results of vestibular function testing were considered along with other medical history to develop a management plan that was ultimately successful.
The patient underwent audio-vestibular assessment including comprehensive audiogram, videonystagmography, cervical vestibular evoked myogenic potential, and postural stability testing.
Results from initial testing were most consistent with uncompensated peripheral vestibular dysfunction affecting the right superior vestibular nerve. These results, considered along with history and symptoms, supported vestibular neuritis. After a second vertigo event, we became concerned about the potential temporal association between the patient's rheumatoid arthritis treatment and symptom onset. It is established that treatment for rheumatoid arthritis can exacerbate latent viral issues, but this has not specifically been reported for vestibular neuritis. There are reports in the literature in which patients successfully used viral suppressant medication to decrease viral activity while they were able to continue benefiting from immunosuppressive therapy. We hypothesized that, if the current patient's vestibular neuritis events were related to her treatment for rheumatoid arthritis, she may also benefit from use of viral suppressant medication while continuing her otherwise successful immunosuppressive intervention.
Patients treated with biologic disease-modifying antirheumatic drugs are more susceptible to viral issues, and this may include vestibular neuritis. For the current case, identifying this possibility and recommending viral suppressant medication allowed her to continue with successful treatment of rheumatoid arthritis while avoiding additional vertigo events.
本临床报告旨在描述如何结合前庭功能测试结果及其他病史来制定最终成功的管理计划。
患者接受了听-前庭评估，包括全面听力图、视频眼震图、颈前庭诱发肌源性电位和姿势稳定性测试。
初始测试结果最符合影响右侧上前庭神经的未代偿性外周前庭功能障碍。这些结果结合病史和症状，支持前庭神经炎的诊断。在第二次眩晕发作后，我们开始关注患者类风湿关节炎治疗与症状发作之间可能存在的时间关联。已有研究表明，类风湿关节炎的治疗可能会加重潜在的病毒问题，但这尚未专门针对前庭神经炎进行报道。文献中有报道称，患者在能够继续从免疫抑制治疗中获益的同时，成功使用病毒抑制药物降低了病毒活性。我们推测，如果当前患者的前庭神经炎发作与她的类风湿关节炎治疗有关，那么她在继续成功的免疫抑制干预的同时，可能也会从使用病毒抑制药物中获益。
使用生物性疾病改善抗风湿药物治疗的患者更容易出现病毒问题，这可能包括前庭神经炎。对于当前病例，识别出这种可能性并推荐使用病毒抑制药物，使她能够在避免额外眩晕发作的同时继续成功治疗类风湿关节炎。
