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双侧前庭病的病因分析及前庭评估

[Etiology analysis and vestibular assessment of bilateral vestibular vestibulopathy].

作者信息

Lin Y, Gao L X, Li L, Wang J L, Shen J J, Sun F, Qiu J H, Zha D J

机构信息

Department of Otolaryngology Head Neck Surgery, Xijing Hospital, Medical University of the Air Force, Xi'an, 710032, China.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Mar;32(5):379-382. doi: 10.13201/j.issn.1001-1781.2018.05.015.

Abstract

To define clinical and laboratory characteristics of bilateral vestibulopathy(BVP) and to propose diagnostic criteria of this disorder based on clinical and laboratory vestibular function test findings.Forty-two case series with a clinical suspicion of BVP were retrospectively analyzed, in an attempt to determine etiology. Presenting auditory-vestibular symptoms, bedside dynamic visual acuity tests and laboratory test were reviewed, including bithermal caloric test, rotatory chair tests, video head impulse test (vHIT), vestibular-evoked myogenic potentials (VEMP).Among these 42 patients, dizziness was seen in 42 cases(100%), oscillopsia was seen in 21 cases(50%), hearing loss was seen in 30(71.4%). Eight cases(19%) had tinnitus. Twenty-five cases showed vestibular loss in dynamic visual acuity test (69.4%). Definite diagnosis of complete BVP was made in 36 patients when the patients showed abnormal findings on caloric test, rotatory chair test and vHIT in addition to the symptoms. Whereas probable diagnosis of partial BVP was obtained in 6 patients with abnormal caloric test and rotatory chair test but no pathological vHIT. VEMP (ocular or cervical) could be recorded in 20 patients. Fourteen cases were caused by ototoxic drugs while no causes could be determined in 6 cases among these 42 cases.The diagnosis of BVP is a challenge. Vestibular laboratory test battery which reflect full frequency function of VOR has great value to confirming the diagnosis and differentiate complete BVP to partial BVP. Diagnosis standard shall be made combining clinical history, characteristic symptoms and the results of auditory-vestibular function testing. Ototoxic drugs contribute most considering etiology.

摘要

明确双侧前庭病(BVP)的临床和实验室特征,并根据临床及实验室前庭功能测试结果提出该病的诊断标准。对42例临床怀疑为BVP的病例系列进行回顾性分析,以确定病因。回顾了呈现的听觉 - 前庭症状、床边动态视力测试及实验室检查,包括冷热试验、转椅试验、视频头脉冲试验(vHIT)、前庭诱发肌源性电位(VEMP)。在这42例患者中,42例(100%)出现头晕,21例(50%)出现视振荡,30例(71.4%)出现听力损失。8例(19%)有耳鸣。25例(69.4%)在动态视力测试中显示前庭功能丧失。当患者除症状外,冷热试验、转椅试验及vHIT检查均出现异常结果时,36例患者被明确诊断为完全性BVP。而6例冷热试验及转椅试验异常但vHIT无病理改变的患者被诊断为可能的部分性BVP。20例患者可记录到VEMP(眼性或颈性)。42例中有14例由耳毒性药物引起,6例病因不明。BVP的诊断具有挑战性。反映VOR全频率功能的前庭实验室检查对确诊及区分完全性BVP和部分性BVP具有重要价值。诊断标准应结合临床病史、特征性症状及听觉 - 前庭功能测试结果制定。考虑病因时,耳毒性药物起主要作用。

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