Kim Chang-Hee, Shin Jung Eun, Yoo Myung Hoon, Park Hong Ju
Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kyungpook National University, Daegu, Korea.
Clin Exp Otorhinolaryngol. 2019 Aug;12(3):255-260. doi: 10.21053/ceo.2018.00038. Epub 2018 Dec 5.
Direction-changing positional nystagmus (PN) was considered to indicate the presence of benign paroxysmal positional vertigo involving lateral semicircular canal in most cases. We investigated the incidence of PN on the supine head-roll test and compared the characteristics of nystagmus in patients with vestibular neuritis (VN) and Meniere disease (MD).
A retrospective review of patients, who were diagnosed with unilateral VN or unilateral definite MD between September 2005 and November 2011, was conducted. Sixty-five VN patients and 65 MD patients were enrolled. Eye movements were recorded for 30-60 seconds at the positions of sitting, head roll to the right, and head roll to the left, and maximum slow-phase eye velocity was calculated. PN was classified as direction-fixed (paretic or recovery) and direction-changing (geotropic or apogeotropic).
Spontaneous nystagmus was observed in 57 patients (87%, the slow-phase eye velocity of 7°/sec±5°/sec) with acute VN, 39 (60%, 2°/sec±1°/sec) with follow-up VN, and 32 (49%, 2°/sec±2°/sec) with MD. Direction-fixed PN was the most common type. Direction-fixed paretic type was most common in acute VN (80%) and follow-up VN (42%), and direction-fixed recovery type was most common in MD (31%). Paretic type was significantly more common in acute VN (80%) than in follow-up VN (42%) and MD (26%), and the recovery type was significantly more common in MD (31%) than in acute VN (3%) and follow-up VN (14%). Direction-changing PN was more common in MD (22%), followed by follow-up VN (14%) and acute VN (9%).
Though direction-fixed paretic PN was most common in VN and MD patients, direction-changing PN could be observed in a few patients (9%-20%) with peripheral vestibular disorders regardless of the duration from the onset of dizziness, suggesting the presence of otolith-related dizziness.
在大多数情况下，变向性位置性眼球震颤（PN）被认为提示存在累及水平半规管的良性阵发性位置性眩晕。我们研究了仰卧头转试验中PN的发生率，并比较了前庭神经炎（VN）和梅尼埃病（MD）患者的眼球震颤特征。
对2005年9月至2011年11月期间诊断为单侧VN或单侧明确MD的患者进行回顾性研究。纳入65例VN患者和65例MD患者。在坐位、头向右侧转动和头向左侧转动的位置记录眼动30 - 60秒，并计算最大慢相眼速度。PN分为方向固定型（麻痹性或恢复性）和变向型（地向性或背地性）。
急性VN患者中有57例（87%，慢相眼速度为7°/秒±5°/秒）出现自发性眼球震颤，随访VN患者中有39例（60%，2°/秒±1°/秒），MD患者中有32例（49%，2°/秒±2°/秒）。方向固定型PN是最常见的类型。方向固定麻痹型在急性VN（80%）和随访VN（42%）中最常见，方向固定恢复型在MD（31%）中最常见。麻痹型在急性VN（80%）中显著多于随访VN（42%）和MD（26%），恢复型在MD（31%）中显著多于急性VN（3%）和随访VN（14%）。变向型PN在MD中更常见（22%），其次是随访VN（14%）和急性VN（9%）。
尽管方向固定麻痹型PN在VN和MD患者中最常见，但在少数外周前庭疾病患者（9% - 20%）中可观察到变向型PN，无论头晕发作后的病程长短，提示存在耳石相关的头晕。
