Hornibrook J, Gourley J, Vraich G
Department of Otolaryngology-Head and Neck Surgery and Audiology, Christchurch Hospital, 2 Riccarton Avenue, 8011, Christchurch, New Zealand.
University of Canterbury, Christchurch, New Zealand.
HNO. 2020 May;68(5):352-358. doi: 10.1007/s00106-019-0722-7.
Reliable confirmation of the presence or absence of endolymphatic hydrops is essential to avoid confusing vestibular migraine with Meniere's disease. MRI inner ear imaging is a promising new method to confirm hydrops, avoiding both unnecessary invasive or destructive inner ear treatments, but it is not universally available. Tone burst electrocochleography is an older simple, quick, safe, and sensitive test that is potentially available, with existing (or minorly upgraded) equipment at most tertiary medical centers. In Meniere's disease hydrops remains after intratympanic treatments. A case is presented of a 45 year-old man with a long history of recurrent vertigo attacks who, due to an erroneous diagnosis of Meniere's disease, was given five intratympanic treatments with no effect. He was subsequently found by tone burst electrocochleography to have no hydrops and was differentially diagnosed with probable vestibular migraine. Response to treatment confirms this diagnosis. This patient's electrocochleographic findings are compared with two other patients with definite Meniere's disease, one of whom had demonstrable hydrops despite intratympanic gentamycin treatments.
可靠地确认是否存在内淋巴积水对于避免将前庭性偏头痛与梅尼埃病混淆至关重要。内耳磁共振成像（MRI）是一种有前景的确认积水的新方法，可避免不必要的侵入性或破坏性内耳治疗，但并非普遍可用。短纯音电耳蜗图是一种较老的、简单、快速、安全且敏感的测试，大多数三级医疗中心现有的（或稍作升级的）设备即可进行该测试。在梅尼埃病中，鼓室内治疗后积水仍会存在。本文介绍了一名45岁男性患者，他有长期复发性眩晕发作病史，因被错误诊断为梅尼埃病，接受了五次鼓室内治疗但均无效。随后通过短纯音电耳蜗图检查发现他没有积水，并被鉴别诊断为可能的前庭性偏头痛。对治疗的反应证实了这一诊断。将该患者的电耳蜗图检查结果与另外两名确诊为梅尼埃病的患者进行了比较，其中一名患者尽管接受了鼓室内庆大霉素治疗，但仍有明显积水。
