Sichnarek Jakub, Mrazkova Eva, Zathurecky Evald, Tomaskova Hana
Department of Epidemiology and Health Protection Institute, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic Health Protection Institute Faculty of Medicine University of Ostrava Ostrava Czech Republic.
Department of Hearing and Balance Disorder Centre, Ostrava Poruba, Czech Republic Department of Hearing Balance Disorder Centre Ostrava Poruba Czech Republic.
Int Tinnitus J. 2019 Jan 1;23(1):1-5. doi: 10.5935/0946-5448.20190001.
Until recently, vestibular caloric stimulation was the only objective diagnostic method for isolating the function of the lateral semi-circular canals responsible for maintaining balance. Since 2014, the Video Head Impulse Test (vHIT) has been applied in the Czech Republic to investigate the function of all semi-circular canals. Studies conducted so far have shown that the results of these two methods do not often agree.
The aim of this study was to compare the results of vestibular caloric stimulation and vHIT in a cohort of patients with peripheral vestibular syndrome at a specialized outpatient clinic. The study lasted from July 2016 to August 2017 and included patients with unilateral peripheral vestibular syndrome (n=32; 24 females and 8 males, mean age 49.4 years) and a positive result with either vestibular caloric stimulation or vHIT.
90% of the patients had a positive vestibular caloric stimulation result, while the vHIT was positive only in 50% of the patients. Both methods were positive in 13 subjects, vestibular caloric stimulation was positive and vHIT was negative in 16 subjects and in 3 cases vestibular caloric stimulation was negative and vHIT was positive. Based on these numbers, both methods concur in 45% of the cases. In 13 patients, apart from lateral canal disorders, vHIT revealed disorders in one of the vertical canals - the front right in 4, the rear right in 2, the front left in 3 and the rear left in 4. When sorted into subgroups of the "TiTrATE" diagnostic algorithm based on the time course and triggering factor, vHIT was found to be positive for acute spontaneous vertigo in 62.5% of cases. vHIT was negative for 70% of chronic and spontaneous episodic complaints.
The diagnosis of peripheral vestibular disorders should take the pathophysiological basis of the disease into account, as this can differ in peripheral disorders. This could then explain the discrepancy between the results of the two methods. The time course of the disease can be a predictor of the vHIT outcome. Localizing the impaired function of particular semi-circular canals using vHIT can inform selective vestibular rehabilitation.
直到最近，前庭冷热试验仍是唯一一种用于分离负责维持平衡的外侧半规管功能的客观诊断方法。自2014年以来，视频头脉冲试验（vHIT）已在捷克共和国应用于研究所有半规管的功能。迄今为止进行的研究表明，这两种方法的结果并不经常一致。
本研究的目的是在一家专科门诊比较前庭冷热试验和vHIT在一组外周前庭综合征患者中的结果。该研究从2016年7月持续至2017年8月，纳入了单侧外周前庭综合征患者（n = 32；24名女性和8名男性，平均年龄49.4岁），且前庭冷热试验或vHIT结果为阳性。
90%的患者前庭冷热试验结果为阳性，而vHIT仅在50%的患者中为阳性。两种方法均为阳性的有13名受试者，前庭冷热试验阳性而vHIT阴性的有16名受试者，3例前庭冷热试验阴性而vHIT阳性。基于这些数据，两种方法在45%的病例中结果一致。在13名患者中，除了外侧半规管疾病外，vHIT还显示垂直半规管之一存在疾病——右前半规管4例，右后半规管2例，左前半规管3例，左后半规管4例。根据“TiTrATE”诊断算法的时间进程和触发因素分为亚组后，发现vHIT在62.5%的急性自发性眩晕病例中为阳性。vHIT在70%的慢性和自发性发作性主诉病例中为阴性。
外周前庭疾病的诊断应考虑疾病的病理生理基础，因为外周疾病可能不同。这进而可以解释两种方法结果之间的差异。疾病的时间进程可以作为vHIT结果的预测指标。使用vHIT定位特定半规管的功能受损情况可为选择性前庭康复提供依据。
