Pal'chun V T, Guseva A L, Baybakova E V, Makoeva A A
N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia, 117997; Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia, 117152.
N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia, 117997.
Vestn Otorinolaringol. 2019;84(6):33-37. doi: 10.17116/otorino20198406133.
The aim of this study is to evaluate clinical symptoms and recovery of vestibule-ocular reflex (VOR) in patients with vestibular neuronitis (VN) in dependence on severity of VOR damage according to video head impulse test (vHIT).
45 patients with VN and superior or both superior and inferior vestibular nerves involvement were recruited and horizontal gain was measured with vHIT. According to gain asymmetry the patients were divided in three groups: 11 patients with 8-19% gain asymmetry, 10 patients with 20-39% gain asymmetry and 24 patients with more than 40% gain asymmetry.
Coexisting chronic heart and endocrinological diseases could contribute to greater damage of VOR in VN. In patients with less gain asymmetry the full recovery of gain on the affected side was more often. When gain asymmetry was more than 40%, only 10% of patients demonstrated full recovery of gain in 8-12 months. Dynamic visual acuity (DVA) could normalize in patients with clinically significant gain asymmetry. DVA stays decreased more often in patients with in the most gain asymmetry even after vestibular rehabilitation. Benign paroxysmal positional vertigo appeared in 8.9% of patients with VN and had no correlation with VOR asymmetry. Steroid treatment didn't show significant impact on VOR recovery in patients with VN.
本研究旨在根据视频头脉冲试验（vHIT）评估前庭神经炎（VN）患者的临床症状及前庭眼反射（VOR）的恢复情况，该评估依赖于VOR损伤的严重程度。
招募45例VN且累及前庭上神经或前庭上、下神经的患者，采用vHIT测量水平增益。根据增益不对称性将患者分为三组：增益不对称8%-19%的患者11例，增益不对称20%-39%的患者10例，增益不对称超过40%的患者24例。
并存的慢性心脏和内分泌疾病可能导致VN患者的VOR损伤更严重。增益不对称性较小的患者中，患侧增益更常完全恢复。当增益不对称超过40%时，仅10%的患者在8-12个月时增益完全恢复。具有临床显著增益不对称的患者动态视力（DVA）可恢复正常。即使在前庭康复后，增益不对称最严重的患者中DVA更常持续下降。8.9%的VN患者出现良性阵发性位置性眩晕，且与VOR不对称无关。类固醇治疗对VN患者的VOR恢复未显示出显著影响。
