Department of Neurology, Korea University Medical Center.
Department of Neurology, Seoul National University College of Medicine, Seoul.
Otol Neurotol. 2020 Jul;41(6):e744-e750. doi: 10.1097/MAO.0000000000002645.
To determine the vestibulo-ocular reflex (VOR) performance during the attacks of Menière's disease (MD) using video head-impulse tests (video-HITs) according to each ictal phase.
Retrospective case series review.
We analyzed the results of video-HITs in 24 patients with unilateral definite MD during and between the attacks.
The head impulse gain of the VOR was usually normal (81%, 39 of the 48 semicircular canals [SCCs] in 16 patients) in the affected ear during the irritative or recovery phase, and did not differ from that for each SCC between the attacks (horizontal [HCs], p = 0.412; anterior [ACs], p = 0.920; posterior canals [PCs], p = 0.477). During the paretic phase, however, the head impulse gains of the VOR were equally normal (22/42, 52%) or decreased (20/42, 48%) for the affected ear (42 SCCs in 14 patients). The gains for the HCs were lower during the paretic phase than those between the attacks in the affected ear, while those for the ACs and PCs did not differ (HCs, p = 0.001; ACs, p = 0.158, PCs, p = 0.401). Covert saccades were more frequently observed even in the presence of normal VOR gains during the paretic phase as well.
During the attacks of MD, HITs are usually normal during the irritative/recovery phases, but become positive in more than a half of the patients during the paretic phase. This evolution in the ictal findings of HITs may reflect characteristic ictal vestibular discharges in MD and should be considered in evaluating patients with MD according to each ictal phase during the attacks.
根据梅尼埃病（MD）的每个发作期，通过视频眼动测试（video-HIT）来确定前庭眼反射（VOR）在发作期间的表现。
回顾性病例系列研究。
我们分析了 24 例单侧明确 MD 患者在发作期间和发作之间进行视频-HIT 的结果。
在刺激性或恢复期，患耳的 VOR 头脉冲增益通常正常（81%，16 例患者的 48 个半规管中的 39 个），与发作之间的每个 SCC 无差异（水平[HCs]，p=0.412；前[ACs]，p=0.920；后管[PCs]，p=0.477）。然而，在麻痹期，患耳的 VOR 头脉冲增益同样正常（22/42，52%）或降低（20/42，48%）（14 例患者的 42 个 SCC）。与发作之间相比，麻痹期患侧 HCs 的增益较低，而 ACs 和 PCs 的增益没有差异（HCs，p=0.001；ACs，p=0.158，PCs，p=0.401）。即使在麻痹期 VOR 增益正常的情况下，也更频繁地观察到隐蔽性扫视。
在 MD 发作期间，刺激性/恢复期的 HIT 通常正常，但在麻痹期超过一半的患者中变为阳性。HIT 发作期发现的这种演变可能反映了 MD 特有的发作性前庭放电，在根据发作期间的每个发作期评估 MD 患者时应予以考虑。
