Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Nord, CHU Saint-Étienne, Avenue A Raimond, 42270 Saint Priest en Jarez, France.
Service d'Audiologie et d'Explorations Otoneurologiques, Hôpital Edouard Herriot, 69003 Lyon, France; Hôpital Femme Mère Enfant, 69500 Bron, France; Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; Institut de l'Audition, Centre de recherche de l'Institut Pasteur, Inserm U1120, 75012 Paris, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2021 Dec;138(6):459-465. doi: 10.1016/j.anorl.2020.11.011. Epub 2020 Dec 14.
In the context of the SARS-CoV-2 pandemic, patients may have been dissuaded from seeking consultation, thus exposing themselves to a risk of loss of chance. This guide aims to define how teleconsultation can assist in assessing vertiginous adults or children, and to gather the information needed to provide quick medical care.
These recommendations rely on the authors' experience as well as on literature. A survey on otoneurologic approach via telemedicine has been conducted based on a literature search until March 2020.
The first clinical assessment of the vertiginous patient via teleconsultation can only be successful if the following conditions are met: initial contact to verify the feasibility of the assessment at a distance, the presence of a caregiver in order to assist the patient, the possibility of making video recordings. Medical history via telemedicine, as in a face-to-face assessment, allows to assess the characteristics, duration, frequency, and potential triggering factors of the vertigo, in both children and adults. During teleconsultation, the following tests can be carried out: oculomotricity evaluation, assessment of balance, simple neurological tests, checking for positional vertigo/nystagmus and, eventually to perform canalith-repositioning procedures. In children, the following should be searched for: history of hearing or visual impairment, a context of fever or trauma, otorrhea, signs of meningeal irritation.
The neurotologic telemedicine relies on the accuracy of the clinical assessment, which is based on history taking and a few simple tests, encouraging the development of a decision-making algorithm adapted for teleconsultation. However, the latter has its limitations during an emergency examination of a new patient presenting vertigo, and, at least in some cases, cannot replace a face-to-face consultation. Teleconsultation is often adapted for follow-up consultations of previously selected vertiginous patients during face-to-face assessment.
在 SARS-CoV-2 大流行的背景下，患者可能被劝阻不去就诊，从而使自己面临错失机会的风险。本指南旨在定义远程问诊如何帮助评估眩晕的成人或儿童，并收集提供快速医疗服务所需的信息。
这些建议基于作者的经验以及文献。根据文献检索，截至 2020 年 3 月，我们对通过远程医疗进行耳神经科评估进行了调查。
如果满足以下条件，通过远程咨询对眩晕患者进行首次临床评估才有可能成功：进行初步接触以验证远程评估的可行性，有一位照顾者以便协助患者，能够进行视频录制。通过远程医疗进行病史采集，就像面对面评估一样，可以评估儿童和成人眩晕的特征、持续时间、频率和潜在诱发因素。在远程咨询期间，可以进行以下检查：眼动评估、平衡评估、简单的神经学检查、位置性眩晕/眼震检查，以及最终进行管石复位程序。在儿童中，应寻找以下内容：听力或视力受损史、发热或创伤病史、耳漏、脑膜刺激征。
神经耳科远程医疗依赖于临床评估的准确性，该评估基于病史采集和几项简单的检查，鼓励开发适用于远程咨询的决策算法。然而，在新出现眩晕的紧急检查期间，远程咨询存在局限性，并且在某些情况下不能替代面对面咨询。远程咨询通常适用于在面对面评估中已经选择的眩晕患者的随访咨询。
