Stahl Maximilian C, Otteson Todd
Albert Einstein College of Medicine, Bronx, New York, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
Laryngoscope. 2022 Apr;132(4):873-880. doi: 10.1002/lary.29819. Epub 2021 Aug 16.
Enlarged vestibular aqueduct (EVA) is a congenital condition that can lead to various outcomes in pediatric patients including hearing loss and vestibular dysfunction. Our goal was to critically appraise the literature on the proportion of patients with EVA who report vestibular dysfunction, determine relevant risk factors for the development of these symptoms, and describe vestibular tests and interventions used to improve outcomes.
A systematic review was performed in accordance with the PRISMA guidelines. We queried the EMBASE, Ovid Medline, and Cochrane Library databases for relevant literature. Studies were included if they had n > 10, reported vestibular symptoms or vestibular function testing in patients with EVA, and were published in English. Nonhuman studies, systematic reviews, and review articles were excluded.
Of 808 identified studies, 20 met inclusion criteria. Subjective vestibular symptoms included dizziness, episodic vertigo, and imbalance. Seventeen studies reported subjective vestibular symptoms, ranging from 2% to 71% of patients between studies. Seventeen studies performed some form of vestibular function test, including physical exam maneuvers (Dix-Hallpike), caloric testing, electronystagmography, and vestibular evoked myogenic potentials. Of those who had vestibular function testing, 7% to 92% had an abnormal result. Two studies identified head trauma as a risk factor. One study successfully treated patients with BPPV using the Epley maneuver, but other vestibular symptoms were not targeted with treatment.
The degree to which vestibular symptoms impact patients with EVA varies significantly. Performing vestibular function testing may help identify asymptomatic patients with vestibular dysfunction. Future studies should target improving treatment of vestibular symptoms in EVA patients. Laryngoscope, 132:873-880, 2022.
扩大的前庭导水管（EVA）是一种先天性疾病，可导致儿科患者出现各种后果，包括听力损失和前庭功能障碍。我们的目标是严格评估关于报告有前庭功能障碍的EVA患者比例的文献，确定这些症状发生的相关危险因素，并描述用于改善预后的前庭测试和干预措施。
按照PRISMA指南进行系统综述。我们在EMBASE、Ovid Medline和Cochrane图书馆数据库中查询相关文献。纳入的研究需满足n>10，报告了EVA患者的前庭症状或前庭功能测试，且以英文发表。排除非人研究、系统综述和综述文章。
在808项已识别的研究中，20项符合纳入标准。主观前庭症状包括头晕、发作性眩晕和失衡。17项研究报告了主观前庭症状，各研究中出现症状的患者比例从2%至71%不等。17项研究进行了某种形式的前庭功能测试，包括体格检查手法（Dix-Hallpike试验）、冷热试验、眼震电图和前庭诱发肌源性电位。在进行前庭功能测试的患者中，7%至92%的结果异常。两项研究将头部外伤确定为危险因素。一项研究使用Epley手法成功治疗了良性阵发性位置性眩晕（BPPV）患者，但未针对其他前庭症状进行治疗。
前庭症状对EVA患者的影响程度差异很大。进行前庭功能测试可能有助于识别无症状的前庭功能障碍患者。未来的研究应致力于改善EVA患者前庭症状的治疗。《喉镜》，2022年，第132卷：873 - 880页
