Maeda Yukihide, Takao Soshi, Abe-Fujisawa Iku, Kariya Shin, Ando Mizuo
Department of Otolaryngology- Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Kita-Ku, Okayama 700-8558, Japan.
Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Kita-Ku, Okayama 700-8558, Japan.
J Clin Neurosci. 2022 May;99:244-247. doi: 10.1016/j.jocn.2022.03.018. Epub 2022 Mar 15.
The vestibulo-ocular reflex (VOR) in neurotologic patients can be evaluated most quickly by spontaneous nystagmus examinations, and the video Head Impulse Test (vHIT) quantitatively evaluates the VOR of the semicircular canals. We aimed to clarify the concordance and discrepancies between spontaneous nystagmus and vHIT findings, to provide guidance on screening vestibular functions by initial spontaneous nystagmus examination then vHIT. We evaluated 169 outpatients by spontaneous nystagmus examination in the dark using a charge-coupled device camera, then by horizontal vHIT the same day. Vestibular loss on vHIT was defined if both reduced VOR gain (<0.8) and corrective saccade were observed. Adjusted logistic regression modelling revealed that differences in right and left VOR gain positively impacted the presence of nystagmus, which suggests lateralised vestibular dysfunction (P<0.05; odds ratio 1.39 [95% confidence interval, 1.1-1.8] per 0.1 increment). When vHIT is regarded as the standard clinical test, the positive predictive value of nystagmus for vestibular loss on vHIT was 44.4%, and the negative predictive value was 93.5%. The adjusted odds ratio of adults ≥65 years old compared to younger patients associated with a discrepancy of nystagmus and vHIT was significant (2.4 [1.1-5.3]). In conclusion, if spontaneous nystagmus is initially observed in patients, further assessment by vHIT could confirm vestibular dysfunction in 40-50% of cases. If no nystagmus is observed, vHIT might also result in a negative finding in >90% of cases. Older adults appear more likely to show discrepancies between nystagmus and vHIT.
对于神经耳科患者，通过自发性眼震检查可以最快速地评估前庭眼反射（VOR），而视频头脉冲试验（vHIT）则可定量评估半规管的VOR。我们旨在阐明自发性眼震与vHIT结果之间的一致性和差异，以便为通过初始的自发性眼震检查然后进行vHIT来筛查前庭功能提供指导。我们使用电荷耦合器件相机在黑暗环境中通过自发性眼震检查对169名门诊患者进行了评估，然后在同一天进行了水平vHIT检查。如果同时观察到VOR增益降低（<0.8）和纠正性扫视，则定义为vHIT检查存在前庭功能丧失。调整后的逻辑回归模型显示，左右VOR增益的差异对眼震的存在有正向影响，这表明存在单侧前庭功能障碍（P<0.05；每增加0.1，比值比为1.39 [95%置信区间，1.1 - 1.8]）。当将vHIT视为标准临床检查时，眼震对vHIT检查前庭功能丧失的阳性预测值为44.4%，阴性预测值为93.5%。与年轻患者相比，≥65岁成年人眼震与vHIT结果不一致的调整后比值比具有显著性（2.4 [1.1 - 5.3]）。总之，如果患者最初观察到自发性眼震，通过vHIT进一步评估可在40 - 50%的病例中确认前庭功能障碍。如果未观察到眼震，vHIT在>90%的病例中也可能得出阴性结果。老年人似乎更有可能出现眼震与vHIT结果不一致的情况。
