Black F O, Wade S W, Nashner L M
Am J Otol. 1996 May;17(3):401-9.
Living with an uncompensated, abnormal vestibular system requires oppressive modification of life style and often prevents return to work and activities of daily living. Patients with vestibular abnormalities were studied to determine the minimal residual vestibular function required to achieve compensation. Three groups of patients with (a) complete unilateral loss of vestibular function with normal horizontal canal-vestibulo-ocular (HCVOR) function in the opposite ear, (b) complete unilateral loss with abnormal HCVOR function in the opposite ear, and (c) bilateral reduction of vestibular function from aminoglycoside toxicity underwent vestibuloocular (VOR), optokinetic (OKN), visual-VOR (VVOR), and computerized dynamic posturography (CDP) tests before and after therapeutic procedures. Results suggest that a minimal VOR response amplitude must be present for compensation of VVOR function to occur. The roles of VOR and OKN phase shifts in vestibular compensation are more complicated and require further study. Compensation of vestibulospinal function does not necessarily accompany VOR or VVOR compensation. Ascending and descending vestibular compensatory mechanisms may involve different spatial sensory inputs. Results of these studies have important implications for the diagnosis and treatment of patients with vestibular disorders, including selection and monitoring of patients for therapeutic regimens such as vestibular nerve section and streptomycin therapy.
患有未代偿性异常前庭系统的人需要对生活方式进行严格调整，并且常常无法重返工作岗位和进行日常生活活动。对前庭异常患者进行了研究，以确定实现代偿所需的最小残余前庭功能。三组患者分别为：(a) 一侧前庭功能完全丧失，对侧耳水平半规管 - 前庭眼反射（HCVOR）功能正常；(b) 一侧前庭功能完全丧失，对侧耳HCVOR功能异常；(c) 因氨基糖苷类药物毒性导致双侧前庭功能减退。在治疗前后，对这些患者进行了前庭眼反射（VOR）、视动眼反射（OKN）、视觉 - 前庭眼反射（VVOR）以及计算机动态姿势描记法（CDP）测试。结果表明，必须存在最小的VOR反应幅度，才能实现VVOR功能的代偿。VOR和OKN相移在前庭代偿中的作用更为复杂，需要进一步研究。前庭脊髓功能的代偿不一定伴随着VOR或VVOR的代偿。前庭代偿的上行和下行机制可能涉及不同的空间感觉输入。这些研究结果对前庭疾病患者的诊断和治疗具有重要意义，包括为前庭神经切断术和链霉素治疗等治疗方案选择患者并进行监测。
