水平半规管良性阵发性位置性眩晕与前庭性偏头痛性眩晕的听-前庭功能比较

目的比较水平半规管良性阵发性位置性眩晕(BPPV)与前庭性偏头痛(VM)性眩晕患者的听-前庭功能差异。方法收集2016年11月-2017年11月潍坊医学院附属医院眩晕中心门诊收治的水平半规管良性阵发性位置性眩晕患者30例及前庭性偏头痛性眩晕患者33例。所有患者均进行听-前庭功能检查,检查项目包括纯音测试、眼震检查、冷热试验及前庭诱发的肌源性电位(VEMP)等。结果 30例水平半规管BPPV患者纯音测听异常率为23.3%(7/30),7例纯音异常患者均属单侧轻度或中度感音神经性聋;中枢性眼动异常率为26.7%(8/30),均为扫视试验异常;冷热试验异常率为83.3%(25/30),均为单侧前庭反应减弱;VEMP异常率为13.3%(4/30),其中7例显示患侧低振幅,2例显示患侧P13波潜伏期延长;接受ABR检查的患者共12例,异常率为58.3%(7/12),均显示为单侧异常。33例MV患者纯音测听异常率为24.2%(8/33),均属单侧感音神经性聋;眼震检查中枢性眼动异常率为48.5%(16/33),冷热试验异常率为21.2%(7/33),VEMP异常率为51.5%(17/33),接受ABR检查的患者共15例,异常率为26.7%(4/15)。经统计分析,二者的冷热试验异常率(t=13.62,P=0.000)、中枢性眼动异常率(t=9.65,P=0.000)、VEMP异常率(t=5.76,P=0.000)均显著高于前庭性偏头痛性眩晕。结论与前庭性偏头痛性眩晕相比,水平半规管良性阵发性位置性眩晕显示出更高的冷热试验异常率和较低的中枢性眼动异常率,可以为二者的诊断与鉴别提供参考。     

150例眩晕患者临床分析

目的 探讨眩晕患者的病因、病变部位及前庭功能检测的特点.方法对2001～2002年我院门诊病房共计150例眩晕患者行纯音测听、声导抗、听性脑干反应（ABR）、耳蜗电图、眼震电图（ENG）、颅脑CT、颈部动脉多普勒超声检查等,并对结果进行分析.结果诊断为梅尼埃病30例,占20%,突发性聋伴眩晕19例,占12.7%,前庭神经炎4例,占2.7%,耳毒性药物中毒10例,占6.7%,良性阵发性位置性眩晕56例,占37.3%,听神经瘤1例,椎-基底动脉供血不足25例,占16.6%,脑供血不足5例,占3.3%.中枢性眩晕31例患者ENG显示眼辩障碍试验有过冲20例,自发性眼震18例,视动性眼震试验双侧不对称25例,视跟踪试验Ⅲ型曲线6例,双温试验轻瘫2例,麻痹15例.周围性眩晕119例患者ENG结果显示眼辩障碍试验有过冲42例,自发性眼震4例,视动性眼震34例,视跟踪试验Ⅰ型曲线80例,双温试验轻瘫42例.结论本组150例眩晕患者中,周围性眩晕发病率比中枢性高.周围性眩晕患者中纯音测听高频听力下降为主,ABR正常.中枢性眩晕患者中高刺激率听性脑干反应异常对听神经瘤有一定的诊断价值.中枢性眩晕患者双温试验异常率低,而周围性眩晕患者异常率偏高,说明迷路病变与周围件眩晕发病有关.     

偏头痛性眩晕的神经耳科学表现

目的研究偏头痛相关的眩晕（migrainous vertigo，MV）的临床特点，了解听觉与前庭系统受累的情况以及功能障碍的范围和程度，判断偏头痛相关眩晕是中枢性抑或外周性眩晕。方法22例急性（5例）或亚急性（17例）MV检查包括神经一耳科学检查、自发性眼震和位置性眼震记录以及听力学检查。结果22例患者男6例，女16例。15例次有偏头痛，17例次有运动病，15例次有偏头痛或运动病家族史，1例次有视觉先兆，7例次对运动敏感（身体运动或改变头位出现眩晕），4例次畏光，6例次畏声，5例次失眠、情绪影响易引起眩晕发作，2例次与月经期关系密切。眩晕持续数分钟到1天。纯音测听异常9例，均为轻至中度感音神经性聋。高刺激率听性脑干反应双侧异常3例，单侧异常10例。主观垂直视觉检查均正常。前庭诱发的肌源性电位异常14例（13例为患侧低振幅，1例为患侧P13波潜伏期延长）。前庭双温检查异常3例；中枢性异常眼动11例，其中视动性眼震低增益9例，1例扫视过冲，1例摇头试验出现垂直眼震，同时高刺激听性脑干反应异常者10例，1例正常。4例患者有位置性眩晕，但均不符合良性阵发性位置性眩晕的诊断。结论偏头痛性眩晕应作为外周或中枢性眩晕的一种常规鉴别诊断的疾病，可为中枢性或外周性眩晕。     

神经耳科学检查对听神经瘤的诊断意义

目的：探讨神经耳科学检查对听神经瘤的诊断意义。方法：对１３例听神经瘤行纯音测听,声导抗,眼震电图,听性脑干诱发电位（ＡＢＲ）,耳蜗电图及面神经电图等神经电生理检查。结果：患侧纯音听阈１例正常,另４例２ｋＨｚ以下在正常范围,声导抗镫肌反射试验结果不一,冷热试验８例患侧半规管麻痹,均伴有一项或多项视－前庭眼动眼震异常;ＡＢＲ２例未能引出,敏感度为９０．９％;７例面神经电图异常;３例面神经电图异常;３例     

伴或不伴眩晕的突发性聋的比较

目的探讨伴或不伴眩晕突发性聋的听力学和前庭功能检查结果的不同.方法25例突发性聋按伴或不伴眩晕分为两组,同时进行听力学、前庭功能等检查,包括纯音测听、听性脑干反应(ABR)、耳蜗电图、视频眼震电图(VNG)等,比较其检查结果的不同.结果突发性聋伴眩晕者发病时即多为重度或极重度感音神经性聋,耳蜗电图多表现为-SP/AP≥0.4,提示有膜迷路积水,与VNG表现出来的单侧减弱及优势偏向相对应,且可合并有耳石症.     

偏头痛与眩晕、耳鸣、听力下降

目的观察偏头痛患者的神经耳科学改变;方法回顾性总结321例偏头痛患者的神经耳科学表现,并将其按有无眩晕分成伴眩晕组和不伴眩晕组。所有存在与偏头痛相关的耳部症状的患者进行纯音测听、听性脑干反应及耳鸣匹配检查,所有存在与偏头痛相关的眩晕患者行前庭功能检查。结果 25.5%(82/321)的偏头痛患者伴有眩晕,7.5%(24/321)的患者有耳鸣症状,2.8%(9/321)的患者自觉听力下降,8.4%(27/321)的患者纯音测听异常,9.0%(29/321)的患者听性脑干反应异常(表现为各波绝对潜伏期延长和或波间期延长)。对比两组耳鸣发生率、纯音测听、听性脑干异常率,有显著性差异。结论伴随眩晕的偏头痛患者更易出现前庭耳蜗症状,本文旨在加深耳鼻喉科医生对偏头痛在耳蜗及前庭器官上所产生的影响的认识,从而对其在接诊偏头痛患者时做出更加精准的评估、诊断提供帮助。     

一个中国DFNA9家系的听力学及前庭功能特点

目的 分析携带COCH基因新突变的一个中国DFNA9家系成员的听力学及前庭功能特点.方法 对家系成员进行详尽的听力学及前庭功能检查,包括纯音测听、听性脑干反应、耳蜗电图;视眼动、冷热试验、旋转试验、前庭诱发性肌源性电位,评价有无听力及前庭损害.结果 该家系患者听力学检查表现为以高频下降为主的进行性感音神经性聋;前庭功能检查正常.结论 中国DFNA9家系的所有vWFA2结构域突变携带者一生中均无前庭障碍的症状,详尽的前庭功能检查正常.中国DFNA9家系的临床资料分析表明DFNA9存在基因型和表现型的相关性.     

听力学检测和内耳磁共振成像在梅尼埃病诊断中的作用

目的探讨多种临床检测方法在梅尼埃病诊断中的应用价值方法回顾性分析2012年1月至2015年12月确诊为梅尼埃病的77例患者的病历资料,分析梅尼埃病患者的听力学检查以及磁共振水成像检查结果。结果共69例纯音测听结果异常(异常率92.3%);接受前庭诱发肌源性电位检测者65例,异常37例,异常率56.9%;接受耳蜗电图检测者22例,结果异常者15例(异常率68.2%);接受冷热气试验者71例,两侧对称比异常者47例,双侧低下者2例,异常率69.0%;接受甘油试验者12例,试验阳性者3例,异常率25.0%;接受磁共振造影者76例,迷路积水者70例,异常率92.1%。结论纯音测听和磁共振造影在梅尼埃病患者中阳性率高,冷热气试验及耳蜗电图假阳性率次之,可作为梅尼埃病观察的参考指标。     

前庭学

941024椎一基底动脉供血不足的眼姚电图表现/毋哲生…了新疆医学一1993,23(3)。一142~143 对90。例眩晕病人做了眼震电图检查,确诊为椎一基底动脉供血不足性眩晕170例。在眼震电图中扭颈试验阳性为椎一基底动脉供血不足的特征性表现。当椎一基底动脉供血不足主要发生在内听动脉时,扭颈试验出现水平旋转性眼震,冷热试验可出现单侧或双侧前庭功能低下。当供血障碍累及脑干、小脑时,扭颈试验多出现水平旋转性眼震,也可出现垂直性眼震,同时可有凝视试验阳性、视测距障碍试验阳性、跟踪试验l型曲线和视动试验不对称等中枢性改变。参5(原提要)9410…     

几项耳功能检查在梅尼埃病诊断中的意义

目的：探讨前庭功能检查[前庭双温试验和前庭诱发肌源性电位（VEMP）检查]及耳蜗电图在梅尼埃病诊治中的意义。方法：梅尼埃病患者行纯音测听、听性脑干反应测听、前庭双温试验（冷热气或冷热水）、VEMP检查和耳蜗电图检查（单侧或双侧耳蜗电图检查）。结果：①前庭双温试验：病程0～5年，冷热试验CP值异常的百分率为56．9％；6～10年为75．9％；11年以上为50．0％。前庭双温试验的总阳性率为61．6％。冷热试验CP值与病程短相关（P〈0．05）。②VEMP：病程0～5年，VEMP异常的百分率为57．4％；6～10年为60．0％；11年以上组为57．1％。VEMP的总阳性率为58．0％。VEMP正常和异常的患者病程差异无统计学意义（P〉0．05）。③耳蜗电图：病程0～5年，-SP／AP异常的百分率为72．1％；6～10年为73．3％；〉11年为81．3％。总阳性率为73．7％。-SP／AP正常和一SP／AP异常的患者病程差异无统计学意义（P〉0．05）。结论：梅尼埃病的诊断仍以临床症状为基础，结合耳蜗电图、前庭双温试验和VEMP检查，可达到早期诊断、提高确诊率的目的。     

The relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss

Objective: To investigate the relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss (SSHL).

Methods: Clinical data including the symptom of vertigo of 149 SSHL patients were investigated retrospectively. Pure tone audiometry, ocular vestibular-evoked myogenic potential (oVEMP) and cervical vestibular-evoked myogenic potential (cVEMP) evoked by air-conducted sound (ACS), and caloric test were employed for cochlear and vestibular function assessment. The relationship between hearing level and vestibular dysfunction was analyzed.

Results: The pure tone averages (PTAs) (mean?±?SD) of SSHL patients with and without vertigo were 88.81?±?21.74 dB HL and 72.49?±?21.88 dB HL (Z?=??4.411, p?=?0.000), respectively. The PTAs of SSHL patients with abnormal and normal caloric test were 84.71?±?22.54 dB HL and 70.41?±?24.07 dB HL (t?=??2.665, p?=?0.009), respectively. Conversely, vertigo and abnormal caloric results also happened more frequently in patients with profound hearing loss. However, no consistent tendency could be found among vestibular evoked myogenic potentials (VEMPs) responses or hearing loss.

Conclusions: SSHL patients with vertigo or abnormal caloric test displayed worse hearing loss; and vice versa, vertigo and abnormal caloric results happened more frequently in SSHL patients with profound hearing loss.     

突发性聋与前庭神经炎的前庭损伤差异性研究

目的　通过比较研究伴有前庭损伤的突发性聋和前庭神经炎,探讨两类疾病前庭损伤的差异。方法  2016-02-25～2016-07-20解放军总医院耳鼻咽喉头颈外科眩晕诊疗中心,突发性聋组55例,其中39例伴眩晕患者;前庭神经炎组46例。前庭双温冷热试验、头脉冲试验、颈性前庭诱发肌源性电位、眼性前庭诱发肌源性电位评价及比较突发性聋及前庭神经炎两组疾病前庭损伤差异性。结果　前庭双温冷热试验突发性聋组异常率25.45%,前庭神经炎组异常率97.82%,两组比较差异有统计学意义（χ2=54.01,P＜0.001）。头脉冲试验：突发性聋组异常率9.09%,前庭神经炎组异常率32.61%,两组比较差异有统计学意义（χ2=8.72,P =0.003）。颈性前庭诱发肌源性电位突 发性聋组异常率69.10%,前庭神经炎组异常率43.47%,两组比较差异有统计学意义（χ2=6.72,P =0.010）;眼性前庭诱发肌源性电位突发性聋组异常率54.55%,前庭神经炎组异常率63.04%,两组比较差异无统计学意义（χ2=0.745,P =0.388）。结论　突发性聋与前庭神经炎两组患者前庭损伤比较,突发性聋合并眩晕者更有可能为球囊/前庭下神经受累,损伤部位更多靠近神经终末端,损伤是低频段的;前庭神经炎的前庭损伤范围大,损伤是全频段的,高位可能性更大。     

梅尼埃病前庭功能分级的探讨

目的 建立一种新的梅尼埃病患者前庭功能分级方法,初步探索其临床意义及与梅尼埃病听力分期的相关性。 方法 收集112例单侧梅尼埃病患者资料,所有患者均完成包括纯音测听、cVEMP、oVEMP、vHIT以及冷热试验检查。冷热试验和vHIT的结果中任一项异常均视为半规管功能异常。cVEMP结果异常视为球囊功能异常,oVEMP结果异常视为椭圆囊功能异常。球囊、椭圆囊、半规管功能均正常的患者为前庭功能I级,球囊、椭圆囊、半规管功能其中1项异常者为前庭功能Ⅱ级,2项异常者为前庭功能Ⅲ级,3项均异常者为前庭功能Ⅳ级。 结果 根据听力分期,符合入组标准的95例梅尼埃病患者中Ⅰ期13例、Ⅱ期13例、Ⅲ期52例、Ⅳ期17例。患耳平均听阈为(51.86±21.70)dB HL。前庭功能检测结果cVEMP异常率63.2%,oVEMP24异常率74.7%,vHIT异常率33.7%,冷热试验异常率52.6%。前庭功能分级Ⅰ级9例、Ⅱ级28例、Ⅲ级39例、Ⅳ级19例。前庭功能分级与患者的听力差异有统计学意义(P<0.01, r=0.35)。前庭功能分级与患者梅尼埃病分期差异有统计学意义(P<0.01, r=0.35)。前庭功能分级与患者的病程差异有统计学意义(P=0.02, r=0.24)。前庭功能分级与患者的年龄差异无统计学意义(P=0.084)。 结论 梅尼埃病患者随着病程的进展,耳石器功能和半规管功能检测异常率会逐渐增加。通过对球囊、椭圆囊、半规管低频和高频功能的精细化检测,能够对梅尼埃病患者前庭功能进行精准评估。听力分期与前庭功能分级的同步评估能够反映患者疾病的进展状态,同时能够对患者治疗方案的选择和术后康复的预判起到参考作用。     

梅尼埃病首发症状的临床分析

目的了解梅尼埃病患者的性别、首发的年龄、症状,并根据首发症状进行临床分类。方法回顾分析准确提供首发症状的145例梅尼埃病患者,按照耳聋和（或）耳鸣（耳蜗症状）、半规管（旋转性眩晕）和耳石器症状（倾到或平衡障碍）进行分类。结果首发症状依次为耳鸣45例、耳蜗加眩晕症状30例、眩晕28例、耳鸣加耳聋27例、听力下降9例、耳石器症状6例。累及耳蜗及前庭系统30例;累及耳蜗81例：累及半规管28例：累及耳石器6例。小于20岁和大于60岁年龄组患者数最少。男性高发年龄较女性高发年龄早10年,男性和女性在30-49岁年龄段发病例数最多。三种类型梅尼埃病临床首发症状与典型症状出现的间隔差异均较大。结论梅尼埃病耳蜗受累明显高于前庭,首发症状耳鸣最常见,其次是听力下降,再次为眩晕,倾倒的出现率最低。对不典型病例的早期诊断酌情选择纯音测听、耳蜗电图、前庭双温试验和前庭诱发的肌源性电位等检查。     

前庭自旋转试验和冷热试验在突发性聋预后评估中的应用比较

目的 在突发性聋患者诊治过程中运用前庭自旋转试验(vestibular autorotation test,VAT)和冷热试验(caloric test,CT)技术进行半规管功能检测,探讨两种方法在突发性耳聋预后评估中作用的差异性.方法 对23例突发性聋患者进行前庭功能检查(VAT,CT)及听力学检查(纯音测听、声导抗测试、听性脑干反应);用Stata 4.0统计软件做统计分析,分别按痊愈、显效、有效、无效,听力曲线类型及是否伴眩晕进行分组,用R×C联表对各计数因素行卡方检验.结果 统计结果表明两种方法差异无统计学意义(P>0.05).结论 前庭自旋转试验和冷热试验在突发性聋预后评估中的作用无差异.有无眩晕仅在前庭功能异常时对突聋的预后有较大的影响.突聋伴发的眩晕不一定是前庭损害的结果.     

Subjective Visual Horizontal Determination During Otolith Stimulation by Eccentric Rotation in Conservatively Treated Meniere's Disease

Peripheral vestibular equilibrium disorders may originate in various parts of the labyrinth or of the vestibular nerve. Traditionally, the function of the lateral semicircular canals has been assessed by caloric irrigation and has been interpreted (sometimes falsely) as demonstrating a vestibular nerve lesion. The vertical semicircular canals are not assessed easily. Caloric testing with the head in various positions is not very helpful, but the canals may be tested in pairs using specific rotational techniques. Often, the otolith organs, detecting linear acceleration forces, are forgotten as a source of vertigo and dizziness. The extent of otolith involvement in Meniere's disease is not well understood. The tested subject is seated eccentrically in a rotatory chair and faces the direction of rotation. Thus, the otolith organs are stimulated in steady-state rotation. The subject experiences a lateral tilt and, in darkness, is instructed to point a short light bar in the position that he or she thinks a water surface would have (identical to the perceived tilt). Patients with conservatively treated unilateral Meniere's disease were tested. In the eccentric rotation test, the patients with unilateral Meniere's disease showed highly variable, sometimes even paradoxical, responses. No correlation was noted between the eccentric otolith test and pure-tone audiometry or the side difference of the caloric responses. Otolith and lateral semicircular canal functions may differ in patients with Meniere's disease, the nature of which remains to be elucidated in further studies.     

Vestibular evoked myogenic potentials and glycerol testing

OBJECTIVES/HYPOTHESIS: The objective was to evaluate dizziness as the first symptom of endolymphatic hydrops, which could provide valuable information on the initial stages of endolymphatic hydrops development. STUDY DESIGN: The present investigation was specifically designed to establish whether a combination of the traditional glycerol test and the vestibular evoked myogenic potential (VEMP) glycerol test is capable of diagnosing endolymphatic hydrops early and to identify potential Meniere's disease. The study was limited to patients who complained of dizziness as their only vestibular symptom. METHODS: Thirty-eight consecutive patients with dizziness who had received no treatment were investigated. Each patient underwent glycerol testing measured with both conventional pure-tone audiometry and vestibular evoked myogenic potential testing. For the vestibular evoked myogenic potential glycerol test, an increase of more than 20% in both latency and amplitude after glycerol intake was considered an improvement.RESULTS In one patient, the reappearance of the vestibular evoked myogenic potentials was observed. In another six patients, there was an increase in the vestibular evoked myogenic potential amplitudes, unilaterally in four cases and bilaterally in two. One patient showed a bilateral improvement in amplitude and an unilateral amelioration in latency. CONCLUSION: The assumption of saccular dilation as a sign of early Meniere's disease was not supported by the literature, which considered saccular hydrops as the final progression of the dilation of the endolymphatic compartments into the cochlea. These data seem to indicate that in our patients a saccular dysfunction rather than an early saccular hydrops has been documented, confirming vestibular evoked myogenic potential testing as an intriguing diagnostic option for a lesion of this structure. The vestibular evoked myogenic potential glycerol test proved capable of identifying dysfunctions of the saccule that were not otherwise detectable by the routine methods. Therefore, the vestibular evoked myogenic potential glycerol test should be considered as an additional method of diagnosis in patients with vertigo or dizziness.     

良性阵发性位置性眩晕的听-前庭功能研究

目的了解良性阵发性位置性眩晕（benign paroxysmal positional veaigo，BPPV）在听和前庭功能检查方面的特点，进一步了解BPPV的可能发病机制，并提出防治策略。方法对86例BPPV患者行纯音测听、高刺激率听性脑干反应、前庭双温试验、前庭诱发的肌源性电位检查。分析BPPV患者几种耳功能检查的阳性率，以及在BPPV发病机制中的作用。结果86例BPPV患者中，原发性占82％（70／86）。纯音测听异常者占52％（45／86）；高刺激听性脑干反应异常者在原发性BPPV中60％（30／50）。前庭诱发的肌源性电位异常为34％（11／32）。前庭双温试验异常者25％（18／72），其中，与BPPV同侧者占67％（12／18）。水平半规管BPPV，双温试验异常者占11％（2／18），后半规管异常者占89％（16／18）。结论原发性BPPV发病率高于继发性BPPV（x^2=67．8140，P〈0．01），纯音测听结果正常与异常的例数几乎相同。高刺激听性脑干反应异常对于原发性BPPV有一定的贡献。水平半规管前庭双温试验异常率低，而后半规管异常率较高。前庭诱发的肌源性电位的异常率明显低于高刺激听性脑干反应和前庭双温试验，说明上迷路的病变与BPPV发病密切相关。鉴于内耳供血可能对BPPV的发病有一定的影响，对于异常的患者应给改善内耳供血的药物，以减少复发。     

Changes in Ribbon Synapses and Rough Endoplasmic Reticulum of Rat Utricular Macular Hair Cells in Weightlessness

Although still the subject of discussion, vestibular-evoked myogenic potentials (VEMPs) have been considered to reflect the function of the saccular and, more recently, the cochlear tracts. To accurately determine the precise afferent pathway carrying VEMPs, we studied the outcomes of VEMPs and other examinations in patients with unilateral vestibular schwannomas. Eleven patients with unilateral vestibular schwannomas resected using a middle cranial fossa approach were included in the study. Patients underwent pure-tone threshold audiometry, caloric tests and analysis of auditory brainstem responses (ABRs) and VEMPs pre- and postoperatively. The results were compared with those obtained in patients with intact superior or inferior vestibular and cochlear nerves. Among the 11 patients studied, 4 retained their VEMPs postoperatively. Three of the 10 patients with inferior vestibular schwannomas exhibited normal VEMPs, preserved hearing levels (20 dB HL) and anatomically intact superior vestibular nerves. In all of these cases, ABRs more closely correlated with VEMPs than with caloric responses. In one of the cases with inferior vestibular schwannomas, VEMPs were preserved postoperatively and VEMP latencies were shortened, which indicates the preoperative presence of a conduction block in either the cochlear or superior vestibular nerve. VEMPs may be conducted in both the superior vestibular and cochlear nerves, as well as in the inferior vestibular nerve. Thus, evaluation of saccular nerve function should be performed carefully, especially in cases where hearing is preserved. It appears that cochlear conduction may proceed along two pathways, one direct and the other via the brainstem, but this remains to be verified.