视频眼震电图对突发性聋伴眩晕患者前庭功能的诊断价值分析

目的探讨视频眼震电图对突发性聋伴眩晕患者前庭功能的诊断价值。方法将2013年2月~2017年12月收纳的500例突聋患者作为研究对象，根据是否合并眩晕分为眩晕组（180例）和非眩晕组（320例），所有患者入院后进行纯音听力测试、视频眼震电图（videonystagmograph，VNG）检测等，比较眩晕组和非眩晕组患者纯音测听和视频眼震电图检测结果，同时统计患者平坦型、全聋型、低频型、中频型、高频型的听力曲线例数及冷热试验的前庭功能评价结果，并比较组间差异。患者根据视频眼震电图和相关检测结果进行对应治疗，统计两组患者的治疗效果。结果①眩晕组患者的前庭功能正常比例（48.9%）显著低于非眩晕组（83.8%）（P＜0.05）；听力学结果显示听力损失严重者比例（67.2%）显著高于非眩晕组（28.1%），轻度患者比例（8.3%）明显低于非眩晕组（40.0%）（P均＜0.05）；②患者的听力曲线主要有平坦型108例，其中前庭功能异常15例（13.9%）；全聋型78例，其中前庭功能异常34例；低频型100例，其中前庭功能异常28例（28.0%）；中频型94例，其中前庭功能异常25例（26.6%）；高频型120例，其中前庭功能异常42例（35.0%）。表明全聋型曲线前庭功能异常率显著高于其他类型听力曲线患者，冷热试验结果表明前庭功能异常的主要表现为半规管轻瘫；③两组患者临床疗效其中眩晕组患者显效率26.7%（48/180）、有效率28.9%（52/180）及总有效率55.6%（100/180）明显低于非眩晕组的38.1%（122/320）、45.6%（146/320）及83.7%（268/320）（P均＜0.05）。结论突发性聋伴眩晕患者前庭功能受到明显损伤，采用视频眼震电图进行前庭功能检测对突发性聋伴眩晕患者的病情评估、诊断、治疗具有重要指导意义，值得临床借鉴。     

对急性低频感音神经性听力损失患者前庭功能的研究

目的:对急性低频感音神经性听力损失(ALHL)患者进行前庭功能检查,了解该类患者的前庭功能是否异常。方法:对52例ALHL患者在治疗前和治疗后分别进行前庭功能检查,包括眼震电图检查和静态姿势描记图检查,并与对照组进行比较。结果:52例ALHL患者重心晃动的路径总长明显延长,晃动速度明显增快,与对照组治疗前闭眼状态下相比较,差异有统计学意义(P<0.05);治疗前9例(17.3%)眼震电图检查异常,治疗后2例(3.8%)仍异常;治疗后静态姿势描记图检查与对照组比较,差异无统计学意义(P>0.05)。结论:ALHL患者虽无眩晕主诉,但部分患者前庭功能已经受损,在临床工作中应对该类患者行前庭功能检查,以进一步了解其整个内耳功能状态,并应进行长期随访。     

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.     

视频眼震电图检查在椎-基底动脉短暂缺血性眩晕诊断中的意义

目的：探究椎-基底动脉短暂缺血性眩晕（VBTIV）患者视频眼震电图的表现及临床意义。方法：对38例以眩晕为主诉的VBTIV患者行系列化眼震电图检查,并以20例正常健康人为对照,对结果进行统计学分析。结果：VBTIV组有自发性眼震1例。视眼动系统检查28例（73.7%）出现1项或多项异常,表现为扫视试验26例异常（68.4%）;视跟踪试验Ⅲ型改变13例、Ⅳ型改变3例,共16例异常（42.1%）;视动眼震减弱或节律、振幅不规则,双侧不对称17例（44.7%）,未出现凝视眼震。引出异常位置性眼震29例（76.3%）,位置性眼震强度（4.08±3.18）°/s,明显高于对照组（P〈0.01）。15例变位试验出现眼震。温度试验一侧或双侧反应低下19例（50.0%）,出现优势偏向者6例（15.9%）,5例出现固视抑制失败。患者慢相速度之和的人数分布与健康对照组有所不同。结论：VBTIV功能改变既累及前庭中枢,又累及前庭外周,视频眼震电图检查异常率达92%（35/38）,对VBTIV的诊断具有重要意义。     

眼震电图与动态姿势图在良性阵发性位置性眩晕中的临床应用

目的:探讨眼震电图(ENG)及动态姿势描记(DPG)2种前庭功能检查在良性阵发性位置性眩晕(BPPV)中的临床应用。方法:应用ENG与DPG对40例34～79岁的原发性BPPV患者(BPPV组)和20例正常者(对照组)进行检查,其中DPG评定参数选取感觉器官测试(SOT)中前庭感觉评分、本体感觉评分、视觉评分、Romber′s评分和综合评分。结果:40例BPPV患者的ENG检查中,温度试验异常者26例(65.0%);DPG异常者33例(82.5%),并且DPG中均表现为前庭觉评分低,其他几项评分均未见差别。温度试验和DPG两项结果均异常者24例(60.0%),温度试验正常患者中有9例(64.3%)出现前庭觉评分低,在SOT中除前庭觉评分低外其他几项评分均未见明显异常。此外,与对照组比较BPPV组ENG中温度试验和DPG的前庭评分明显异常(P<0.05),并且≥12个月患者上述检查异常程度更高(P<0.05)。结论:ENG与DPG是重要的前庭功能检查方法,二者联合应用能够全面分析BPPV患者前庭功能病变,且BPPV患者病程直接影响其前庭功能。     

梅尼埃病的听-前庭功能诊断的Logistic回归分析

目的:采用多指标的Logistic回归分析方法探讨梅尼埃病临床特征及耳蜗与前庭功能损害的特征.方法:36例梅尼埃病患者和30例其他外周性眩晕对照组进行临床资料分析,完成纯音测听、Metz重振测试、耳蜗电图、甘油试验、ABR等听力学检查以及双温试验、摇头眼震试验、Fukuda踏步试验.对临床体征、耳蜗与前庭功能检查的各项指标进行单因素χ2 分析,然后进行多因素Logistic回归分析.结果:①波动性听力下降、四联征出现的个数、Tullio现象、耳蜗电图-SP/AP幅值比、Metz重振试验、甘油试验在梅尼埃组与非梅尼埃组间差异有统计学意义(P<0.05);②建立了以耳蜗电图(X1)、甘油试验(X2)、症状的个数(X3)、波动性听力下降(X4)为变量的梅尼埃病Logistic回归预测方程:Logit(p)=-9.443+3.110 X1 +5.015X2 +2.506 X3 +3.963 X4.Logistic模型预报正确率为95.5%,ROC曲线下面积为0.993.结论:梅尼埃病的临床表现特征性明显,配合耳蜗-前庭功能的客观检查,可与其他外周性眩晕相鉴别,相关因素的Logistic回归预测方程可对梅尼埃病进行辅助诊断.     

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.     

眼性前庭诱发肌源电位与眩晕诊断

眩晕是临床常见病和多发病,多由半规管或耳石器病变、前庭神经传入通路异常、大脑皮层颞上回前庭皮质区病变或受刺激引起.此外,颈椎病、椎基底动脉供血不足也能诱发眩晕.由于病因繁多,发病机制不明,眩晕的定位定性诊断一直是困扰临床医生的难题之一.目前常用的前庭功能检查方法主要有:眼震电图(electronystagmography,ENG)、眼震视图( videonystagmography,VNG)、转椅试验、姿势图和前庭诱发肌源电位(vestibular-evoked myogenic potentials,VEMP)等.其中VEMP因在球囊和椭圆囊功能评估中的独特作用,在眩晕临床诊治中受到越来越多的关注.     

前庭自旋转试验在位置性眩晕患者中的检测

目的 通过对位置性眩晕患者进行前庭自旋转试验(Vestibular autorotation test,VAT)检查,探讨VAT用于鉴别中枢性和外周性位置性眩晕的作用.方法 回顾性分析140例位置性眩晕患者的临床资料,均无耳聋、耳鸣或前庭功能低下.患者资料包括病史,专科检查,视频眼震电图(videonystagmography,VNG),VAT,头颅磁共振(MRI),位置试验,手法复位治疗.结果 138例良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV),VAT参数水平增益正常,部分患者的垂直向下的眼震(positional down beating nystagmus,pDBN)通过手法复位消失,经MRI排除其他疾病.2例颅底凹陷综合征(Arnold-Chiari malformation,ACM)通过头颅MRI得到确诊,其VAT水平增益增高,手法复位后pDBN不消失.结论 VAT可用以辅助BPPV的鉴别诊断.     

起立性低血压:血压与眼震的关系

起立性低血压患者大部分自述眩晕,但在当时记录血压与眼震的极少。作者对一例糖尿病并有多种合并症在起立时出现明显眼震的患者,在记录血压的同时应用眼震电图(ENG)记录眼震并进行分析。患者男,62岁,有浮动感、头痛和左侧面瘫,浮动感多在立位时出现,而在卧位时减轻,发作时有呕吐。经听力、前庭检查,变     

Trends in blunt laryngotracheal trauma in children

Objective

To examine the presentation, mechanisms, and management of blunt laryngotracheal trauma in a pediatric population, emphasizing the rise in severity.

Design

Retrospective analysis of laryngotracheal trauma evaluated from 1995 to 2008. The presentation, mechanism, management and outcomes data are detailed.

Setting

Tertiary medical center.

Patients

Thirty-five patients were identified with major laryngotracheal trauma.

Main outcome measures

Surgical results, airway patency, voicing, swallowing and other residual disabilities are tabulated.

Results

Average age was 10.8 years, with boys outnumbering girls 22-13. In cases of major trauma, mechanisms were related to motor vehicle accidents (MVAs) in seven patients. Five of 11 major trauma victims were unconscious at presentation. Definitive airway reconstruction involved laryngotracheoplasty and tracheal resection/reanastomosis. Ten of 11 remain decannulated.

Conclusions

In an increasingly mobile society, major laryngotracheal trauma is occurring in a younger population. Victims of major laryngotracheal trauma may be unconscious or have other injuries that obscure airway injury, highlighting the need for vigilance. Once the airway is secured and the patient stabilized, airway reconstruction is undertaken, achieving decannulation in most patients. Hoarseness is often a lasting morbidity.     

Immunotype findings in macrophages in aural cholesteatomas

Summary Since a heavy cellular infiltrate is seen in the stroma of most aural cholesteatomas, we attempted to characterize this cell population in more detail using monocyte/macrophage-specific monoclonal antibodies. KiM1+ (specific for CD 11c antigen, the 150kDa -chain of a leukocyte integrin), and KiM6+ phagocytes were present in two- or fourfold higher numbers in the stroma of the six excised cholesteatomas than in the control tissues. Since the stroma of the cholesteatoma is devoid of microvessles, the typical perivascular localization of dermal macrophages was not seen in the cholesteatomas studied. The density of the macrophages in the normal ear skin was much higher in the upper dermis than in the lower dermis. In the cholesteatomatous specimens, the phagocytes were evenly scattered within the connective tissue and the cellular infiltrate. In contrast to diseased skin, no Mac 387+ macrophages were detected in the cholesteatomas. A great number of phagocytic cells closely resembling dermal macrophages was found in the stroma of the cholesteatomas and probably contributes to an active autoimmune process. Offprint requests to: B. Negri     

Deafness gene mutations in newborns in Beijing

Objective To determine the incidence of congenital hearing loss (HL) in newborns by the rate of deafness-related genetic mutations. Design Clinical study of consecutive newborns in Beijing using allele-specific polymerase chain reaction-based universal array. Study sample This study tested 37 573 newborns within 3 days after birth, including nine sites in four genes: GJB2 (35 del G, 176 del 16, 235 del C, 299 del AT), SLC26A4 (IVS7-2 A?>?G, 2168 A?>?G), MTRNR1 (1555 A?>?G, 1494 C?>?T), and GJB3 (538 C?>?T). The birth condition of infants was also recorded. Results Of 37 573 newborns, 1810 carried pathogenic mutations, or 4.817%. The carrier rates of GJB2 (35 del G, 176 del 16, 235 del C, 299 del AT), GJB3 (538 C?>?T), SLC26A4 (IVS7-2 A?>?G, 2168 A?>?G), and MTRNR1 (1555 A?>?G, 1494 C?>?T) mutations were 0.005%, 0.104%, 1.924%, 0.551%, 0.295%, 0.253%, 1.387%, 0.024%, and 0.274%, respectively. Logistic regression analysis indicated no statistically significant relationship between mutations and infant sex, premature delivery, twin status, or birth weight. Conclusions The 235delC GJB2 mutation was the most frequent deafness-related mutation in the Chinese population. Genetic screening for the deafness gene will help detect more cases of newborn congenital HL than current screening practices.     

HLA associations in otosclerosis in Japanese patients

Otosclerosis is a disease of the otic capsule that is caused by abnormal resorption and redeposition of bony tissue. Sixty-two unrelated Japanese patients exhibiting clinical otosclerosis were typed for HLA-A, -B,-C antigens. Twenty-one of the patients were also typed for DR antigens. The frequency of HLA-Aw33 was significantly higher in otosclerosis patients than in the control group (24.2% vs 9.5%). This finding suggests that the presence of HLA-Aw33 antigens may be related to an increased susceptibility to otosclerosis or to its clinical outcome.