视抑制试验的临床应用研究

对２００例诊断明确的几种周边和中枢前庭疾病患者，在进行冷水试验的同时测试了视抑制功能，用眼震电图仪记录，计算ＶＳ值。１６２例周围性前庭损害者ＶＳ均正常，３８例中枢前庭损害者中２７例ＶＳ异常，占７１％。讨论了各种定量测试固视机能方法的优缺点，并就各种眩晕疾患的视抑制试验结果进行分析，探讨其临床意义。     

Ménière's disease

There now exists a vast literature on Ménìere's disease. In this review, we examine closely the foundations of some of the current concepts regarding various aspects of the disorder, including definitions, clinical features, natural history, pathology, pathogenesis, pathophysiology, diagnosis and treatment. We will highlight areas where the current state of knowledge is incomplete and also suggest some avenues for further research.     

Middle-ear ceruminous adenoma as a rare cause of hearing loss and vertigo: case reports

Middle-ear ceruminous adenomas are rare benign neoplasms arising from the epithelium of the middle ear. Progressive hearing loss, ear fullness and tinnitus are common symptoms of this tumour; facial nerve paresis and vestibular disturbances occur very infrequently. We present two cases of middle-ear ceruminous adenomas, one showed rapid unilateral hearing loss with aural fullness, followed by purulent aural discharge and vertigo. In the second case, the disease affected an already deaf ear and the only symptom of the disease was increasing vertigo. The clinical features, intraoperative findings, and histological and radiological findings are presented. The cases are compared to those described in the literature.     

VEMP recording by binaural simultaneous stimulation in subjects with vestibulo-cochlear disorders

To reduce the testing time of vestibular evoked myogenic potentials (VEMP) and the physical efforts of subjects, we studied if VEMP recording by binaural simultaneous stimulation in patients with vestibulo-cochlear disorders can be applicable as a screening test. Twenty-eight patients with vestibulo-cochlear disorders (12 men and 16 women, 22 to 77 years of age) were enrolled in this study. Patients were presented with binaural or monaural click (95 dBnHL) stimulation to record VEMPs. Their VEMP responses to binaural simultaneous stimulation were compared with those of monaural individual stimulation. Twenty-six of the 28 patients (93%) showed the same results in binaural simultaneous stimulation as in monaural individual stimulation. Amplitudes of p13-n23 to binaural simultaneous stimulation showed significant correlation to those of monaural individual stimulation ( r =0.774, P <0.0001 t -test). Peak latencies of p13 and n23 of binaural simultaneous stimulation also showed significant correlation to those of monaural individual stimulation (p13: r =0.684, P <0.0001 t -test, n23: r =0.657, P <0.0001 t -test). The binaural simultaneous stimulation method for VEMP recording is applicable for patients with vestibulo-cochlear disorders as a screening test in the clinic.     

Cogan’s syndrome: clinical evolution of deafness and vertigo in three patients

The aim of this study was to evaluate the clinical symptoms, the otoneurological examinations, the treatment and the clinical course of three patients suffering from Cogans syndrome, a rare disease based on the clinical association of a non-syphilitic interstitial keratitis with a cochleo-vestibular deficit. This case series involved three patients with follow up. The clinical course of the three patients (aged 30, 48 and 49 years) with Cogans syndrome during a follow-up period of 2 to 6 years is reported. All patients underwent complete otoneurological, ophthalmologic and rheumatologic examinations and were treated with immunosuppressive therapy such as glucocorticoids and cyclophosphamide in two and glucocorticoids and methotrexate in one patient. Using immunosuppressive therapy, ophthalmologic symptoms disappeared rapidly in two patients. Hearing improved only in one and stabilized in a second patient. One patient died after 6 years of treatment because of complications of generalized vasculitis. Early diagnosis and rapid initiation of a combined immunosuppressive therapy such as corticosteroids and cyclophosphamide seem to be important in controlling the disease and avoiding persistent deafness. Whether systemic complications and a fatal outcome also can be prevented is still questionable.This paper was presented at the 35th Congress of the International Society of Otoneurology, Paris, France, 25 May 2001.     

Paroxysmal positional vertigo as a complication of osteotome sinus floor elevation

Paroxysmal positional vertigo (PPV) is a high prevalence, vestibular end organ disorder due to the detachment of the utricular otoconia floating in the posterior or lateral semicircular canal. Even though in the majority of cases the etiology of PPV is unknown, it may follow viral infection, vascular disorders and head trauma after different surgical procedures. The aim of this study was to investigate the correlation between PPV and the surgical trauma induced by the vibratory and percussive forces on the upper maxilla during the osteotome sinus floor elevation procedure. We performed a complete otoneurological examination on 146 patients affected by atrophic ridges before and after upper maxilla surgery. Four patients showed a PPV of the posterior semicircular canal controlateral to the implanted side 1 or 2 days after the surgical procedure, which promptly was solved with the Epley re-positioning maneuver. We hypothesize that the surgical trauma, and specifically the pressure exerted by the osteotomes, determines the detachment of the otoliths from the utricular macula while the patient head position, hyper-extended and tilted opposite to the side where the surgeon is working, favors the entry of these free-floating particles in the posterior semicircular canal of the implanted side. Although this disease is rather frequent in the normal population and it is a benign, self-limiting peripheral disorder, it should be considered by the oral surgeon as a possible complication of pre-prosthetic upper maxilla surgery, and the patient should be informed before undergoing surgery.     

Variables affecting treatment in benign paroxysmal positional vertigo

OBJECTIVE: To identify variables affecting outcome in patients with benign paroxysmal positional vertigo (BPPV) treated with canalith repositioning maneuvers. STUDY DESIGN: Retrospective review of patients at a tertiary vestibular rehabilitation center. METHODS: Variables identified for statistical analysis included method of diagnosis, age, sex, onset association with trauma, semicircular canal involvement, presence of bilateral disease, treatment visits, and cycles of canalith repositioning maneuvers per treatment visit. Multivariate statistical analysis using Pearson chi2, likelihood ratio, linear-by-linear association, and cross-tabulation tests were performed. RESULTS: Two hundred fifty-nine patients with BPPV who received treatment were identified from 1996 to 1998. Average follow-up time was 16.9 months. 74.8% required one treatment visit, 19.0% required a second treatment visit, and 98.4% were successfully treated after three treatment visits. The remainder required up to seven treatment visits for relief of symptoms. Variables affecting the number of treatment visits included bilateral disease or location of disease other than in the posterior semicircular canal. Patient age, sex, method of diagnosis, and onset association with trauma had no statistically significant impact. CONCLUSION: Patients with benign paroxysmal positional vertigo not located in a single posterior semicircular canal are more likely to require multiple visits for canalith repositioning.     

水平半规管良性阵发性位置性眩晕的眼震特点和治疗

目的:探讨水平半规管良性阵发性位置性眩晕(HSC-BPPV)的眼震特点和治疗方法.方法:对43例HSC-BPPV患者应用红外线视频眼动记录仪分析其变位试验诱发的眼震特点,进行分型、定侧,并采用相应的耳石复位法治疗.结果:43例患者中:①水平向地性眼震患者27例,其中19例接受Barbecue翻滚疗法,或结合强迫侧卧体位疗法,8例不适于翻滚或体位维持困难者接受AspreUa法治疗;②水平背地性眼震16例,其中自行或采用Gufoni疗法后转变为水平向地性眼震12例,方向不能转换4例,采用Barbecue翻滚和(或)强迫侧卧体位疗法.1周后随访总有效率为72.1%,3个月后总有效率为81.4%.结论:HSC-BPPV的诊断和治疗应根据不同变位试验诱发的眼震特征判别耳石位于半规管的不同部位及不同发病机制类型,并选择合适的耳石复位技术治疗.     

甲磺酸倍他司汀治疗内耳缺血相关性眩晕的疗效研究

目的通过观察良性阵发性位置性眩晕（benign positional paroxysrnal vertigo，BPPV）、后循环缺血（posterior circulation ischemia，PCI）、偏头痛性眩晕（migrainousvertigo，MV）、青少年良性眩晕在服用不同剂量的甲磺酸倍他司汀后的临床表现，了解甲磺酸倍他司汀治疗内耳缺血性眩晕的疗效。方法BPPV、PCI、MV各30例，分成2组。组一：甲磺酸倍他司汀6mg，3／日：组二：甲磺酸倍他司汀12mg，3／El，治疗均为期1个月。观察量-效关系。青少年良性阵发性眩晕25例不分组，甲磺酸倍他司汀6mg3／19，服药治疗1月。分别观察治疗前后高刺激听性脑干测听（auditory brainstem response，ABR）和眩晕残障程度（dizziness handicap inventory，DHI）的变化。结果四类眩晕治疗后症状减轻，高刺激ABR和DHI均有改善，而眼动异常变化不明显。连续用药1个月后，BPPV、PCI、MV三类患者12mg，3／日方案疗效优于6mg，3／日方案。青少年良性眩晕6mg，3/日方案也获得满意疗效。结论甲磺酸倍他司汀对良性阵发性位置性眩晕、后循环缺血、偏头痛性眩晕和青少年良性眩晕等与内耳低灌注有关的眩晕有较好的治疗作用，并表现出量效关系，12mg，3/日方案疗效优于6mg，3／日方案。     

环椎椎动脉沟桥与颈性眩晕关系的临床影像研究

目的探讨环椎椎动脉沟桥与颈性眩晕的关系,提高环椎椎动脉沟桥的认识。方法分析103例环椎椎动脉沟桥X线表现,11例结合脑血管多普勒检查,评价基底动脉供血情况。结果环椎椎动脉沟桥表现为全环型和半环型,后者又分为前半环型、后半环型和双半环型（中间骨性桥板缺如）,沟桥可一侧出现,也可双侧出现。全环型沟桥多呈椭圆型,沟桥桥板厚薄不一,密度也可不一致。11例主诉眩晕,照片仅见沟桥存在,而其他未见异常,头颈部前屈、后仰或旋转时,其眩晕症状加重。显示沟桥与眩晕存在密切的关系,沟桥的发生机制应包括环椎解剖变异和环枕韧带钙化或骨化两个方面。结论环椎椎动脉沟桥可以对椎动脉产生压迫,引起供血不足,产生眩晕,应重视环椎椎动脉沟桥的X线诊断。