三个半规管阻塞动物模型的建立

目的　旨在建立豚鼠单侧三个半规管阻塞的动物模型。方法　利用 2 0只豚鼠行单侧三个半规管阻塞 ,观察手术前后眼震电图、听性脑干反应 (auditorybrainstemresponses,ABR)、畸变产物耳声发射 (distortionproductotoacousticemissions,DPOAE)及形态学的变化 ,非手术耳作为对照。结果　豚鼠术后 1d出现自发性眼震 ,正弦摆动刺激单侧眼震反应消失 ,侧别与术侧一致 ,术后 30d左相与右相眼震反应对称。术前微量冰水灌注 ,两耳均能引出眼震 ,术后 30d做冰水实验结果为术耳未能引出眼震 ,非术耳出现正常的眼震反应。术后ABR阈值有轻度升高 ,DPOAE反应幅度无明显改变。 8只动物病理切片证实三个半规管完全阻塞而耳蜗Corti器和壶腹嵴结构正常。结论　表明三个半规管阻塞动物模型成功 ,提示三个半规管阻塞术可望成为治疗难治性外周性眩晕的安全有效、操作相对容易的手术方法。     

后半规管阻塞前后豚鼠前庭及耳蜗功能的动态变化

目的 探讨机械性后半规管阻塞前后豚鼠前庭和耳蜗功能的动态变化。方法 采用２０只豚鼠建立单侧后半规管阻塞的动物模型,观察手术前后眼震电图,听性脑干反应,耳声发射等变化。结果 术后第１天,第３天豚鼠正弦摆动刺激术侧眼震反应,明显减术,术后第５天起双侧眼震恢复正常。术后早期ＡＢＲ阈值一度升高,第５天达高峰,ＡＢＲ阈值平均升高４．５ｄＢ。ＤＰＯＡＥ反应幅度无明显改变。结论 后半规管阻塞能选择性地消除后半规     

三半规管阻塞与迷路切除术后前庭功能动态变化

目的 :比较豚鼠三半规管阻塞与迷路切除术后前庭功能代偿的异同。材料与方法 :将 15只健康豚鼠分为 2组 ,其中 8只豚鼠行右侧三半规管阻塞术 (triple semicircular canal occlusion,TCO) ,7只豚鼠行右侧迷路切除术(labyrinthectomy,L E) ,于术后一个月内观察豚鼠行为学及眼震电图 (ENG)的动态变化。结果 :发现术后第 1天两组均出现自发性眼震 ,正弦摆动刺激术侧时未引出诱发性眼震 ,头向右侧偏斜并沿地面垂直轴向术侧旋转 ;L E组却出现翻滚现象。术后第 3、5、10、15、30天正弦摆动眼震试验 ,两组豚鼠术侧眼震均随时间的推移逐渐恢复 ,TCO组于 15天左右向眼震基本恢复对称 ,而 L E组至术后 30天仅摆动幅度 12 0°、15 0°、180°左右向眼震基本对称 ,摆动幅度为 6 0°、90°双向眼震反应差异仍有显著性意义 (P <0 .0 5 ) ;另外 ,L E组有 3只豚鼠仍存在头偏。结论 :TCO组要比 L E组动物恢复快 ,建立代偿和失平衡时间短     

三半规管阻塞与迷路切除术后前庭功能动态变化

目的：比较豚鼠三半规管阻塞与迷路切除术后前庭功能代偿的异同。材料与方法：将15只健康豚鼠分为2组，其中8只豚鼠行右侧三半规管阻塞术（triple semicircular canal occlusion,TCO)，7只豚鼠行右侧迷路切除术（labyruinthectomy,LE)，于术后一个月内观察豚鼠行为学及眼震电图（ENG）的动态变化，结果：发现术后第1天两组均出现自发性眼震，正弦摆动刺激术侧时未引出衣发性眼震，头向右侧偏斜并沿地面垂直轴向术侧旋转；LE组却出现番滚现象，术后第3，5，10，15，30天正弦摆动眼震试验，两组豚鼠术侧眼震均随时间的推移逐渐恢复，TCO组于15天左右向眼震基本恢复对称，而LE组至术后30天仅摆动幅度120，150度，180度左右向眼震基本对称，摆动幅度为60度，90度双向眼震反应差异仍有显著意义（P＜0．05），。另外，LE组有3只豚鼠仍存在头偏，结论：TCO组要比LE组动物恢复快，建立代偿和失平衡时间短。     

三个半规管阻塞动物模型的建立

目的 旨在建立豚鼠单侧三个半规管阻塞的动物模型。方法 利用２０只豚鼠行单侧三个半规管阻塞,观察手术前后眼震电图、听性脑干反应（ａｕｄｉｔｏｒｙ ｂｒａｉｎｓｔｅｍ ｒｅｓｐｏｎｓｅｓ,ＡＢＲ）、畸变产物耳声发射（ｄｉｓｔｏｒｔｉｏｎ ｐｒｏｄｕｃｔ ｏｔｏａｃｏｕｓｔｉｃ ｅｍｉｓｓｉｏｎ,ＤＰＯＡＥ）及形态学的变化,非手术耳作对照。结果 豚鼠术后１ｄ出现自发性眼震,正弦摆动刺激单侧眼震反应消失,     

豚鼠半规管阻塞术中听性脑干反应的变化

目的：观察正常豚鼠行三个半规管阻塞术中ABR反应阈值的动态变化。方法：健康白色纯种豚鼠10只，分别于术前、打开听泡、开放与阻塞各个半规管后测ABR阈值。结果：三个半规管阻塞结束后，ABR阈值平均升高6．82dB。各个半规管开窗前后ABR阈值上升较明显，而阻塞前后ABR阈值变化不明显。结论：半规管阻塞术中的听力下降是一个渐进的过程，引起听力下降的主要原因可能是外淋巴的流失，迷路受刺激并非造成听力下降的主要因素。     

氨基苷类药物对内淋巴积水豚鼠前庭及耳蜗功能的影响

目的探讨氨基甙类药物对内淋巴积水豚鼠前庭及耳蜗功能的影响。方法8只内淋巴积水模型豚鼠全身应用链霉素,观察给药前后豚鼠行为学、眼震电图(ENG),听性脑干反应(ABR),畸变产物耳声发射(DPOAE)及形态学变化。结果给药后未出现头偏斜、走路不稳等前庭功能紊乱的行为征象,连续给药第10天、停药后第7天摆动幅度90°,停药后第21天,摆动幅度为90°、120°时积水侧眼震反应降低的幅度明显大于对照耳(     

单侧半规管阻塞对豚鼠前庭内侧核谷氨酸变化的影响

目的　探讨单侧外半规管阻塞造成的急性眩晕动物模型,前庭内侧核谷氨酸神经递质的变化规律。方法  在行为学验证基础上,利用活体微透析技术结合高效液相 色谱（high performance liquid chromatography,HPLC）-荧光检测方法,研究清醒状态下豚鼠前庭内侧核谷氨酸水平的变化。结果　半规管阻塞术后第1天动物出现头偏、头震及强迫环形运动等表现,上述症状于术后第4天逐渐消失。术后第1天实验组豚鼠前庭内侧核谷氨酸浓度较对照组显著提高,差异有统计学意义（t =7.4637,P <0.001）。术后第4天实验组豚鼠前庭内侧核谷氨酸浓度降低,与基线水平相比无显著差异（t =0.2447,P >0.05）。结论　豚鼠前庭内侧核谷氨酸水平显著性升高,可能与单侧半规管阻塞造成动物急性眩晕有关。     

Dix-Hallpike诱发试验双侧阳性的良性阵发性位置性眩晕的临床分析

目的探讨良性阵发性位置性眩晕(Benign Paroxysmal Positional Vertigo,BPPV)患者Dix-Hallpike诱发试验双侧阳性的眼震特点和诊治策略。方法回顾性分析2018年1月至2019年12月就诊于安徽医科大学第二附属医院耳鼻喉科的BPPV患者的诊治过程。结果 Dix-Hallpike诱发试验,阳性患者150例,其中双侧阳性患者14例,2例双侧可见扭转、向上、向地性眼震,进一步行平躺试验为垂直向上性眼震,分次给予双侧改良Epley法复位后双侧眼震均消失;12例患侧为扭转、向上、向地性眼震,健侧为扭转、向上、离地性眼震者,给予患侧改良Epley法复位后双侧眼震均消失。结论除了双侧后半规管BPPV,部分单侧后半规管BPPV患者行Dix-Hallpike诱发试验也可表现为双侧阳性结果,临床诊治应注意眼震方向形式的差别。     

冷热刺激先后顺序对眼震最大慢相角速度的影响

目的 :　了解变温实验检查中冷热刺激顺序同眼震反应强度的关系。方法 :应用眼震电图仪和冷热空气刺激仪进行冷热刺激检查。将 12 0例眩晕患者分成两组 ,第 1组先热后冷刺激 ,第 2组先冷后热刺激 ,观察不同冷热顺序刺激下眼震最大慢相角速度的变化。结果 :冷热反应强度差同冷热刺激顺序明显相关 ,第 2组比第1组大 (P <0 .0 1)。另外第 2组眼震最大慢相角速度半规管轻瘫差相对值和优势偏向差相对值比第 1组大 (P <0 .0 1)。结论 :变温实验中变温的顺序影响前庭对冷热刺激的敏感性和半规管轻瘫差值以及优势偏向差值。     

后半规管阻塞术对内耳功能与形态影响的实验观察

本实验对１５只豚鼠行后半规管阻塞术，术前、术后测定ＣＡＰ阈值和ＥＮＧ，并作常规火棉胶连续切片及透射电镜观察内耳形态变化。结果显示：ＣＡＰ阈值手术前、后无显著性差异（Ｐ＞０．０５）；眼震持续时间，术后１周明显缩短（Ｐ＜０．０１），术后８周接近术前（Ｐ＞０．０５）。术后１周，光镜下见耳蜗底圈前庭膜向蜗管内膨隆，其余结构无明显异常；电镜观察见椭圆囊、壶腹峙毛细胞个别线粒体肿胀，耳蜗毛细胞正常。术后８周组内耳各结构正常。初步表明该手术对内耳功能与结构无永性损害。     

Triple semicircular canal occlusion in guinea pigs with endolymphatic hydrops.

HYPOTHESIS: Triple semicircular canal occlusion will eliminate rotatory stimulation to the vestibular peripheral system (as it blocks endolymphatic fluid movement) and therefore release rotatory vertigo attack. This surgery is safe in ears with endolymphatic hydrops. BACKGROUND: Semicircular canal occlusion has been used as an alternative treatment of intractable benign paroxysmal positional vertigo with varied success. Triple semicircular canal occlusion in animal models blocks the responses of the semicircular canals to rotation and spares cochleae and the otolithic apparatus. This result suggests that triple semicircular canal occlusion is a prospective method in vertigo management for patients with Ménière's disease. However, the effectiveness and safety of triple semicircular canal occlusion has not been fully evaluated in ears with endolymphatic hydrops. METHODS: Endolymphatic hydrops was established in 20 guinea pigs by endolymphatic sac obliteration. Triple semicircular canal occlusion was performed in 12 of them 120 days after endolymphatic hydrops surgery, whereas 8 others were killed for morphologic observation to confirm endolymphatic hydrops. Auditory and vestibular functions were monitored from the time before endolymphatic hydrops until 1 month after triple semicircular canal occlusion. Endolymphatic hydrops and canal occlusion were confirmed by morphologic observation. RESULTS: Successful establishment of endolymphatic hydrops was indicated by mild elevation of the auditory brainstem response threshold and tentative asymmetry in nystagmus. Endolymphatic hydrops was confirmed by cochlear morphology in all eight animals that were killed 120 days after endolymphatic hydrops surgery. After triple semicircular canal occlusion, all 12 animals showed spontaneous nystagmus with a slow component toward the side that had been operated on, head tilt, rotated walking, and tentative asymmetry in rotatory nystagmus. The static symptoms disappeared within 1 month after triple semicircular canal occlusion. Caloric nystagmus was only slightly reduced after endolymphatic hydrops as compared with the contralateral ears but could not be elicited at all after triple semicircular canal occlusion. No significant elevation in auditory brainstem response threshold was found after triple semicircular canal occlusion. The canal occlusion and endolymphatic hydrops were confirmed in all surgical ears. CONCLUSION: Triple semicircular canal occlusion is effective for eliminating the response of semicircular canals to rotation and caloric stimulation and is safe in ears with endolymphatic hydrops. Also, the static compensation to the disequilibrium is quick and complete. These results suggest that triple semicircular canal occlusion should be an option for controlling rotatory vertigo in Ménière's disease.     

Treatment of anterior benign paroxysmal positional vertigo by canal plugging: a case report

A 75-year-old man with incapacitating anterior canal benign paroxysmal positional vertigo (BPPV) was relieved of symptoms following anterior semicircular canal occlusion using a transmastoid approach. The preoperative symptoms were similar to those of posterior canal BPPV. The preoperative findings on Dix-Hallpike's maneuver were a paroxysmal torsional nystagmus with a down-beating component that increased when the patient's gaze was directed towards the affected ear. The most provoking head movement for the vertigo/nystagmus was Dix-Hallpike's maneuver with the affected ear lowermost.     

Particulate Matter in the Posterior Semicircular Canal

The pathoetiology of benign paroxysmal positional vertigo (BPPV) is controversial. Particulate matter within the posterior semicircular canal has been identified intraoperatively in patients with BPPV but has also been reported in non-BPPV patients at the time of translabyrinthine surgery (Parnes LS, McClure JA. Free-floating endolymphatic particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 1992;102:988-92; Schuknecht HF, Ruby RRF. Cupulolithiasis. Adv Otorhinolaryngol 1973;20:434-43; Kveton JF, Kashgarian M. Particulate matter within the membranous labyrinth: pathologic or normal? Am J Otol 1994;15:173-6). The nature of the particulate matter remains unknown. The purpose of this study was to prospectively examine the posterior semicircular canal of patients with and without a clinical history of BPPV for the presence of particulate matter. Seventy-three patients without BPPV symptoms undergoing labyrinthine surgery (vestibular schwannoma excision or labyrinthectomy) and 26 patients with BPPV undergoing the posterior semicircular canal occlusion procedure were compared. Additionally, 70 archived temporal bones without a history of BPPV were examined microscopically for the presence of particulate matter within the lumen of the membranous labyrinth. No particles were observed intraoperatively in any of the 73 patients without a history of BPPV. Particulate matter was observed in 8 of 26 patients at the time of the posterior semicircular canal occlusion procedure for intractable BPPV. Of the 70 temporal bones examined, 31 did not show significant postmortem changes and also did not demonstrate cupulolithiasis or canalithiasis. Particulate matter from within the membranous posterior semicircular canal was removed from one patient at the time of posterior semicircular canal occlusion for intractable BPPV symptoms and was examined by scanning electron microscopy. The particulate matter appeared morphologically consistent with degenerating otoconia. These data show a statistically significant association between the presence of particles within the posterior semicircular canal in this study and the symptom complex of BPPV.     

垂直平面摆动试验检测垂直半规管功能及其正常值的研究

目的 利用垂直平面摆动试验检测垂直半规管功能并探讨中青年垂直半规管功能正常值.方法 运用自主研制的SRM-Ⅳ全自动前庭功能诊治系统,采用垂直平面180°正弦非阻尼摆动方法对100名18 ～59岁的健康受试者诱发垂直眼震,记录眼震视频和眼震曲线,采集眼震个数、持续时间、慢相速度等参数.将100名健康受试者以45岁为界分为青年组(68例)和中年组(32例)进行比较.试验中以右前半规管和左后半规管为一对(right anterior semicircular canal and left posterior semicircular canal,RALP),以左前半规管和右后半规管为一对(left anterior semicircular canal and right posterior semicircular canal,LARP),计算出两对垂直半规管垂直眼震平均慢相速度两侧不对称比( canal paresis,CP),采用SPSS 13.0软件进行统计学分析.结果 青年组和中年组平均慢相速度CP值差异无统计学意义(P＞0.05),总体CP值,RALP为10.2％±7.1％,LARP为10.4％±6.2％.健康中青年人群垂直半规管垂直眼震平均慢相速度CP值95％参考值范围,RALP为低于23.7％,LARP为低于22.9％;CP正常范围:≤20％为理想值,20％～ 25％为正常偏高.结论 垂直平面180°摆动试验可有效检测垂直半规管功能,此方法有望在临床得到应用.     

Surgical management for benign paroxysmal positional vertigo of the superior semicircular canal

Benign paroxysmal positional vertigo of the superior semicircular canal is a rare form of BPPV. It accounts for 1% to 3% of cases. The characteristic nystagmus is positional, down‐beating, with a torsional component elicited by the Dix‐Hallpike maneuver. Symptoms of superior semicircular canal BPPV often resolve spontaneously; however, it can be refractory to repositioning maneuvers. Surgical management is described for posterior semicircular canal BPPV. To date, however, there is only one reported case of surgical management for superior semicircular canal BPPV. Here we show video documentation of positional, down‐beating nystagmus and describe a case of superior semicircular canal BPPV requiring canal occlusion with successful resolution of symptoms. Laryngoscope, 125:1965–1967, 2015     

Selective stimulation of the equilibrium organ using monochromatic near infrared

BACKGROUND: The aim of this study was, to establish, if a selective thermal warm-stimulation using monochromatic near infrared radiation (NIR) in healthy persons, patients with chronic otitis media (chronic mucosal inflammation) and after radical surgery of one ear shows quantitative or qualitative changes of the nystagmus reaction. PATIENTS AND METHODS: Healthy persons (n = 3), patients with a large central defect of the tympanic membrane (n = 5) and after radical ear surgery (n = 6) were examined. In healthy persons a stimulation with monochromatic NIR (lambda = 980 nm) of several areals of the external auditory canal was performed. In patients with large defects of the tympanic membrane the promontorium was stimulated. In patients with a radical cave of the ear a selective NIR-stimulation of the region of the vertical and the anterior semicircular canal was performed. The horizontal semicircular canal was visible as a landmark. Registration of the nystagmus was performed by means of videonystagmography. RESULTS: In healthy persons the mean slow phase velocity of the nystagmus depended on the stimulated region. But there was no qualitative change of three dimensional eye movement. Stimulation of the promontorium showed a strong directional horizontal nystagmus. In patients with a radical cave the stimulation of the regions of the three semicircular canals showed a qualitative difference in three dimensional eye movement. NIR-stimulation showed in all cases a nystagmus into the stimulated ear. CONCLUSIONS: The method of monochromatic near infrared stimulation can be used for selective stimulation of several regions of the external auditory canal, the promontorium and the regions of the semicircular canals in a radical cave of the ear as well as to prove the warm reaction of the equilibrium organ. A specific nystagmus after stimulation of the semicircular canal-region in a radical cave of the ear could be an indication for a normal semicircular canal function.