突发性聋伴眩晕患者的半规管损伤频率特性研究

目的评估突发性聋(sudden deafness,SD)伴眩晕患者半规管损伤的频率特征。方法对突发性聋伴眩晕患者124例进行视频头脉冲试验(video head impulse test,vHIT)、摇头试验(head shaking test,HST)和低频冷热试验(caloric test,CT),30例正常人为对照组进行vHIT试验。以vHIT的增益值(video-head impulsetest gain,vHIT-G)、HST诱发摇头眼震(head shaking nystagmus,HSN)和冷热试验单侧半规管反应非对称值(u-nilateral weakness,UW)为指标,分析两组对象三组不同责任半规管的三项试验结果特点及其相互关系。结果正常对照组六个半规管的vHIT-G均符合正态分布,相互间差异无统计学意义(F=0.005,P=1.000);两侧前、水平和后三个半规管平均vHIT-G分别为16.80%±9.80%、16.57%±10.30%、16.52%±11.12%。突聋组的患耳前、水平和后三个半规管vHIT-G分别为22.84%±8.08%、30.17%±11.26%、31.03%±8.90%,均符合正态分布,与对照组相应半规管结果比较,差异均有统计学意义(P值均<0.01);vHIT、HST和CT阳性率分别为37.9%、45.2%和79%,CT分别与HST及vHIT阳性率比较,差异有统计学意义(P值均等于0.000,),vHIT与HST阳性率比较,差异无统计学意义(P=0.246)。在不同UW值区间,HST和vHIT的阳性率随着UW值增加也逐渐增加。结论突发性聋伴眩晕患者多存在半规管损伤,且主要发生在低频区;随着损伤的加重,也可累及半规管的中、高频区。中频HST和高频vHIT不宜用作突聋患者半规管损伤的筛查。     

良性阵发性位置性眩晕半规管功能分析

目的 评估良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者半规管损伤与异位耳石的关系及其损伤频率特征.方法 BPPV患者214例,包括后半规管管石症(posterior semicircular canal canalithasis,PSC-Can) 107例,水平半规管管石症(horizontal semicircular canal canalithasis,HSC-Can) 80例,水平半规管嵴顶结石症(horizontal semicircular canal cupulolithiasis,HSC-Cup) 27例;其中合并有其他疾病者190例(88.8％),无合并疾病者24例(11.2％).三组患者均完成高频视频头脉冲试验(video head impulse test,vHIT)、中频摇头试验(head shaking test,HST)和低频冷热试验三项检查,以vHIT的增益值(vHIT gain,vHIT-G)、HST诱发摇头眼震(head shaking nystagmus,HSN)和冷热试验单侧半规管反应非对称值(unilateral weakness,UW)为指标,分析三组不同责任半规管BPPV患者的三项试验结果特点及其相互关系.结果 所有BPPV患者vHIT、HST及冷热试验的阳性率分别为7.0％、24.3％和71.0％,相差比较明显,经x2检验,差异具有统计学意义(P值均＜0.05);有和无合并疾病的两类BPPV患者上述三项试验的阳性率结果比较,差异无统计学意义(P值均＞0.05).三组BPPV患者每一项试验(vHIT、HST及冷热试验)结果进行组间比较,差异均无统计学意义(P值均＞0.05).三组BPPV患者各组内上述三项试验结果之间比较,差异均具有统计学意义(P值均为0.000).三组冷热试验单侧异常者UW值比较,差异无统计学意义(F=0.970,P=0.383).结论 BPPV多存在与椭圆囊病变同源的半规管损伤,该损伤主要发生在低频区,异位耳石不是其损伤的主要原因;中频HST和高频vHIT不宜用作BPPV半规管损伤的筛查项目.     

视频头脉冲试验在急性单侧外周前庭功能下降疾病中的应用进展

视频头脉冲试验(video head impulse test, vHIT)可定量评价受试者各半规管高频角前庭-眼动反射(vestibulo-ocular reflex, VOR)功能。临床发现, vHIT在不同急性外周前庭功能下降疾病中的结果可表现出异质性。如在前庭神经炎和亨特综合征患者中, 病理性vHIT发生率最高的是水平半规管, 且在前庭神经炎患者的前庭代偿期间, 病理性vHIT的增益和回复性扫视表现为不同的恢复特征;而在突发性聋伴眩晕患者中, vHIT异常发生率最高的是后半规管, 且后半规管的损伤与突发性聋患者的听力预后有关。vHIT与其他前庭功能检查技术(如前庭诱发肌源性电位)的综合应用可以为临床相关眩晕疾病的诊断、分型、预后评估和前庭康复治疗提供更多依据。     

视频头脉冲试验联合温度试验评估前庭性偏头痛患者半规管功能

目的 分析确诊型前庭性偏头痛(definite vestibular migraine, dVM)与可疑型前庭性偏头痛(probable vestibular migraine, pVM)患者视频头脉冲试验(video head impulse test, vHIT)和温度试验结果。方法 选取2018年1月至2021年7月于上海中冶医院眩晕门诊就诊的dVM患者40例和pVM患者40例。所有入组对象进行问卷调查，收集患者性别、年龄、头痛类别(侧别、搏动性、影响因素)、伴随症状(畏光、畏声)、疼痛视觉模拟评分(visual analogu scale, VAS)、眩晕类别、眩晕持续时间。对两组患者进行vHIT试验及温度试验，记录vHIT试验中三对半规管功能增益值及不对称性比，以及温度试验中半规管功能眼震慢相速度(slow phase velocity, SPV)、半规管单侧减弱值(unilateral weakness, UW)、优势偏向(directional preponderance, DP)以及固视抑制指数(fixation index, FI)。采用SPSS 20.0统计软件对数...     

突发性聋伴眩晕患者头脉冲抑制试验特征分析

目的 探讨头脉冲抑制试验在外周前庭疾病中的应用价值.方法 以2019年10月至2020年4月确诊的33例突发性聋伴眩晕患者为研究对象,进行视频头脉冲试验(video head impulse test,vHIT),获取患者患侧头脉冲试验(head impulse paradigm,HIMP)和头脉冲抑制试验(suppr...     

视频头脉冲试验研究现状

视频头脉冲试验（video head impulse test, vHIT）是在Halmagyi头脉冲床旁检查基础上发展而来的视频头脉冲前庭诱发性试验,近年来被认为是一种能够反映前庭眼动反射（vestibulo-ocular reflex, VOR）直接通路完整性的无创高频检测技术,它除了能客观的评价水平半规管功能,还可对垂直半规管定量测定。本文就其起源和发展、主要原理、检测方法和临床应用做一综述。     

摇头眼震在前庭外周损伤的临床价值探讨

目的 探讨摇头眼震在前庭外周损伤的临床价值.方法 83例单侧前庭外周损伤患者,分别按顺序规范完成自发眼震(spontaneous nystagmus,SN)、摇头眼震(head shaking nystagmus,HSN)及冷热实验(caloric test,CT)检查.以HSN与SN的强度和方向及CT结果的单侧半规管...     

前庭功能筛查的初步研究

目的面对日益增加的眩晕患者量,效率成为前庭功能检查选择的重要考量。本文的主要目的是评估自发眼震+变位试验+摇头试验(head shaking test, HST)+视频头脉冲检查(video head impulse test,vHIT)这种新的前庭速查方法作为前庭功能筛查的临床有效性。方法回顾性分析1282名于2020年3月至2021年3月到解放军总医院耳鼻咽喉头颈外科眩晕专科门诊就诊且有单独明确诊断的患者,整理其前庭功能检查结果,包括自发眼震、体位试验、HST、前庭双温检查和vHIT(增益和扫视波记为两个参数)。通过雷达图和树状图可视化检查异常率。结果通过比较不同功能检查异常率,可知vHIT增益值在不同疾病间异常率的变化不明显。新速查方法中vHIT的异常率仅考虑扫视波是否出现,新速查方法异常率整体优于前庭双温,主要表现为BPPV(100%vs.49%),VN(87%vs. 76%), MD(81%vs. 59%),VM(45%vs. 36%)。通过优化分类的比较,新速查方法的异常率为72%,再进一步进行温度试验的结果(+/-)分别为35%与27%,而在新速查方法阴性筛查后再行双温试...     

头脉冲抑制试验

头脉冲抑制试验（suppression head impulse paradigm，SHIMP）是在头脉冲试验（head impulse paradigm, HIMP）或者视频头脉冲试验（video head impulse test，vHIT）基础上发展而来的一种新型检查技术。SHIMP和HIMP都是通过计算前庭眼动反射增益（vestibulo ocular reflex gain，VOR gain）及校正性扫视（corrective saccades）来评估半规管功能的检查方法。VOR增益在两种检查中测定方法相似，扫视却相互补充：在HIMP中，代偿性扫视显示了前庭功能的损失，而在SHIMP中，反代偿性扫视显示了前庭功能的保留。本文就SHIMP的检测方法、原理及研究进展等进行综述。     

视频头脉冲试验的应用现状及研究进展北大核心CSCD

视频头脉冲试验(Video head impulse test,vHIT)是一种高频前庭功能检查技术,对于外周前庭疾病的判断起到重要作用。本文旨在探讨视频头脉冲试验的应用现状以及目前国内外的研究进展,希望帮助医师更好地运用vHIT进行眩晕疾病的辅助判断。     

视频头脉冲试验与冷热试验的相关性研究

目的 分析常见外周性眩晕疾病视频头脉冲试验与冷热试验的特征,探讨其结果的相关性.方法 应用视频头脉冲试验及冷热试验对151例常见外周性眩晕患者进行检查,统计其结果进行分析.结果 151例患者包括良性阵发性位置性眩晕58例,前庭神经炎34例,梅尼埃病39例,突发性聋伴眩晕20例.良性阵发性位置性眩晕患者冷热试验(CT)阳...     

Superior canal dehiscence reveals concomitant unilateral utricular loss (UUL)

Conclusion: We report enhanced symmetrical cervical vestibular evoked myogenic potential (cVEMP) but asymmetrical ocular VEMP (oVEMP) responses in a patient with CT-verified bilateral superior semicircular canal dehiscence (SCD) but with acute vestibular syndrome. This implies that absence of unilateral utricular macula function alone is sufficient to cause symptoms of acute vertigo. Acute vertigo should not automatically be presumed to originate from semicircular canal dysfunction. Objectives: To identify the cause of an acute vertigo attack in a patient with bilateral SCD. Methods: The functional state of all peripheral vestibular sense organs was tested using the video head impulse test (vHIT) for all semicircular canals and VEMPs to air-conducted sound (ACS) or bone-conducted vibration (BCV) to test all otolith organs. The cVEMP tested mainly saccular function and the oVEMP mainly utricular function. Results: All semicircular canals showed normal function. The cVEMPs showed enhanced, but symmetrical saccular function. In contrast, oVEMPs showed an enhanced but asymmetric n10 component – it was greatly reduced beneath the left eye, implying decreased function in the right utricular macula. That result was confirmed using very high frequency stimuli which are effective in SCD: 4000 Hz BCV stimuli showed that oVEMP n10 was present beneath the right eye but absent beneath the left eye.     

Acute vestibulopathy with simultaneous bilateral involvement of the vestibulo-ocular reflex limited to the low-frequency range

We report a novel type of idiopathic bilateral vestibulopathy with acute simultaneous involvement of the vestibulo-ocular reflex limited to the low-frequency range. A 64-year-old female presented with dizziness, oscillopsia, and difficulty walking. She did not experience rotatory vertigo and did not show any nystagmus. Vestibular function tests showed absent caloric responses in both ears, while vestibulo-ocular reflex (VOR) gains in the video head impulse test (vHIT) were preserved in all six semicircular canals. Cervical and ocular vestibular evoked myogenic potentials in response to air-conducted sound were absent on both sides. Since the caloric test and vHIT measures low-frequency and high-frequency VOR, respectively, we diagnosed the patient as having a bilateral VOR deficit limited to the low-frequency range. During a 1-year follow-up with vestibular rehabilitation, the subjective symptom of dizziness gradually recovered while recovery of vestibular function was minimal.     

Machine learning method intervention: Determine proper screening tests for vestibular disorders

ObjectiveTo evaluate the performance of different vestibular indicators in disease classification based on machine learning method.MethodsThis study use retrospective analysis of the vertigo outpatient database from a tertiary care general hospital. 1491 patients with definite clinical diagnoses were enrolled in this study. Spontaneous nystagmus, head-shaking nystagmus, positional nystagmus, unilateral weakness in caloric test, and gain and saccade in video head impulse test (vHIT) were recorded as variables. Diagnoses were mainly reorganized as acute vestibular syndrome, episodic vestibular syndrome, and chronic vestibular syndrome. The trained random forest model was applied based on exploratory data analysis results.ResultsRandom forest accuracies on acute, episodic, and chronic vestibular syndrome are 90%, 81.74%, and 91.3%, respectively. The most important features in acute vestibular syndrome are spontaneous nystagmus, and vHIT variables. In episodic vestibular syndrome, unilateral weakness in caloric test, gain and saccades on lateral semicircular canal are the top three parameters. Lateral vHIT gain, head-shaking nystagmus, and unilateral weakness in caloric test are the main parameters on chronic vestibular syndrome. In acute vestibular syndrome, spontaneous nystagmus and vHIT make major contributions in vestibular disorders distinction. When the disease course prolongation, unilateral weakness and head-shaking nystagmus become increasingly important.ConclusionFast clinical test sets including spontaneous nystagmus, head shaking nystagmus, and vHIT should be the first consideration in screening vestibular disorders.     

非综合征型听神经病患者前庭上下成分功能障碍定位研究与频率特征

目的 探讨听神经病伴发前庭功能障碍的可能性,并分析其部位和频率特征。 方法 以眼肌前庭诱发肌源性电位(oVEMP)、颈肌前庭诱发肌源性电位(cVEMP)、视频头脉冲试验(vHIT)、头脉冲抑制试验(SHIMP)和冷热试验对20例(40耳)非综合征型听神经病患者进行前庭功能评估,对统计学处理结果进行客观分析。 结果 20例患者(40耳)接受oVEMP和cVEMP测试,oVEMP异常率为85%,cVEMP异常率为95%,差异无统计学意义。11例(22耳)接受vHIT和SHIMP测试,外、上、后半规管vHIT和SHIMP的异常率分别为14%、18%、9%和9%,组间差异无统计学意义。19例患者行冷热试验,异常率为74%。11例接受vHIT和SHIMP测试的患者,冷热试验异常率为82%,显著高于vHIT和SHIMP异常率,差异有统计学意义。 结论 听神经病患者存在前庭功能障碍,前庭上下成分(包括感受器和前庭上下神经)受累概率相当,耳石器和半规管均可受累,各半规管受累概率相当,半规管功能损伤主要累及低频。     

视频头脉冲试验在眩晕疾病诊断中的应用研究

目的 探讨视频头脉冲试验(vHIT)评估周围性眩晕患者前庭眼反射(VOR)的临床价值.方法 选取2019年4月-2020年10月收治的52例良性阵发性位置性眩晕(BPPV)患者和57例前庭性神经炎(VN)患者为研究对象,并选取同期30名健康者作为对照.采用vHIT定量测定一对水平半规管平面、两对垂直半规管平面的VOR增...     

190例特发性良性阵发性位置性眩晕患者半规管功能分析

目的 分析特发性良性阵发性位置性眩晕(benign paroxysmal position vertigo,BPPV)患者半规管功能的特征,为患者的治疗提供进一步帮助.方法 选择本院2019年8月至2020年2月收治的单侧特发性BPPV患者190例,包括后半规管BPPV患者162例,水平半规管BPPV患者28例.行冷热...     

Assessment of the vestibuloocular reflex in fighter pilots with the video head impulse test

Conclusion: There were no changes in the function of the six semicircular canals in active fighter pilots, through the use of the video head impulse test (vHIT). These results suggest that the vestibuloocular reflex (VOR) works well at the high frequencies related to the natural head movements in this population. Objectives/hypothesis: The vestibular function in pilots has been reported as being different from that of other normal subjects. These differences are attributed to adaptation of the vestibuloocular reflex (VOR) or by habituation. These studies were conducted with caloric and/or rotatory tests and were limited to the lateral semicircular canals. The aim of the present study was to verify the occurrence of high frequency changes in the function of the six semicircular canals in active fighter pilots, through the use of the video head impulse test (vHIT). Study design: Cross-sectional design. Methods: The subjects participating in this study were divided in three groups, according to their flight experience. The control group (Group 1) consisted of 20 soldiers with no experience of in-flight training. For the test subjects 14 fighter pilots were selected and divided into two groups. Group 2 included the pilots with 1000–2000 hours of flight experience and Group 3 included pilots with 2001–3000 hours of flight experience. They were all submitted to a video head impulse test and the gains of the six semicircular canals were analysed. Results: There were significantly low gain values (p < 0,013) only in the left posterior semicircular canal in the control group as compared with the subject groups. However, there were no significant differences in gain values between the two groups of the active pilots.     

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.