摇头眼震与前庭冷热试验的互补作用

目的：探讨摇头眼震（HSN）检查与前庭冷热试验前庭系统疾病定侧诊断方面的互补作用。方法：60例眩晕疾病患者均行前庭冷热试验、HSN及相关听力学检查。结果：半规管轻瘫（CP）正常，引出HSN者19例：①HSN的方向与CP方向相反者11例，HSN指向健侧；②HSN的方向与CP方向相同者8例，HSN指向患侧。CP正常，未引出HSN者10例。CP异常，未引出HSN者8例。CP异常，引出HSN者23例：①HSN的方向与CP方向相反者19例；②HSN的方向与CP方向相同者4例，HSN指向患侧。结论：HSN与前庭冷热试验可互为补充，两者联合应用有助于全面了解水平半规管的功能。     

眼震电图对老年头晕病人有诊断价值吗？

为了明确眼震电图(ENG)对六十五岁以上老年头晕病人的诊断价值,对96位健康无症状的志愿者和149例头晕患者行ENG检查,包括随意扫视试验、平稳跟踪试验、视动性眼震、位置性眼震的冷热试验。所     

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。     

位置性眼震对眩晕的诊断意义

对56例位置性眼震进行临床分析,并对位置性眼震的分型与临床诊断意义进行讨论,认为前庭外周性疾病一般表现为方向固定型位置性眼震,而中枢性疾病则表现为方向固定型或变换型位置性眼震,临床应结合系统的ENG检查作全面分析。     

中老年眩晕患者病因及眼震电图

目的探讨中老年眩晕患者的致病原因及眼震电图特点。方法应用眼震电图(electronystagmography,ENG)结合听力学、影像学及其它检查方法对129例45～68岁的眩晕患者进行检查。结果129例患者中,病因为椎基底动脉供血不足(Vertebrobasilar insufficiency,VBI)者72例(55．8％);耳毒性药物中毒15例(11。6％);梅尼埃病(Meniere‘s disease)12例(9．3％);突发性耳聋7例(5．4％)：脑供血不足5例(3。9％);听神经瘤5例(3．9％);前庭神经元炎2例;良性位置性眩晕2例：后颅窝肿瘤1例;病因未明8例(6。2％)。结论中老年心脑血管疾病较多,常2～3种以上疾病并存,应注意鉴别,并采取综合治疗。在鉴别中枢性、外周性眩晕方面,病史的详尽分析,临床神经耳科学检查,影像学检查,包括纯音测听和脑干诱发电位(auditory brainstem response,ABR)在内的听力学检查以及ENG检查均具有重要作用。     

冷热气灌注顺序对冷热试验结果影响的研究

目的:研究冷热试验冷热气灌注顺序对试验结果是否存在影响,为冷热试验的规范和质控提供依据.方法:应用视频眼震图和冷热气刺激仪进行冷热试验.将健康志愿者30例(60耳)分为两组,每组15例(30耳).第1组先进行冷气刺激再行热气刺激(先冷后热组),第2组先行热气刺激再行冷气刺激(先热后冷组).观察比较两组受试者在冷热气试验...     

后半规管良性阵发性位置性眩晕患者复位中眼震分析

目的 分析后半规管良性阵发性位置性眩晕(posterior semicircular canal benign paroxysmal positional vertigo,PC-BPPV)患者复位中的眼震,探讨BPPV可能的发病机制.方法 2007年12月至2008年4月眩晕门诊就诊的66例PC-BPPV患者,详细记录病史、体位试验及复位中不同位置眼震的情况,对PC-BPPV患者可能发病机制进行探讨.结果 变位试验完伞符合贵阳会议诊断标准的66例PC-BPPV患者,采用改良Epley复位,视频眼震记录技术记录复位中四个位置的眼震方向及强度,24例患者复位中出现的眼震均为垂直扭转向上眼震;21例除第一个位置出现上向扭转眼震,其余三个位置眼震阴性;7例变位试验初诊PC-BPPV的患者在第二次复位中出现强烈水平眼震;14例患者复位的第二或第三个位置出现下向垂直眼震.由复位中不同位置出现的眼震分析,66例确诊为PC-BPPV的患者,52例复位中的表现符合管石及嵴顶耳石症理论,占78.8%.结论 除了目前公认的管石症及嵴顶耳石症理论外,推测部分PC-BPPV可能与耳石器官及球囊椭圆囊神经病变有关.     

良性阵发性位置性眩晕患者裸眼及视频眼震图下眼震特征及定位诊断分析

目的探讨裸眼及视频眼震图(videonystagmograph,VNG)下观察良性阵发性位置性眩晕(benign positional paroxysmal vertigo,BPPV)患者眼震及诊断结果的差异。方法108例BPPV患者分别进行Dix-Hallpike和滚转试验(Roll),应用红外视频眼震电图仪观察眼震特点,进行定位诊断,并与裸眼下观察其眼震特征及诊断结果进行比较。结果 108例患者中共诊断后半规管BPPV(PSC-BPPV)75例(69.44%,75/108),裸眼及VNG辅助下典型眼震检出率分别为66.67%(50/75)和93.33%(70/75);前半规管BPPV(ASC-BPPV)18例(16.67%,18/108),裸眼及VNG下典型眼震检出率分别为72.22%(13/18)和100%(18/18),两者差异均有统计学意义(P<0.05);水平半规管BPPV(HSC-BPPV)9例(8.33%),裸眼及VNG辅助下分别正确诊断7例和9例;混合型BPPV6例(5.56%),裸眼及VNG辅助下分别正确诊断3例和6例。结论 VNG能够客观地记录BPPV患者的眼震情况,有助于提高眼震的检出率及诊断的准确性。     

震动眼震在单侧前庭外周疾病中的临床意义

目的研究震动眼震（vibration—induced nystagmu，VIN）在前庭外周疾病诊断中的临床意义，并确定震动实验（vibration test，VT）的灵敏度和特异度。方法30例健康成人和眩晕门诊112例单侧外周前庭疾病患者纳入本研究，排除具有自发性眼震患者，采用置于乳突和前额的震动刺激（92Hz）进行震动实验，观察记录VIN的诱发情况，患者和正常受试者同时还进行摇头眼震（headshaking nystagmus，HSN）和前庭双温冷热试验检查，并进行比较。结果112例患者中，有91例（81％）出现VIN，主要是水平眼震，VIN在乳突比在前额更常诱发出，其中76例VIN的方向朝向健侧，然而15例梅尼埃病患者VIN方向朝向患侧。30例健康受试者，均未出现VIN。随着前庭双温冷热试验中半规管轻瘫（canal paresis，CP）值的增加，VIN出现率增加。分别有70例（63％）单侧外周前庭疾病患者和9例健康受试者（30％）出现HSN。前庭双温检查，112例患者中CP值〈25％有10例，25％≤CP值≤40％有32例，40％〈CP值〈70％有48例，cP值≥70％有22例，30例健康受试者CP值均〈25％，VIN出现率随着cP值的增加而增加。结论VIN检查是一项简单、非侵入性的、患者能很好耐受的检测单侧外周前庭功能障碍的临床测试方法，具有比HSN检查更高的灵敏度和特异度。     

300例眩晕病人颈肌、颅骨振动诱发眼震的诊断价值

关于振动刺激颅骨诱发眼震曾有过多次报道,为进一步增强试验的敏感性,并探讨其对眩晕的诊断价值,选择双侧乳突、颅顶和左右颈肌五个部位为振动点,应用电磁振荡器(振幅0.6mm)对300例眩晕病人     

眩晕头晕主诉患者中良性阵发性位置性眩晕的占比分析

研究分析良性阵发性位置性眩晕（BPPV）在眩晕头晕主诉患者的占比。     

伴有眩晕或头晕重度以上突聋患者的临床疗效差异分析

目的分析伴有眩晕或头晕重度以上突聋患者的临床疗效差异。方法选取2013年1月~2016年12月收治的重度以上突聋病例70例,其中不伴眩晕或头晕者（A组）30例,伴头晕者（B组）11例,伴眩晕者（C组）29例。3组患者均给予：①降低纤维蛋白原药物;②糖皮质激素;③改善内耳微循环药物治疗。比较3组临床疗效差异。结果治疗前A、B、C组患者平均听阈［分别为（86.88±10.19）、(98.58±9.28)、(96.84±8.81）dB］三者差异无统计学意义（P＞0.05）。治疗后A、B、C组患者平均听阈［分别为(60.73±26.06)、(89.33±18.70)、(85.99±19.23)dB］,三者比较差异具有统计学意义（P＜0.05）,表明治疗后不伴眩晕或头晕组的平均听阈明显低于伴眩晕或头晕组。治疗后A、B、C组总有效率（分别为66.67%、36.37%、37.93%）,三者差异具有统计学意义（P＜0.05）,表明治疗后不伴眩晕或头晕组的总有效率明显高于伴眩晕或头晕组。治疗结束后A组痊愈率为30%,B、C组痊愈率为0;治疗出院3个月后随访时A、B、C组痊愈率分别为53.33%、18.18%、13.79%。治疗后与治疗出院3个月后随访时3组痊愈率比较,差异均具有统计学意义（P<0.05）,表明治疗后不伴眩晕或头晕组的痊愈率明显高于伴眩晕或头晕组。患者出院时总痊愈率为12.86%,3个月后随访时总痊愈率为31.42%,两组痊愈率差异具有统计学意义（P＜0.05）,表明出院后部分患者听力继续好转,且多为出院时有效或显效患者。结论重度以上突聋患者治疗后不伴眩晕或头晕组的平均听阈明显低于伴眩晕或头晕组,且治疗结束后及治疗出院3个月后随访时总有效率、痊愈率明显高于伴眩晕或头晕组,出院后患者听力仍可继续恢复至3个月达到稳定。     

Paroxysmal vertigo with nystagmus in children

IntroductionA pathological nystagmus is an objective sign that a patient feels vertigo. However, there have been few opportunities to observe and record pathological nystagmus during a paroxysmal vertigo attack. Furthermore, it can be difficult to obtain cooperation in pediatric patients. We present two cases of paroxysmal vertigo in children in whom we successfully recorded and analyzed their pathological nystagmus during a vertigo attack.MethodsOf a total sample of 4349 patients seen at our hospital for dizziness in the last decade, a retrospective analysis revealed that 68 were children (<15 years old; 1.6%). Of these 68 children, we successfully identified pathological nystagmus during paroxysmal vertigo in only two (2.9%).ResultsCase 1 was a 4-year-old girl. She felt vertigo the strongest when her left ear was down in the supine position. We observed and recorded her nystagmus during a vertigo attack with her mother's permission. Her positional nystagmus in the supine position was horizontal persistent apogeotropic nystagmus. Rightward nystagmus in the left-ear-down supine position was stronger than leftward nystagmus in the right-ear-down supine position. Therefore, the diagnosis was right lateral canal type of benign paroxysmal positional vertigo, of which the pathophysiology was cupulolithiasis. The other patient was an 11-year-old boy. He had a family history of migraines. His vertigo attacks occurred after onset of a severe migraine and lasted between 2 and 48 h. During an attack that we observed, he showed nystagmus, which was direction-fixed right torsional and rightward in darkness. His mother had noticed that his eyes moved abnormally and that his left eye did not shift to the left side when he looked leftward. He was old enough to clearly express his own symptoms. Other neurological examinations were normal. The diagnosis was vestibular migraine.ConclusionsWe analyzed a pathological nystagmus during paroxysmal vertigo in two children. We conclude that children can be diagnosed with a combination of careful history taking and accurate examinations of a pathological nystagmus.     

Brandt-Daroff康复练习治疗不典型眼震良性阵发性位置性眩晕

目的探讨Brandt-Daroff康复练习对11例变位试验中出现不典型眼震的良性阵发性位置性眩晕患者的疗效。方法2006～2007年间11例变位试验中出现不典型眼震的患者,即Hallpike及翻滚试验多个位置出现方向不特异、持续时间长（超过3分钟）且强烈的眼震。除外中枢神经系统病变,嘱患者进行Brandt．Daroff练习,每天2～3组,每组1套动作重复6～10次。结果11例多个位置出现强烈持久眼震的患者练习3～4天症状有所减轻,10例患者练习1～2周症状消失,复诊时症状消失,眼震消失,1例复诊时仍有症状,眼震仍然存在,较前强度减弱。结论对于变位试验中多个位置出现强烈的不典型眼震患者,Brandt-Daroff康复练习取得较好的疗效。     

Age predicts the absence of caloric-induced vertigo

Introduction

The absence of vertigo during the caloric test, despite a robust response, has been suggested to represent a central vestibular system phenomenon. The purpose of this investigation was to determine the prevalence of absent caloric-induced vertigo perception in an unselected group of patients and to assess possible predicting variables.

Which are the parameters of choice for the evaluation of caloric nystagmus?

Summary On hand of caloric tests on 202 healthy subjects, the coefficient of correlation between the currently most frequently used intensity parameters was established separately for each of the four irrigations, i.e. between maximum velocity of the slow phase, maximum amplitude, maximum frequency, total number of beats and duration of reaction. The maximum velocity of the slow phase is so closely correlated to the maximum amplitude, and the maximum frequency is so closely correlated to the total number of beats (r=always > 0.75) that it is sufficient to merely determine one of the two well correlated parameters in healthy subjects. However, the parameters maximum velocity of the slow phase and maximum amplitude are less closely correlated to the parameters maximum frequency and total number of beats (r=smaller, in part considerably smaller than 0.75). A better correlation exists between the nystagmus parameters nearly always by warm irrigations, as compared to cold ones. The findings speak for the fact that maximum velocity of the slow phase and maximum amplitude on one hand, and maximum frequency and total number of beats on the other, are an expression of various characteristics of the experimental nystagmus. In a consecutive publication, we are going to report in which way the various nystagmic parameters of patients are being changed by different lesions of the vestibular system.We gratefully acknowledge the valuable assistance given by Prof. Dr. Dr. Fuchs, Director of the Institute of Medical Documentation and Statistics, in connection with our statistical investigations.     

Vestibular rehabilitation of older adults with dizziness

The role of rehabilitation for treatment of older adults with dizziness and balance disorders is reviewed. Theories related to functional recovery from peripheral and central vestibular disorders are presented. Suggestions on which older adults might benefit from vestibular rehabilitation therapy are presented. Promising innovative rehabilitation strategies and technologies that might enhance recovery of the older adult with balance dysfunction are discussed.     

Intractable Ménière's disease. Modelling of the treatment by means of statistical analysis

Objective

To evaluate the value of different variables of the clinical history, auditory and vestibular tests and handicap measurements to define intractable or disabling Ménière's disease.

Methods

This is a prospective study with 212 patients of which 155 were treated with intratympanic gentamicin and considered to be suffering a medically intractable Ménière's disease. Age and sex adjustments were performed with the 11 variables selected. Discriminant analysis was performed either using the aforementioned variables or following the stepwise method.

Results

Different variables needed to be sex and/or age adjusted and both data were included in the discriminant function. Two different mathematical formulas were obtained and four models were analyzed. With the model selected, diagnostic accuracy is 77.7%, sensitivity is 94.9% and specificity is 52.8%.

Conclusion

After discriminant analysis we found that the most informative variables were the number of vertigo spells, the speech discrimination score, the time constant of the VOR and a measure of handicap, the “dizziness index”.