单侧前庭功能丧失患者前庭眼反射和视动反射眼震电图定量分析

目的观察前庭代偿过程中前庭功能的变化规律。方法对１０５例单侧前庭功能丧失患者进行自发性眼震、前庭眼反射及视动反射眼震电图检查，并行定量分析。结果①２１例患者出现自发性眼震，其病程为３天～６年，眼震平均慢相速度为７．１２～１２．７０°／ｓ；②患者组健侧耳冷热水灌注前庭眼反射眼震强度均低于健康人；③０．１６７Ｈｚ正弦摆动、幅度９０°试验患者组双向眼震强度低于健康人，病程≤５年的患者眼震优势偏向向健侧，病程＞５年的患者无眼震优势偏向；④非桥小脑角占位病变及直径＜２．５ｃｍ的桥小脑角占位病变患者，视动性眼震强度与健康人差异无显著性，直径≥２．５ｃｍ的桥小脑角占位病变患者，视动性眼震强度低于健康人，眼震优势偏向向健侧。结论在前庭代偿过程中前庭功能处于抑制状态，通过抑制达到前庭系统的重新平衡。     

单侧前庭功能丧失患者前庭眼反射和视支反射眼震电图定量 …

OBJECTIVE: To study changes of the vestibular function in the process of vestibular compensation. METHODS: The electronystagmography recording of spontaneous nystagmus(SN) with tests for vestibulo-ocular reflex (VOR) and optokinetic reflex (OKR) were performed in 105 patients with unilateral loss of vestibular function, the results were analysed quantitatively. RESULTS: (1) Twenty-one patients with courses from 3 days to 6 years presented a SN directed towards the intact side, with an average slow phase velocity (ASPV) of 7.12-12.07 degrees/s. (2) The intensity of VOR nystagmus as a response to the warm-cold water stimulation to the intact ear was lower than that of normal subjects. (3) By 0.167 Hz, 90 degrees sinusional oscillation stimulation, the ASPVs of the patients' VOR nystagmus directed towards the intact and affected sides were lower than that of the normal. A predominance of VOR nystagmus rotation towards the intact side was found in patients with courses < or = 5 years. There was no predominance of VOR nystagmus found in patients with courses > 5 years. (4) There was no significant difference between the optokinetic nystagmus (OKN) intensity of the normal persons and that of patients with lesions outside the cerebellopontine angle and with tumors in cerebellopontine angle which was < 2.5 cm in diameter. The OKN intensity of patients with tumors in cerebellopotine angle with diameters > or = 2.5 cm was lower than that of normal subjects. A predominance of OKN towards the intactside was found in these patients. CONCLUSION: The vestibular function is in inhibitory and the vestibular system becomes rebalanced due to this inhibition in the process of vestibular compensation.     

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。     

不同头动速度对健康人群视频头脉冲前庭眼反射增益的影响

目的研究视频头脉冲试验中不同头动速度对前庭眼反射增益的影响。方法对50名健康受试者应用视频头脉冲试验仪进行测试,以不同头动速度(50°/s-100°/s、101°/s-150°/s、151°/s-200°/s、201°/s-250°/s、251°/s-300°/s)将前庭眼反射增益值分组,分析头动速度对增益的影响。结果水平半规管平均增益按不同头动速度组(50°/s-100°/s、101°/s-150°/s、151°/s-200°/s、201°/s-250°/s、251°/s-300°/s)分别为0.992±0.130、0.983±0.154、0.999±0.151、0.945±0.142、0.835±0.106,其中201°/s-250°/s组与101°/s-150°/s组(P<0.05,P=0.035)、151°/s-200°/s组(P<0.01,P=0.000)差异显著,251°/s-300°/s组和其他组别间差异均显著(P1<0.01,P1=0.000;P2<0.01,P2=0.000;P3<0.01,P3=0.000;P4<0.05,P4=0.010);前半规管平均增益按不同头动速度组分别为0.984±0.136、0.916±0.181、0.926±0.179、0.895±0.169、0.863±0.174,其中50°/s-100°/s组和101°/s-150°/s组(P<0.05,P=0.018)、201°/s-250°组(P<0.01,P=0.005)间VOR增益差异显著;后半规管平均增益按不同头动速度组(50°/s-100°/s、101°/s-150°/s、151°/s-200°/s、201°/s-250°/s、251°/s-300°/s)分别为0.997±0.158、0.846±0.156、0.793±0.130、0.815±0.112、0.830±0.046,50°/s-100°/s组和101°/s-150°/s组(P<0.01,P=0.000)、151°/s-200°/s组(P<0.01,P=0.000)、201°/s-250°/s组(P<0.01,P=0.000)间差异显著,101°/s-150°/s组和151°/s-200°/s组间差异显著(P<0.01,P=0.001)。结论前庭眼反射增益随头动速度的提高呈现递减的趋势,其中部分组别存在显著差异,实际操作中应避免头动速度过低导致的结果误判。     

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...     

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。     

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。     

头脉冲试验与头脉冲抑制试验参数相关性分析

目的验证头脉冲试验（HIMP）和头脉冲抑制试验（SHIMP）在前庭眼动反射中的互补效应。方法选择前庭上神经炎患者33例,健康成人10例（20耳）,对前庭上神经炎患者患侧和健康成人左右侧HIMP和SHIMP增益、扫视潜伏期、扫视波振幅及显性扫视产生百分比进行匹配分析,比较HIMP和SHIMP各项参数之间相互关系。结果HIMP增益与SHIMP增益呈线性正相关,并且HIMP增益大于SHIMP增益,差异具有统计学意义（t=5.890,r=0.956,P均=0.000）。HIMP潜伏期大于SHIMP潜伏期,差异具有统计学意义（t=-3.360,P=0.001）,但无相关性（r=0.180,P=0.196）。HIMP扫视振幅与SHIMP扫视振幅呈负相关（r=-0.484,P=0.000）,HIMP扫视百分比与SHIMP显性扫视百分比呈负相关（r=-0.604,P=0.000）。HIMP增益与HIMP扫视潜伏期、振幅及百分比均呈负相关,且均具有统计学意义（P＜0.05）。SHIMP增益与SHIMP代偿性扫视振幅及百分比呈正相关,具有统计学意义（P＜0.05）。SHIMP增益与SHIMP扫视潜伏期无相关性（r=-0.044,P=0.756）。结论SHIMP和HIMP均可检查水平性角前庭眼动反射（VOR）的直接通路,代偿性扫视和反代偿性扫视的增益、振幅和扫视产生的百分比可作为动态观察指标评估前庭功能。两者参数变化对评估VOR通路的损伤和恢复情况起到一定指导意义。     

闭目踏步试验对单侧外周前庭损伤的定侧价值

目的 探讨闭目踏步试验对单侧前庭病变的定侧价值.方法 可定病变侧别的单侧前庭外周功能损伤患者126例,其中颞骨外伤11例,突发性聋伴眩晕94例,前庭神经炎21例;健康对照组50例.原地闭目踏步50步,发生倾倒,侧移1 m或偏转＞45°为存在偏向.实验数据采用SPSS13.0软件进行x2检验.结果 126例患者中50.0%(63/126)偏向患侧,24.6%(31/126)偏向健侧,25.4%(32/126)无偏向.发病3 d内的23例患者中偏向健侧39.1%(9/23),偏向患侧39.1%(9/23),21.8%(5/23)无偏向;随着时间的延长,偏向患侧和无偏向的比例增大,病程超过1个月的22例患者中1例偏向健侧,病程超过2个月的患者不再偏向健侧.发病1周内偏向健侧的17例患者,在随访的2周内,35.3%变为偏向患侧.观察到自发性眼震的35例患者中22.9%(8/35)闭目踏步偏向和自发性眼震同侧.结论 急性外周前庭受损不能根据闭目踏步试验偏向进行患侧的确定,要根据症状和其他检查一起综合考虑.     

Evaluation of the vestibulo-ocular reflex in patients with chronic otitis media

IntroductionIn recent years, scientific evidence has shown that chronic otitis media may cause balance and vestibular dysfunction.ObjectiveTo compare the results of the video head impulse test (gain and symmetry of the vestibulo-ocular reflex and presence of covert and overt saccades) in patients with chronic otitis media and controls.MethodsCross-sectional study of patients with chronic otitis media (study group), aged between 18 and 60 years. The patients in the study group were further divided according to the chronic otitis media type as (1) non-suppurative, (2) suppurative, and (3) cholesteatomatous. For the comparative analysis, we selected volunteers with no history of ear and vestibular diseases (control group), who met the same inclusion and exclusion criteria as the study group. Patients in both groups underwent a video head impulse test.ResultsThe study group consisted of 96 volunteers, and the control group of 61 individuals. The prevalence of vestibular symptoms was 66% in the study group and 3.2% in the control group (p < 0.001). The results show a higher prevalence of changes in the vestibulo-ocular reflex gain (22.9%) and corrective saccades (12.6%) in the chronic otitis media group compared to the control group (p < 0.001). Despite the higher prevalence of changes in gain, the average vestibulo-ocular reflex gains in the chronic otitis media groups were within the pre-defined values ??of normality; however, the mean vestibulo-ocular reflex gain in the anterior semicircular canal was statistically worse in the cholesteatomatous chronic otitis media group compared to controls (p < 0.001). Regarding the corrective saccades, the prevalence of saccades was statistically higher in the suppurative and cholesteatomatous chronic otitis media subgroups compared to the non-suppurative and control groups (p = 0.004).ConclusionThe present study demonstrated that chronic otitis media is associated with a higher prevalence of vestibular symptoms and also a higher prevalence of changes in gain and corrective saccades when compared to controls.     

主观视觉水平线在单侧前庭周围性病变中的应用研究

目的 探讨外周单侧前庭功能减退患者的主观视觉水平线特点及其对前庭功能评定的临床价值.方法 分别对85例外周单侧前庭功能减退患者及39名健康对照组人群行主观视觉水平线、主观视觉垂直线及冷热试验等前庭功能检测,以主观视觉水平线及主观视觉垂直线偏斜角度、冷热试验优势偏向(directional preponderance,DP)值、单侧半规管轻瘫(unilateral weakness,UW)值为参数,分析总结外周单侧前庭功能减退患者的主观视觉水平线特点,主观视觉水平线、主观视觉垂直线之间及其分别与DP、UW值、病程的相关性.以SPSS 16.0软件对数据进行统计学分析.结果 健康对照组主观视觉水平线、主观视觉垂直线的偏斜角度为-2,～2.以此为判定阳性与阴性的标准.外周单侧前庭功能减退患者的主观视觉水平线、主观视觉垂直线阳性者分别为46例(54.1%)、43例(50.6%),二者比较差异无统计学意义(χ2=12.5,P=0.481);DP阳性者55例(64.7%),与主观视觉水平线、主观视觉垂直线比较,差异均无统计学意义(χ2值分别为0.19、2.86,JP值分别为0.164、0.067).外周单侧前庭功能减退患者的主观视觉水平线与主观视觉垂直线偏斜角度呈正相关(r=0.939,P<0.01),且二者与DP值均呈正相关(r值分别为0.648、0.658,P值均<0.05),与UW值无相关性(r值分别为0.048、0.085,P值均>0.05).根据主观视觉水平线或主观视觉垂直线、DP、UW3个参数的阳性或阴性组合,可分别构成3种主要结果形式,即:主观视觉水平线(+)DP(+)UW(+),主观视觉水平线(-)DP(+)UW(+),主观视觉水平线(-)DP(-)UW(+);主观视觉垂直线(+)DP(+)UW(+),主观视觉垂直线(-)DP(+)UW(+),主观视觉垂直线(-)DP(-)UW(+).以上6种形式的病程中位数分别为5.0、10.0、15.0 d,5.0、9.5、14.5 d,分别行多样本秩和检验,差异均有统计学意义(χ2水平线:8.80,P=0.012;χ2垂直线=6.26,P=0.040).结论 主观视觉水平线可以评估耳石器(椭圆囊)功能.外周单侧前庭功能减退患者的主观视觉水平线、主观视觉垂直线偏斜角度随病程和前庭代偿进程呈动态变化,可用于前庭静态代偿评定.

Abstract：

Objective To analyze the characteristics of subjective visual horizontal ( SVH) and evaluate its clinical value for vestibular function in peripheral unilateral vestibular hypofunction ( UVH). Methods Eighty-five patients with UVH (study group) and 39 normal persons (control group) accepted vestibular function tests, including SVH, subjective visual vertical ( SVV ) and caloric test by video-nystagmography. The parameters of the angle of SVH and SVV, directional preponderance ( DP) and unilateral weakness(UW) of caloric test were observed. The correlation between SVH/SVV, DP, UW and the course of disease were investigated respectively. SPSS 16. 0 software was used to analyze the data. Results Reference range of SVH and SVV was from - 2° to 2° in the control group. Among the 85 patients, 46 cases(54. 1% ) and 43 cases(50. 6% ) had the abnormal values of SVH and SVV respectively, with no statistical significance( χ2 = 12. 5, P = 0. 481 ) by chi square test Fifty-five cases (64. 7% ) withabnormal DP had no statistical significance when compared with SVH and SVV respectively (χ2 values were 0. 19 and 2.86, respectively, P value were 0. 164, 0.067, respectively). In UVH, there were positive correlation between SVH, SVV and DP( r value was 0. 939, 0. 648, 0. 658, all P <0. 05) respectively, but no correlation between UW and SV H or SVV (r value was 0. 048, 0. 085, all P > 0. 05). According to the permutation and combination of the four parameters, positive or negative, three main groups could be defined [SVH(+)DP(+)UW( +), SVH( -)DP( +)UW( +), SVH( -)DP( -)UW( +); SVV( + ) DP ( +)UW( +), SVV( -)DP( +)UW( +), SVV( -)DP( -)UW( +)]. The course of disease in the three main groups was positively skewed distribution,with median of 5. 0, 10. 0, 15. 0 d and 5. 0, 9. 5, 14. 5 d respectively. By Kruskal-Wallis Test, χ2 value were 8. 80 and 6. 26, respectively( P value were 0.012, 0. 040, respectively), with statistical significance between the above three main groups. Conclusions The SVH value can evaluate the function of the otolithic. The angle of SVH and SVV are changing in the course of disease, SVH and SVV can be used as a guidance of the vestibular compensation evaluation.     

Video head impulse test in vestibular migraine

IntroductionVestibular migraine as an entity was described in 1999 and its pathophysiology is still not established. Simultaneously with research to better understand vestibular migraine, there has been an improvement in vestibular function assessment. The video-head impulse test is one of the latest tools to evaluate vestibular function, measuring its vestibular-ocular reflex gain.ObjectiveTo evaluate vestibular function of vestibular migraine patients using video-head impulse test.MethodsCross-sectional case-control study homogeneous by age and gender with vestibular migraine patients according to the 2012–2013 Barany Society/International Headache Society diagnostic criteria submitted to video-head impulse test during intercrisis period.Results31 vestibular migraine patients were evaluated with a predominantly female group (90.3%) and mean age of 41 years old. Vestibular function was normal in both patient and control groups. Gain values for horizontal canals were similar between the two groups, but gain values for vertical canals were higher in the group with vestibular migraine (p < 0.05). Patients with vestibular migraine felt more dizziness while performing the video-head impulse test than control subjects (p < 0.001).ConclusionsPatients with vestibular migraine present normal vestibular function during intercrisis period when evaluated by video-head impulse test. Vertical canals, however, have higher gains in patients with vestibular migraine than in control subjects. Vestibular migraine patients feel dizziness more often while conducting video-head impulse test.     

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.     

Detection of isolated covert saccades with the video head impulse test in peripheral vestibular disorders

Objectives

The function of the semicircular canal receptors and the pathway of the vestibulo-ocular-reflex (VOR) can be diagnosed with the clinical head impulse test (cHIT). Recently, the video head impulse test (vHIT) has been introduced but so far there is little clinical experience with the vHIT in patients with peripheral vestibular disorders. The aim of the study was to investigate the horizontal VOR (hVOR) by means of vHIT in peripheral vestibular disorders.

Methods

Using the vHIT, we examined the hVOR in a group of 117 patients and a control group of 20 healthy subjects. The group of patients included vestibular neuritis (VN) (n = 52), vestibular schwannoma (VS) (n = 31), Ménière's disease (MD) (n = 22) and bilateral vestibulopathy (BV) (n = 12).

Results

Normal hVOR gain was at 0.96 ± 0.08, while abnormal hVOR gain was at 0.44 ± 0.20 (79.1% of all cases). An abnormal vHIT was found in VN (94.2%), VS (61.3%), MD (54.5%) and BV (91.7%). Three conditions of refixation saccades occurred frequently in cases with abnormal hVOR: isolated covert saccades (13.7%), isolated overt saccades (34.3%) and the combination of overt and covert saccades (52.0%).

Conclusions

The vHIT detects abnormal hVOR changes in the combination of gain assessment and refixation saccades. Since isolated covert saccades in hVOR changes can only be seen with vHIT, peripheral vestibular disorders are likely to be diagnosed incorrectly with the cHIT to a certain amount.     

Hunt综合征伴眩晕患者的半规管损伤频率特征

目的 探讨Hunt综合征伴眩晕患者的前庭半规管损伤频率特征以及视频头脉冲试验(video head impulse test,vHIT)在评估其前庭功能中的应用价值.方法 Hunt综合征伴眩晕患者26例(病例组)分别进行高频vHIT、中频摇头试验(head shaking test)和低频冷热试验(caloric test);30例健康人为对照组进行vHIT.以冷热试验单侧半规管反应非对称值(unilateral weakness,UW)、摇头试验诱发摇头眼震(head shaking nystagmus,HSN)、vHIT的增益值(video head impulse test gain,vHIT-G)为观察指标,应用SPSS 16.0统计软件分析对照组vHIT-G、病例组的三项试验结果特点及其相关性.结果 对照组6个半规管的vHIT-G均符合正态分布,方差分析,相互间差异无统计学意义(F=0.005,P＜0.01);双侧前、水平和后半规管平均vHIT-G((x)±s,下同)分别为16.80％±9.80％、16.57％±10.30％、16.52％±11.12％;病例组的患耳前、水平和后半规管vHIT-G分别为46.96％±34.54％、75.35％±35.29％、41.65％±32.87％,均符合正态分布,与对照组对应半规管比较差异有统计学意义(P值均＜0.01);vHIT、摇头试验和冷热试验阳性者分别为23例(88.46％)、22例(84.61％)和24例(92.31％),双侧确切概率法x2检验,P值均＞0.05,差异无统计学意义;UW与水平半规管vHIT-G之间存在正相关(r=0.692,P＜0.01).结论 Hunt综合征伴眩晕患者的半规管功能损伤呈多频或近乎全频性损伤,具有传导阻滞性神经损伤特点;vHIT可以作为Hunt综合征伴眩晕患者前庭功能评定的有效检查方法.     

摇头眼震与前庭双温试验的交互认证

目的研究摇头眼震(headshakingnystagmus,HSN)的临床表现形式及其与前庭双温试验之间的交互认证关系,并拟将HSN列入前庭功能的常规检查。方法对眩晕门诊124例患者行HSN检查及前庭双温检查,分别观察HSN的潜伏期与时程,动态观察前庭神经炎的患者HSN的变化。将前庭双温试验与HSN的关系按照半规管轻瘫(canalparesis,CP)值来分类,并进行比较。结果HSN有3种类型:单相眼震41例、双相眼震11例和倒错性眼震7例。单相HSN潜伏期为(2.75±1.41)s;持续时间变化较大,为(32.16±20.30)s;双相HSN,第一相一般没有潜伏期,持续时间为(12.33±4.42)s,也明显短于第二相的(57.00±17.19)s(P<0.01)。前庭双温CP值无摇头眼震者明显低于有摇头眼震者。结论HSN的引出与前庭损伤后前庭代偿的程度密切相关,眼震的持续时间个体间变异大。一侧前庭损伤的急性期,双侧前庭功能明显失衡,摇头眼震有明显的定侧作用,摇头眼震的方向与自发性眼震的方向相同。随着前庭代偿的进展,双相眼震逐渐取代单相眼震,其中第一相眼震方向代表健侧。代偿完成后,不能引出HSN。当引出HSN时,一般提示前庭双温试验CP值大于25%。而当引出倒错眼震时,则可能存在中枢异常。     

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.