单侧迷路切除术后大鼠前庭神经核γ-氨基丁酸A受体β1亚型表达

目的观察单侧迷路切除术后大鼠前庭神经核复合体内γ-氨基丁酸(gamma-aminobutyric acid,GABA)A受体β1亚型的表达变化。方法成年雄性Wistar大鼠48只,分为实验组(36只)和对照组(12只),前者破坏单侧迷路,对照组手术方式相同但保持迷路完好。单侧迷路切除术后,分别用免疫组织化学法和免疫印迹法按照上述分组方式,检测不同存活时间(术后1、3、7天)组动物前庭神经复合体内GABAA受体β1亚型的表达变化。结果术后1、3、7夭组大鼠左右两侧比较及与对照组比较差异均无显著性意义。结论在前庭代偿的早期,前庭神经复合体内GABAA受体β1亚型表达无变化。     

前庭康复过程中Ⅰ组代谢性谷氨酸受体亚型mGluR5在前庭内侧核中的变化

目的：观察单侧迷路破坏术后前庭内侧核（MVN）内Ⅰ组代谢性谷氨酸受体亚型mGluR5的表达变化。方法：成年雄性Wistar大鼠30只,分为迷路破坏组（24只）和对照组（6只）,前者破坏单侧迷路,对照组手术方式相同但保持迷路完好。单侧迷路破坏术后,通过免疫组织化学、原位杂交组织化学法检测不同存活时间（术后12h、36h、7d）2组动物MVN内mGluR5的表达变化。结果：单侧迷路破坏术后可诱导同侧MVN区Ⅰ组代谢性谷氨酸受体亚型mGluR5增高,术后12h最高,术后36h开始降低,至术后7d后和对照组差异无统计学意义;对侧和术侧的变化趋势相同。结论：单侧迷路破坏术后可诱导MVN区Ⅰ组代谢性谷氨酸受体亚型mGluR5增高。初级前庭传入或中枢前庭神经元的静息放电降低可能与Ⅰ组代谢性谷氨酸受体亚型mGluR5增高有关,但其在前庭代偿中的作用尚有待研究。     

前庭代偿过程中GABAA受体α1亚型在前庭内侧核中的变化

目的 观察单侧迷路破坏术后前庭内侧核(medial vestibular nuclei, MVN)内γ-氨基丁酸A受体(gamma-aminobutyric acid A receptor, GABAA receptor)α1亚型的表达变化.方法 将24只大鼠随机分为术后1、3、7天组和假手术组,每组6只,前三组切除大鼠一侧迷路,第4组行假手术,利用免疫组织化学、原位杂交组织化学的方法,观察术后1、3、7天组前庭内侧核区GABAA受体α1亚型表达的变化,及其在前庭代偿中可能的作用 ,并与假手术组进行比较.结果 手术后1天、3天、7天组行为学上开始均有前庭静态症状,术后7天时前庭静态症状均消失,假手术组无相关症状出现.免疫组织化学、原位杂交组织化学方法前庭内侧核中各组手术侧与对侧比较及术后1天、3天、7天组与假手术组比较,GABAA受体α1亚型表达差异均无统计学意义(P>0.05).结论 在前庭代偿的早期,GABAA受体α1亚型表达的变化可能没有涉及前庭代偿.     

前庭代偿过程中Ⅰ组代谢性谷氨酸受体亚型在前庭内侧核中的变化

目的观察单侧迷路破坏术后前庭内侧核(medialvestibular nuclei,MVN)内I组代谢性谷氨酸受体亚型(group I metabotropic glutamate receptors,mGluR1)的表达变化。方法成年雄性Wistar大鼠28只,分为迷路破坏组(20只)和对照组(8只),前者破坏单侧迷路,对照组手术方式相同但保持迷路完好。单侧迷路破坏术后,通过免疫组织化学、原位杂交组织化学法检测不同存活时间(术后12h、36h、7d、30d)两组动物MVN内mGluR1的表达变化。结果单侧迷路破坏术后可诱导同侧MVN区I组代谢性谷氨酸受体亚型mGluR1减少,术后12h最少,术后36h开始增加,至术后7d和30d后和对照组差异无统计学意义;对侧和术侧的变化趋势相同。结论单侧迷路破坏术后可诱导MVN区I组代谢性谷氨酸受体亚型mGluR1减少。初级前庭传入或中枢前庭神经元的静息放电降低可能与I组代谢性谷氨酸受体亚型mGluR1减少有关,但其在前庭代偿中的作用尚有待研究。     

单侧迷路切除后γ-氨基丁酸A受体亚单位在大鼠小脑绒球中的表达

目的观察单侧迷路切除术后大鼠小脑绒球内γ-氨基丁酸A(gamma-amino butyric acid A,GABAA)受体α3、β1、δ亚单位的表达变化。方法成年雄性Wistar大鼠24只,随机分为迷路破坏组(18只)和对照组(6只),前者破坏单侧迷路,对照组手术方式相同但保持迷路完好。通过免疫组织化学法检测术后不同存活时间(术后1、3、7天)两组动物小脑绒球内GABAA受体α3、β1、δ亚单位的表达变化。结果单侧迷路切除术后大鼠术侧小脑绒球内GABAA受体β1、δ亚单位增加,术后1天最多,此后3~7天处于下降趋势,7天时和对照组比较表达无差异。α3亚单位在小脑绒球的染色很弱,各组两侧比较及术后1、3、7天与对照组比较均无明显差异。结论单侧迷路切除后大鼠术侧小脑绒球内GABAA受体β1、δ亚单位增加;双侧前庭中枢神经元的静息放电的平衡可能与GABAA受体β1、δ亚单位绒球内的增加有关;α3亚单位可能并非GABAA受体在小脑绒球主要的结构与功能亚单位。     

单侧迷路切除术后毒蕈碱受体亚型在大鼠小脑绒球中的变化

目的:观察左侧迷路切除术后大鼠小脑绒球内毒蕈碱受体M1、M3、M5亚型的表达变化。方法:利用RT-PCR的方法,切除大鼠一侧迷路,观察小脑绒球毒蕈碱受体M1、M3、M5亚型表达的变化,及其在前庭代偿中可能的作用。结果:单侧迷路切除术(UL)后可诱导双侧绒球内毒蕈碱受体M1、M3、M5亚型减少,术后1 d最少,此后3~7 d处于上升趋势,7 d时和假手术组比较表达差异无统计学意义。各组手术两侧比较均差异无统计学意义。结论:UL后可诱导绒球内毒蕈碱受体M1、M3、M5亚型减少,但其在前庭代偿中的作用尚有待研究。     

反复发作性眩晕豚鼠前庭内侧核毒蕈碱受体M2、M3表达的研究

目的制造豚鼠迷路瘘管导致的反复发作的眩晕模型,观察不同时程豚鼠前庭内侧核(MVN)毒蕈碱受体M2、M3亚型的表达变化。以探讨前庭代偿的可能机制。方法选择成年实验用豚鼠88只,并随机分配为A组(假手术组,8只)、B组(单侧迷路损毁组,40只)、C组(迷路瘘管+耳镜鼓气组,40只)。B、C组手术后,依据豚鼠所需不同存活时间(术后1天、3天、1周、2周、3周)随机选取8只,A组作为对照组存活3周。所有豚鼠灌流后取脑干,用免疫组织化学染色,观察前庭内侧核毒蕈碱受体M2、M3亚型的表达变化,并与假手术组比较。结果 B、C组术后均可导致双侧MVN区毒蕈碱受体M2、M3亚型表达减少,术后1天表达最少,术后3天至术后7天表达有逐渐增加趋势,术后7天时B组和假手术组比较表达无差异,而C组和假手术组比较表达差异具有统计学意义(P<0.05)。直到术后2周,C组和假手术组比较表达无差异。B、C组术后各时期(术后2周前)相比,C组的表达弱于B组。各组对侧的变化趋势和术侧相同。结论1.豚鼠MVN存在毒蕈碱受体M2、M3亚型,且M3受体的表达可能不及M2受体的丰富。它们可能在前庭代偿的早期促进了前庭代偿的正常进行。2.前庭代偿除胆碱能系统参与外,可能还涉及到其他神经递质或化学物质的参与。3.进一步证明迷路瘘管导致的反复发作性眩晕模型的造模是成功的。     

单侧迷路切除后γ-氨基丁酸A受体α1亚单位mRNA在大鼠小脑绒球中的表达

目的：阐明大鼠小脑绒球中γ-氨基丁酸A（GABAA）受体α1亚单位在前庭代偿过程中的作用。方法：以实时定量PCR技术对迷路切除后GABAA受体α1亚单位mRNA在前庭代偿早期大鼠小脑绒球中的表达进行研究。结果：GABAA受体α1亚单位在小脑绒球中有表达，但迷路切除后在损伤同侧和对侧绒球中其表达无统计学意义。结论：大鼠小脑绒球中存在GABAA受体α1亚单位，在前庭代偿的早期，GABAA受体α1亚单位mRNA表达的变化极可能没有涉及前庭代偿。     

单侧迷路切除后γ-氨基丁酸A受体α1亚单位mRNA在大鼠小脑绒球中的表达

目的:阐明大鼠小脑绒球中γ-氨基丁酸A(GABAA)受体α1亚单位在前庭代偿过程中的作用.方法:以实时定量PCR技术对迷路切除后GABAA受体α1亚单位mRNA在前庭代偿早期大鼠小脑绒球中的表达进行研究.结果:GABAA受体α1亚单位在小脑绒球中有表达,但迷路切除后在损伤同侧和对侧绒球中其表达无统计学意义.结论:大鼠小脑绒球中存在GABAA受体α1亚单位,在前庭代偿的早期,GABAA受体α1亚单位mRNA表达的变化极可能没有涉及前庭代偿.     

前庭代偿过程中代谢性谷氨酸受体I组在大鼠小脑绒球中的表达

目的：阐明大鼠小脑绒球中代谢性谷氨酸受体I组在前庭代偿过程中的作用。方法：用RT-PCR方法对单侧迷路切除术后前庭代偿过程中代谢性谷氨酸受体I组在小脑绒球中的表达进行研究。结果：代谢性谷氨酸受体I组在双侧绒球中均有表达,双侧的手术组和对照组比较均差异有统计学意义,而双侧之间无差异。结论：大鼠小脑绒球存在代谢性谷氨酸受体I组,在前庭代偿过程中有变化,表明其参与前庭代偿的过程。     

Vestibular function outcomes after vestibular neurectomy in Meniere disease: Can vestibular neurectomy provide complete vestibular deafferentation?

Objective

Vestibular neurectomy is considered the reference treatment of incapacitating vertigo accompanying Meniere disease, with an efficiency rate of 85–95% in most literature reports.The aim of this study is to evaluate if vestibular neurectomy can provide a complete vestibular deafferentation by investigating complete vestibular function after surgery.

Methods

Prospective study. Twenty-four patients suffering from incapacitated Meniere vertigo crisis beneficiated from a vestibular neurectomy by retrosigmoid approach. The average time between surgery and vestibular evaluation was 1 year. We performed (i) kinetic test, (ii) caloric test and (iii) vibration-induced nystagmus (VIN) at 30, 60 and 100 Hz under videonystagmography recording, (iv) vestibular evoked myogenic potentials (VEMP), (v) video head impulsed test (VHIT) for each semicircular canals and (vi) an evaluation of visual vertical and horizontal subjective (VVS and HVS).

Results

On clinical evaluation, all the patients except one had never experienced any recurrence of vertigo crisis after surgery. The 24 patients would definitely undergo the surgery again. On vestibular evaluation, on the operated side, all patients showed a total areflexia at caloric test; 23 patients had no VEMP response; 23 patients had abolished canals response to VHIT. All the patients had VVS and HVS deviated towards the operated side; 23 patients had a high velocity VIN from 30 to 60 Hz.

Conclusion

This study proves that vestibular neurectomy can provide a complete vestibular deafferentation. We discuss this vestibular evaluation protocol and the main difficulties encounter during surgery, which could lead to partial nerve section and partial relief, and explain residual vestibular function after vestibular neurectomy.     

前庭神经切断术后的前庭代偿观察

目的观察前庭神经切断术后的前庭代偿过程。方法对1998-2005年10例前庭神经切断术后患者．观察自发性眼震和平衡失调的持续时间，并对4例术前、后眼震电图进行对比观察。结果患者术后均出现快相向健侧的水平性眼震，持续4～7天消失，平衡失调恢复时间为一月至一年不等，年龄越大持续时间越长。4例进行眼震电图检查的患者，3例前庭功能均丧失，1例热水试验出现反向眼震。结论前庭代偿是前庭神经切断术后患者康复的必然过程，前庭康复训练可缩短前庭代偿的时间。     

Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo

A prospective cohort study was designed to evaluate the long-term outcome and health-related quality of life (HRQoL) in patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV) treated by the particle repositioning maneuver (PRM) in the outpatient clinic of a general community hospital. Fifty individuals with PC-BPPV were included, and 45 (90%) completed the study. The diagnosis was based on the history of short episodes of vertigo and a positional nystagmus during the Dix-Hallpike test (DHT). All patients were treated by a single PRM, and relapses were evaluated by DHT at 30, 180 and 360 days post-treatment; a new PRM was performed if the DHT was positive. The main outcome measures were: percentage of patients with a negative DHT after treatment, scores obtained on the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Dizziness Handicap Inventory Short Form (DHI-S) before and 30, 180 and 360 days post-treatment. The DHT was found negative in 80% (40/50) of individuals at 30 days. Ten, seven and five patients presented a positive DHT at 30, 180 and 360 days, respectively. Persistent BPPV was observed in 5% (2/50) of patients at 360 days, despite repeated PRM. Relapses (DH+ after successful PRM) were observed in 7.5% (3/50) at 180 days and 360 days. Both questionnaires showed a reliability Cronbachs alpha >0.7. The average standardized score for each SF-36 scale was compared with the reference population normative data, showing differences with norms for all scales except for vitality. After PRM, patients improved their scores with both instruments, indicating a restoration of HRQoL at 30 days. Physical dimension scores of the SF-36 improved from day 30 to 360. DHI-S scores were statistically better after PRM (P<0.001). Our results show that the effectiveness of PRM is 88% after 1 year of follow-up. Patients with BPPV experienced a decrease in HRQoL, which was restored after PRM. Although relapses were observed in 7.5% of individuals, they did not affect HRQoL.This study was presented at the Research Forum of the AAO-HNSF and the Association for Research in Otolaryngology (ARO) Annual Meeting held in Orlando, FL, on September, 23, 2003     

A proposal for introducing a modified vestibular index in neurotology

The parameters for vestibular dysfunction were modified after our own studies. This index includes the degree of vertigo present, spontaneous nystagmus, dysfunction of the vestibulospinal reflexes and caloric and postrotatory side differences. The index is applicable for defining the extent of a lesion, follow-up, defining its stage and the results of therapy. Introduction of the modified vestibular index is proposed for use in clinical diagnosis. Classification of vestibular neuronitis into groups A, B and C is suggested on the basis of the reversibility of spontaneous nystagmus after caloric stimulation.     

The caloric vestibular test in weightlessness

Summary Although the theoretical background for the caloric vestibular test was assumed to be known, recent studies in weightlessness have thrown doubts on the original theory of its mechanism. It is most likely that several mechanisms are involved in the generation of caloric nystagmus in addition to the convection current theory. Experiments with the caloric test in humans conducted during parabolic flight are described. These results are compared with the results of similar experiments performed in orbital missions.Part of the Round Table Conference presented at the Collegium ORLAS, Munich, Federal Republic of Germany, 7–10 September 1986     

前庭自旋转试验在前庭性偏头痛患者中的应用

目的探讨前庭自旋转试验（vestibular autorotation test, VAT）对前庭性偏头痛（vestibular migraine, VM）患者在前庭功能评估中的应用。方法对26例VM患者和20例正常人进行VAT检查,观察水平增益、水平相移、垂直增益、垂直相移、非对称性五项参数,≥1项异常,即评定为前庭功能异常,VAT试验阳性。结果VAT结果显示VM组21例（80.77%）前庭功能异常;对照组2例（10%）前庭功能异常,两组前庭功能异常检出率比较差异具有统计学意义（P<0.05）。VM患者增益异常18例（69.23%）,其中水平增益增高12例次,垂直增益增高4例次,水平增益降低1例次,水平增益部分增高部分降低2例次。VM患者相移延迟16例（61.54%）,其中水平相移延迟13例次,垂直相移延迟5例次。VM患者非对称性异常3例（11.54%）,提示水平通路双侧前庭功能不对称,右侧功能较弱。VM患者增益异常以2.0~2.7 Hz为主,相移异常以3.5~5.9 Hz为主。结论VM患者以增益增高、相移延迟为主要特征,水平测试比垂直测试敏感。VAT对VM患者的前庭功能评估有效,其诊断能提供有价值的参考依据。     

中国前庭康复现状与前庭康复继续教育

前庭康复是前庭功能损伤后缓解症状与功能恢复的基础。国际上,前庭康复系统化的工作标志是前庭康复专著的出版。中国前庭康复工作起步较晚,推进比较缓慢。目前,国内前庭康复工作的开展基本是以“眩晕中心”为依托,医生在患者就诊时给予康复指导,并进行随访,还缺乏康复科专业的大夫进行眩晕的前庭康复治疗。随着耳科学的发展,眩晕在中国受到前所未有的关注,本文通过了解前庭康复的理论、现状及其教育,指导相关医生掌握康复培训基础与临床的专业技能,以特殊的评价技术和治疗技术积极推进前庭康复,使国内前庭康复工作能够健康发展。     

Primary vestibular projections in the chinchilla

Summary The central projections of fibers from the vestibular nerve were studied in 19 chinchillas after horseradish peroxidase labelling. In addition, the limits of the vestibular nuclei and the anatomical characteristics of their neurons were also studied. All five vestibular nuclei received primary afferents, but there were extensive areas of them that received very little or no projections at all, such as the rostral part of the superior vestibular nucleus, the dorsocaudal part of the lateral vestibular nucleus, the caudal half of the medial vestibular nucleus and the caudalmost aspect of the dorsal vestibular nucleus.Presented at the First European Congress of Oto-Rhino-Laryngology and Cervico-Facial Surgery, Paris, 26–29 September 1988     

前庭诱发的肌源性电位临床应用

前庭诱发的肌源性电位（Vestibular evoked myogenic potentials，VEMP）可用于评价球囊功能及其对称性。本文总结VEMP在神经耳科学中的应用情况。首先建立VEMP的临床适用的检查方法，这些方法包括：刺激声的选择、刺激强度及给声方式，建立VEMP在振幅、阈值、潜伏期和耳间潜伏期的正常值。临床上常用于：梅尼埃病和迟发性膜迷路积水、前庭神经炎、听神经瘤、前半规管裂综合征和听神经病的诊断定位。VEMP的振幅变化较大．潜伏期的变化较大，而阈值较稳定。梅尼埃病和迟发性膜迷路积水、前庭神经炎、听神经瘤可以出现振幅的异常或引不出；梅尼埃病、迟发性膜迷路积水和听神经瘤可见振幅和潜伏期异常。听神经瘤还可见耳间潜伏期延长。听神经病主要表现为振幅的异常，振幅减低或引不出。VEMP是一种稳定的肌源性电位，双侧声刺激较为适宜。VEMP的阈值检查主要用于压力或声音敏感性眩晕；耳间潜伏期的异常主要见于桥一小脑角占位病变：振幅和潜伏期的异常一般没有特异性．可见于累及前庭下神经的病变。