外周性双侧前庭病的听-前庭功能与诊断

目的探讨外周性双侧前庭病的听-前庭功能特点及其在诊断中的价值。方法对自2006年12月～2010年10月我科眩晕专科诊治的具步态不稳和振动幻视特征性症状的外周性双侧前庭病53例,行听-前庭功能检查和病因分析。结果明确或可能病因42例(79.2%),原因不明者11例(20.8%)。听力正常10例(18.9%)、异常43(81.1%)。冷热试验:双侧前庭功能低下共49例(92.5%),双侧前庭功能丧失4例(7.5%)。头脉冲试验病理阳性38例(71.7%)。接受动态姿势描记图检查39例,显示不同程度的前庭输入下降或前庭输入为主下降。结论双侧前庭病的诊断根据病史、特征性的临床表现及听-前庭功能检查,冷热试验及头脉冲试验结合有诊断价值,听力学检查有助原发疾病的诊断。     

走路不稳门诊患者131例双侧前庭病患病率调查

目的:研究双侧前庭病(BVP)在有走路不稳症状的门诊患者中的患病率,并分析其临床特征.方法:依据BVP的常见病因,检索2018年1月-2019年10月诊断为"走路不稳""梅尼埃病(双侧)""化疗复查""系统性红斑狼疮(SLE)"及"血管炎"的门诊患者共2075例,通过电话访谈筛选出符合BVP典型表现的患者,进一步完成问...     

前庭神经炎的诊治

本文对前庭神经炎的临床表现、发病原因、类型以及前庭神经炎的鉴别诊断进行了阐述。对于前庭神经炎的神经损伤定位方法、前庭神经炎治疗的现代观念进行了分析总结，并提出了目前诊断、治疗中存在的问题。     

前庭康复的现状

前庭康复是外周与中枢性眩晕及平衡障碍的重要而有效的治疗方法，利用人类大脑的适应性、可塑性及代偿功能是其治疗的基础。眩晕病及平衡障碍的诊治应归于交叉学科和跨学科的共同协作。前庭康复工作需要耳科医生与神经科医生和康复科医生合作。现将前庭康复的现状综述如下。     

双侧前庭性疾病

双侧前庭性疾病 (ｂｉｌａｔｅｒａｌｖｅｓｔｉｂｕｌｏｐａｔｈｙ)不是一种独立的疾病。其发生于双侧内耳的平衡部分受到损害 ,可为急性如中毒或代谢等原因引起 ;可为慢性疾病或双侧前庭功能先后丧失。双侧前庭性疾病表现为Ｄａｎｄｙ’ｓ综合征 ,典型症状包括失衡和视觉症状。因靠视觉和本体感觉维持平衡 ,故在暗处或地面不平处失衡尤为明显。由于前庭 眼反射消失 ,不能固定于视靶 ,头动时出现振动幻视 ,快速头动时视觉模糊。双侧前庭性疾病占头晕患者的 5 %〔1〕。1　双侧前庭性疾病的病因很多情况下 ,双侧前庭性疾病是由于耳毒性药物所…     

急性前庭病

急性前庭病的特点是：急性或亚急性出现眩晕或平衡障碍，可以由于前庭外周各部或中枢前庭结构的功能低下或各种原因的刺激引起。本文着重于对前庭急性外周病变，如BPPV、前庭神经元炎、上半规管裂隙综合征及前庭阵发症；前庭中枢急性病变如前庭性偏头痛及一些新近认识的文献进行综述。     

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。     

Bilateral vestibulopathy and disabling vertigo: A CARE case series

IntroductionThe term bilateral vestibulopathy (BV) was recently defined by the Bárány Society. Loss of otolith function was not included in their criteria. Although spontaneous progression to complete bilateral impairment of vestibular function is expected, it is unlikely that patients with advanced BV will continue to present episodes of intense vertigo. Here, following CARE case report guidelines, we report the case of patients meeting the criteria for BV and still disabled by vertigo.Case seriesThree patients evaluated in our department meeting the Bárány criteria for definite BV but still complaining of disabling rotatory vertigo were included. All underwent clinical and instrumental vestibular examination. The observations are reported.ConclusionIn case of BV, the conservation of a stable otolithic reference frame could allow patients to optimize postural strategy. It would be useful to revisit a classification of BV by stages, by introducing an evaluation of otolithic function and postural control for possible subsequent vestibular implantation.     

Importance of High-Frequency Vestibular Function in the Prognosis of Bilateral Vestibulopathy

ObjectivesThe aim of this study was to investigate whether preserved vestibular function in the high-frequency range influences the prognosis of patients with bilateral vestibulopathy (BVP) after vestibular rehabilitation.MethodsTwenty-four patients followed up with vestibular rehabilitation were recruited. The enrolled patients were divided into two groups according to the preservation of the high-frequency vestibulo-ocular reflex (VOR) based on the video head impulse test (vHIT). The results of computerized dynamic posturography and the Dizziness Handicap Inventory (DHI) survey collected at baseline and at the 6-month follow-up after vestibular rehabilitation therapy were analyzed.ResultsBoth groups showed significantly increased composite and DHI scores after follow-up with vestibular rehabilitation. The group with preserved high-frequency VOR showed a better composite score (P=0.064) and vestibular score (P= 0.008) than the group with lost high-frequency VOR at the 6-month follow up. The DHI score significantly decreased only in the group with lost high-frequency VOR (P=0.047). Among the three vestibular function tests (caloric test, rotary chair test, and vHIT) used to diagnose BVP, only vHIT showed a significant correlation (P=0.015) with a favorable prognosis (composite score ≥70).ConclusionBetter treatment outcomes are likely in patients with BVP with preserved vestibular function in response to high-frequency stimulation, as measured by the vHIT.     

Bilateral otosyphilis in a patient with HIV infection

Otosyphilis is a rare but important cause of sensorineural hearing loss and dizziness, because this hearing loss can be reversed by early diagnosis and aggressive treatment. Moreover, HIV may alter the course of otosyphilis and hasten the development of otosyphilis by reducing host cellular immunity. We report the case of a 35-year-old HIV-infected patient with bilateral fluctuating sensorineural hearing loss and bilateral total vestibular loss caused by otosyphilis. We include a discussion of the relationship between otosyphilis and HIV infection.     

Acute bilateral vestibulopathy with simultaneous involvement of both superior and inferior vestibular nerves

We report a case of acute vestibulopathy with the simultaneous involvement of both superior and inferior vestibular nerves on both sides. A 36-year-old female presented with dizziness, oscillopsia and a walking impairment subsequent to a high fever. Vestibular function tests including caloric testing, video head impulse testing (vHIT) and cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) were performed. In the first examination, vHIT and caloric testing showed severe impairments in all three semicircular canals in each ear, and both cVEMPs and oVEMPs were absent on both sides. During a 1-year follow-up, the gain of vHIT gradually recovered by more than 0.5 to normal. cVEMPs also recovered to normal on both sides while oVEMPs remained absent on both sides. This is the first reported case of acute bilateral vestibulopathy with simultaneous involvement of both superior and inferior vestibular nerves on both sides. Repeated evaluation of vestibular function using vHIT, cVEMPs and oVEMPs is helpful to assess the time course of recovery in patients with vestibulopathy.     

外周前庭疾病的诊断和治疗

眩晕是外周前庭疾病的主要表现之一,发病原因涉及多个学科,临床诊治较为困难。随着前庭功能检查技术的发展、对前庭疾病研究的不断深入,相关科研成果与日剧增并广泛应用于临床。近年来,随着前庭疾病国际分类标准制定和发布,各类前庭疾病诊断标准相继出台,治疗前庭疾病的药物、手术的相关规范日趋完善,加之前庭康复技术的飞速发展,使得对前庭疾病的诊疗越来越规范和精准。     

Familial Early-onset Progressive Vestibulopathy Without Hearing Impairment

A family with early-onset vestibulopathy is presented. The 34-year-old father had experienced brief attacks of vertigo and currently suffers from unsteadiness and oscillopsia during head movements. His two young sons also experience brief attacks of spontaneous vertigo. In vestibular testing all three subjects showed reduced caloric responses. However, only the father showed reduced otolith function (as reflected by the vestibular-evoked myogenic potentials). Further, all three subjects had walked before the age of 1 year and none of them had had any auditory symptoms. It is suggested that they have familial early-onset progressive vestibulopathy affecting the canals before the otoliths but sparing cochlear function.     

双侧周围性面神经麻痹的诊断和治疗

目的 探讨双侧周围性面神经麻痹的诊断和治疗方法。方法 回顾性分析1996—2003年双侧周围性面神经麻痹患者7例，其中明确诊断6例，分别为急性淋巴细胞白血病L2型1例、Machado-Jesoph病1例、双下颌骨骨折1例、格林-巴利综合征变异型1例、Vogt-小柳-原田病1例、Bell面神经麻痹1例。诊断不明1例，诊断为可疑带状疱疹病毒感染或Lyme病。脑脊液检查5例其中有阳性发现者4例。Lyme抗体检查6例中有阳性发现者1例；影像学检查5例中有阳性发现者2例；肌电图和瞬目反射检查7例，均为周围性损害。7例患者均应用激素和维生素治疗。结果患者随访时间最长2个月，以House-Brackmann Ⅰ级为面神经麻痹完整治愈标准。治愈4例，好转2例，无效1例。结论 双侧周围性面神经麻痹在临床中少见，诊断和鉴别诊断困难，诊断失误可以危及患者的生命，应该在临床中得到足够的重视。临床中面对这样的患者，应详细询问病史，做细致的全身检查；同时应了解可能的原发病及其特点，才能做出正确判断。     

先天性第四鳃裂畸形的诊断和治疗

目的 探讨先天性第四鳃裂畸形(congenital fourth branchial anomaly,CFBA)的解剖学特点、临床表现、诊断和外科处理原则.方法 回顾性分析8例CFBA患者的临床资料,年龄27～300个月(中位年龄114个月);男4例,女4例;初治3例,复发5例;病变均位于左颈,其中囊肿型1例,窦道型3例(均为内瘘口),瘘管型4例;3例表现为急性甲状腺炎,4例表现为颈深部脓肿,1例表现为颈部肿块.结果 术前检查包括食管吞钡8例次、直接喉镜4例次、CT 5例次、MRI 5例次.急性期患者采取充分引流、控制感染;静止期患者行病灶完整切除+喉返神经解剖+甲状腺腺叶部分切除,对复发病例采用择区性颈清扫术根除瘢痕、炎性肉芽和病变组织.术后1例患者切口局部感染,经换药后愈合;1例患者出现暂时性声带麻痹,1个月后完全恢复.患者随访13～42个月,中位随访时间21个月,未见复发.结论 CFBA走行与喉返神经和甲状腺关系密切.食管吞钡、直接喉镜检查最具诊断价值,CT和MRI有助于明确诊断.治疗原则为感染静止期行喉返神经解剖和甲状腺腺叶部分切除,必要时切除部分甲状软骨翼板以减少并发症和预防复发,复发病例可采用择区性颈清扫术治疗.