鼓膜穿孔眩晕者的冷热气试验结果分析

目的：分析冷热气刺激下鼓膜穿孔患者的试验结果特点，探讨鼓膜穿孔者冷热气试验的可行性。方法：慢性中耳炎鼓膜穿孔伴眩晕的患者43例（49耳），行双耳冷热气试验，观测眼震特点、慢相角速度（SPV）和眼震不对称比（UW）。结果：穿孔耳冷热气刺激诱发眼震呈现4种类型：①增强型：穿孔耳诱发性眼震SPV增强并超过正常范围，或强于非穿孔耳、UW＞15％者15例（17耳）；②“正常型”：穿孔、非穿孔耳眼震SPV均在正常范围，UW〈15％者7例；③减弱型：穿孔耳眼震SPV弱于非穿孔耳，UW〉15％者9例；④反向型：非穿孔耳冷热气刺激眼震正常，穿孔耳热气刺激眼震反向者12例（14耳）。反向型眼震均出现在近期慢性中耳炎复发、鼓膜穿孔且有渗出或潮湿者；其余类型均为慢性中耳炎静止期患者。结论：对于穿孔耳，冷热气成为强刺激，半规管功能正常时诱发的眼震强于非穿孔耳；穿孔耳半规管功能不同程度减弱时，诱发眼震可为正常或减弱反应；活动期的中耳炎患者，穿孔耳热气刺激可转化为冷刺激效应，诱发出反向眼震；冷热气试验可用于鼓膜穿孔伴眩晕患者的前庭功能评定。

Analysis of air caloric testing results for patients suffering from tympanic membrane perforation with vertigo

Objective:To analyze characteristic of air caloric testing for patients with tympanic membrane perforation and to assess the availability of this testing for the patients.Method:Forty-three cases of chronic otitis media with tympanic membrane perforation and vertigo were investigated, in which there were 37 cases with single ear perforation and 6 cases with bilateral perforation. The patients were performed by air caloric testing, to observe the characteristic of nystagmus,slow phase velocity (SPV) and unilateral weakness (UW).Result:Four types of nystagmus, including enhancing, "normal", weakening and inversion, were observed with bilateral caloric air stimulation in ears with tympanic membrane perforation. Nystagmus of perforated ear presented SPV increased exceeding normal range or non-perforated ear and UW>15% (15 cases, 17 ears), which was calledenhancing type; normal nystagmus SPV in bilateral ear and UW<15% (7 cases) was called "normal" type; weakened nystagmus SPV in perforated ear to non-perforated ear and UW>15% (9 cases) was called weaken ing type; normal nystagmus in non-perforated ear and inverted caloric nystagmus in perforated ear (12 cases, 14 ears) was called inversion type. In patients with chronic otitis media recurring lately, inverted nystagmus was observed in perforated ears with effusion and humidity in the tympanic cavity, the other types were observed in patients in stillness stage of otitis media.Conclusion:Bilateral caloric air became strong stimulation for the perforated ear, nystagmus of perforated ear with normal function of semicircular canal was stronger than that of the non-perforated ear.While the perforated ear with undermined function of semicircular canal, nystagmus could present normal or weakened. In the patients with otitis media in active stage, hot air stimulation could be turned to cool stimulation response so as to cause inverted nystagmus. Air caloric testing can be used to assess vestibular function of the patients with tympanic membrane perforation and vertigo.