前庭性偏头痛与梅尼埃病患者的听力及前庭功能比较

目的 比较前庭性偏头痛(VM)与梅尼埃病(MD)患者的听力及前庭功能特点,为两者的鉴别诊断提供帮助.方法 回顾性分析2016年1月1日至12月31日在上海市静安区闸北中心医院神经内科就诊的VM和MD患者的临床资料,全部患者均在发病2周内行纯音测听、视频头脉冲试验(VHIT)以及眼震视图(VNG)检查并对检查结果进行比较分析.结果 VM患者共31例,男7例、女24例,平均年龄(53.52±13.80)岁.其中,纯音测听异常17例(54.8％),均为感音神经性聋,其中13例为双侧对称性高频听力轻中度下降.VHIT异常5例(16.1％).VNG中,VM患者均未见自发眼震,变位试验见4例(12.9％)位置性眼震.扫视试验异常10例(32.3％),平稳跟踪试验异常8例(25.8％),视动性眼震异常13例(41.9％),VM患者凝视试验均未见异常.变温试验异常12例(38.7％).MD患者共计31例,男17例、女14例,平均年龄(55.48±12.32)岁.纯音测听均为单侧低、中频感音神经性聋.VHIT异常9例(29.0％).VNG中,自发眼震1例(3.2％).MD患者变位试验均无位置性眼震.扫视试验异常6例(19.4％),平稳跟踪试验异常8例(25.8％),视动性眼震异常6例(19.4％),MD患者均未见凝视试验异常.变温试验异常13例(41.9％).VM与MD患者的的纯音测听、变位试验、视动性眼震异常率差异均有统计学意义(P均＜0.05).结论 VM患者听力异常较MD少见,且多表现为双侧对称性高频感音神经性聋.而VM患者变位试验及视动性眼震异常率高于MD.纯音测听、变位试验和视动性眼震检查可为二者鉴别提供辅助参考.

Comparison of hearing and vestibular function in patients with vestibular migraine and Ménière's disease

Objective To compare the hearing and vestibular function in patients with vestibular migraine (VM) and Ménière''s disease (MD), so as to identify and diagnose the two diseases. Methods The clinical data of patients with VM or MD, who were treated in the Department of Neurology, Jing''an District Zhabei Centre Hospital of Shanghai from Jan. 1, to Dec. 31, 2016, were retrospectively analyzed. All patients received pure-tone audiometry, video head pulse (VHIT) and videonystagmography (VNG) tests within 2 weeks of onset, and the results were compared between the two groups. Results A total of 31 patients with VM, including 7 males and 24 females, had an average age of (53.52±13.80) years old. Seventeen of 31 cases (54.8%) were abnormal in pure-tone audiometry, showing sensorineural hearing loss; and 13 cases had bilateral symmetry high frequency mild to moderate hearing loss. VHIT test was abnormal in 5 cases (16.1%). There was no spontaneous nystagmus in VM patients by VNG test, while position nystagmus existed in 4 cases (12.9%) by positioning test. Ten cases (32.3%) were abnormal in the saccade test, 8(25.8%) were abnormal in the smooth tracking test, 13(41.9%) were abnormal in the optokinetic nystagmus test, 12(38.7%) were abnormal in the caloric test, and no case was abnormal in the gaze test. A total of 31 patients with MD, including 17 males and 14 females, had an average age of (55.48±12.32) years old. All cases had unilateral low to medium frequency sensorineural hearing loss by pure-tone audiometry. VHIT test was abnormal in 9 cases (29.0%). There was one case (3.2%) showing spontaneous nystagmus by VNG test, and no position nystagmus was found. Six cases (19.4%) were abnormal in the saccade test, 8(25.8%) were abnormal in the smooth tracking test, 6(19.4%) were abnormal in the optokinetic nystagmus test, 13(41.9%) were abnormal in the caloric test, and no case was abnormal in the gaze test. There were significant differences in the results of pure-tone audiometry, positioning test and optokinetic nystagmus test between the patients with VM and MD (all P<0.05). Conclusion Compared with MD patients, patients with VM showed lower abnormal rate of pure-tone audiometry, with more having bilateral symmetry high frequency hearing loss, and higher rate of abnormal results in positioning test and optokinetic nystagmus test. Pure-tone audiometry, positioning test, and optokinetic nystagmus test can provide references for the differentiation of VM and MD.