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前庭功能检查方法的研究进展
前庭系统是人体平衡系统的重要组成部分,具有特殊的感受器,如果发生病变将严重影响人体的平衡状态,导致患者眩晕,影响患者的工作和学习.因其位置较深,所以发病机制尚不明确.以往主要依靠问诊和体格检查诊断前庭系统疾病,现在诊断通常结合前庭功能检查.目前常用于前庭功能检查的试验包括冷热试验、头脉冲试验、转椅试验、摇头眼震以及前庭自旋转试验等,了解这些检查的作用机制以及适用范围,可为疾病的确诊和治疗提供参考.
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双侧前庭病
The leading symptoms of bilateral vestibulopathy (BVP) are postural imbalance and unsteadiness of gait,deficits of spatial memory and navigation.The etiology of BVP remains unclear in more than 50％ of patients:in these cases neurodegeneration is assumed.Frequent known causes are ototoxicity mainly due to gentamicin,bilateral Menière's disease,autoimmune diseases,meningitis and bilateral vestibular schwannoma,as well as an association with cerebellar degeneration.The diagnosis of BVP is based on a bilaterally reduced or absent function of the vestibulo-ocular reflex (VOR).Head impulse test (HIT),video-oculography system (vHIT),crvical/ ocular vestibular-evoked myogenic potentials (c/oVEMP) and dynamic visual acuity is an additional test supporting the diagnosis.There are four different subtypes of BVP depending on the affected anatomic structure and frequency range of the VOR deficit:impaired canal function in the low-and/or high-frequency VOR range only and/or otolith function only;the latter is very rare.There are four treatment options:first,detailed patient counseling to explain the cause,etiology,and consequences,as well as the course of the disease;second,daily vestibular exer cises and balance training;third,if possible,treatment of the underlying cause,as in bilateral Menière's disease,meningitis,or autoimmune diseases;fourth,if possible,prevention,i.e.,being very restrictive with the use of ototoxic substances,such as aminoglycosides.
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前庭功能检查在前庭性偏头痛患者预防性治疗疗效预测中的价值
目的:回顾前庭性偏头疼(VM)患者的变温试验、视频头脉冲试验(vHIT)结果,评价前庭功能检查在预测VM患者预防性治疗疗效方面的价值.方法:收集VM患者初诊时变温试验及vHIT检查结果,并于预防性治疗6个月后复查,评价其症状改善情况,分成完全缓解(CR)组:无眩晕发作,不需要继续药物治疗;未完全缓解(UR)组:经治疗仍有眩晕发作,包括症状改善仍需继续治疗和症状完全无改善.结果:75例患者中15例(15.0％)变温试验异常,9例(12.0％)患者vHIT异常.治疗6个月后,58例(77.3％)患者完全缓解,17例(22.7％)患者未完全缓解,CR组和UR组之间变温试验和vHIT结果的异常率差异有统计学意义(P＜0.05).结论:变温试验和vHIT结果异常表明VM患者存在半规管功能异常,其眩晕症状与前庭外周功能异常密切相关,前庭功能检查结果异常的患者可能需要更长时间的预防性治疗或必要的康复治疗.
