双侧前庭病的病因及前庭功能评估  

Etiology analysis and vestibular assessment of bilateral vestibular vestibulopathy

作　　者：林颖 高林溪 李琳 王锦玲 申金金 孙菲 邱建华 查定军 LIN Ying,GAO Linxi,LI Lin,WANG Jinling,SHEN Jinjin,SUN Fei,QIU Jianhua,ZHA Dingjun(Department of Otolaryngology Head Neck Surgery, Xijing Hospital, Medical University of the Air Force, Xi＇an, 710032, Chin)

机构地区：[1]空军军医大学西京医院耳鼻咽喉头颈外科,西安710032

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第5期379-382,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家"十二五"科技支撑计划项目(No:2012BAI12B02);国家自然科学基金面上项目(No:81100715;No:81670924);西京医院学科助推计划(No:XJZT13R20)

摘　　要：目的:双侧前庭病(BVP)是双侧内耳平衡器官或前庭传导通路受损导致的一组临床症状,显著影响患者的日常行动能力,但临床常被误诊和漏诊。因为前庭功能检查的解读和实施在临床上尚无统一的标准,有必要对BVP深入研究。分析其发病特征、病因及不同前庭功能检查法在诊断评估中的作用。方法:回顾性分析42例在西京医院眩晕耳聋门诊就诊的BVP患者的症状,检查动态视敏度、双温试验、转椅试验、视频头脉冲试验、前庭肌源诱发电位(颈肌及眼肌)。结果:42例患者主诉症状所占比例分别为站立或行走时头晕不稳(100.0%)、行走或快速头部运动时的振动幻视(50.0%)、静坐或平卧静止时无症状(85.7%)、双侧听力下降(71.4%)、耳鸣(19.0%)。床旁检查动态视敏度25例(69.4%)患者出现受损;前庭试验结果中:(1)双温试验反应减弱;(2)转椅试验增益下降及时间常数缩短;(3)视频头脉冲试验双侧增益下降伴扫视的患者36例,其中明确病因32例,原因不明4例,仅满足(1)+(2)的BVP 6例,其中明确病因者有4例,原因不明者有2例。病因中最常见的为耳毒性药物(14例)。20例患者仍能记录到前庭肌源诱发电位(颈肌或眼肌)。结论:依据前庭功能检查结果,BVP分为全部频率损失型((1)+(2)+(3))和部分频率损失型((1)+(2)),与患者病因相关。BVP是平衡障碍的少见疾病,临床病因复杂,不易确诊。应利用检测法组合以评估双侧前庭功能,前庭肌源诱发电位仅作为辅助诊断的检测方法。Objective：To define clinical and laboratory characteristics of bilateral vestibulopathy（BVP）and to propose diagnostic criteria of this disorder based on clinical and laboratory vestibular function test findings.Method：Forty-two case series with a clinical suspicion of BVP were retrospectively analyzed,in an attempt to determine etiology.Presenting auditory-vestibular symptoms,bedside dynamic visual acuity tests and laboratory test were reviewed,including bithermal caloric test,rotatory chair tests,video head impulse test（vHIT）,vestibular-evoked myogenic potentials（VEMP）.Result：Among these 42 patients,dizziness was seen in 42 cases（100%）,oscillopsia was seen in 21 cases（50%）,hearing loss was seen in 30（71.4%）.Eight cases（19%）had tinnitus.Twenty-five cases showed vestibular loss in dynamic visual acuity test（69.4%）.Definite diagnosis of complete BVP was made in 36 patients when the patients showed abnormal findings on caloric test,rotatory chair test and vHIT in addition to the symptoms.Whereas probable diagnosis of partial BVP was obtained in 6 patients with abnormal caloric test and rotatory chair test but no pathological vHIT.VEMP（ocular or cervical）could be recorded in 20 patients.Fourteen cases were caused by ototoxic drugs while no causes could be determined in 6 cases among these 42 cases.Conclusion：The diagnosis of BVP is a challenge.Vestibular laboratory test battery which reflect full frequency function of VOR has great value to confirming the diagnosis and differentiate complete BVP to partial BVP.Diagnosis standard shall be made combining clinical history,characteristic symptoms and the results of auditory-vestibular function testing.Ototoxic drugs contribute most considering etiology.

关 键 词：双侧前庭病 头晕 前庭眼反射 视频头脉冲试验 前庭肌源诱发电位 

分 类 号：R764.33[医药卫生—耳鼻咽喉科]