前庭自旋转试验检测结果分析

Evaluation of results of vestibular autorotation testing

目的分析眩晕及平衡功能紊乱病人的前庭自动旋转试验(VestibularAutorotationTest,VAT)检测结果,探讨VAT的临床应用价值。方法对65例眩晕及平衡功能障碍的患者在完成全面临床检查及耳神经功能检查的基础上行VAT测试。结果(1)单侧外周前庭功能损害10例,主要表现为水平前庭-眼反射(VOR)相位延迟及低增益,4例伴有非对称性异常,可伴有垂直VOR相位延迟及增益异常。(2)双侧外周前庭功能低下5例,非对称性均正常,主要表现为垂直VOR相位延迟及增益异常。(3)良性阵发性位置性眩晕(benignpositionalparoxysmalvertigo,BPPV)27例,其中有9例合并噪声性听力损失,主要异常表现为垂直VOR相位延迟和水平或垂直VOR高增益,部分可伴有水平VOR相位延迟。(4)可疑中枢性病变7例,多表现为水平VOR高增益和垂直VOR相位延迟。结论VAT能反应眩晕病人垂直VOR异常以及传统前庭功能检测不能显示的高频水平VOR异常,高频旋转试验是对前庭功能检测技术的发展和完善。

Objective The purpose of this study was to analyse the vestibular autorotation test （VAT） results in patients with vertigo and disequilibrium and to evaluate rationality of VAT in clinical practice. Methods Sixty-five patients with vertigo and disequilibrium were studied with VAT after undergoing a thorough neuro-otologic evaluation and other relevant clinical examinations. Results （ 1 ）Ninety percent of the 10 patients with unilateral peripheral lesions, showed abnormal VAT results. Lag of the horizontal phase was significantly higher in this group. Four patients had abnormal VAT high-frequency asymmetry. Lag of the vertical phase and decreased vertical gain can occur. （2） All 5 patients with bilateral peripheral lesions had normal horizontal asymmetry. The main abnormalities found in this group was lag of the vertical phase and decreased horizontal or vertical gain. （3） Seventy-seven patients suffered from benign positional paroxysmal vertigo （BPPV）, one-third of them associated with noise-induced hearing loss. The main abnormalities found in this group were lag of the vertical phase and higher horizontal or vertical gain, part of whom might have lag of the horizontal phase. （4） Seven patients with central vestibular lesion mainly showed lag of the vertical phase and decreased horizontal gain. Conclusion The results suggest that in patients with vertigo and disequilibrium VAT may reveal their abnormal vertical vestibule-ocular reflex （VOR）, as well as high-frequency horizontal VOR ab- normalities, and the latter can not be disclosed by using conventional vestibular testing. Therefore high-frequency rotational tearing is a valuable addition to the present vestibular test battery.