飞行人员前庭神经元炎的特点及医学鉴定

Characteristics and medical identification of vestibular neuritis in pilots

目的总结飞行人员前庭神经元炎的临床特点及航空医学鉴定原则。方法收集我院1966年-2011年因前庭神经元炎住院的14例飞行人员临床资料,分析其临床特点、诊疗经过及航空医学鉴定结论。结果 14例中,单耳发病13例,双耳发病1例,6例在发病前有明确的上呼吸道感染病史。14例均为急性发作和单次发作型,以突然发生旋转性眩晕伴恶心、呕吐、出汗为主要表现,无明显耳鸣、听力下降,无其他神经系统症状。12例患者前庭功能检查异常,11例观察到偏向健侧的自发性眼震,症状持续1-8周。所有患者均在治疗1-3个月后症状改善或消失。患病后1年内,10例前庭功能恢复正常,4例仍有前庭功能异常。13例飞行合格,1例飞行不合格。结论前庭神经元炎是飞行人员外周性眩晕疾病中可以完全治愈并恢复飞行的疾病,但恢复飞行之前必须进行全面的前庭功能评价,根据病情特点、前庭功能恢复情况并结合飞行机种、飞行职务进行医学鉴定。

Objective To summarize the clinical characteristics of vestibular neuritis in pilots and its aeromedical identification principles. Methods Clinical characteristics, diagnosis and treatment, and aeromedical evaluation of 14 pilots with vestibular neuritis admitted to our hospital from 1966 to 2011 were analyzed. Results Of the 14 pilots with vestibular neuritis, 13 were diagnosed with unilateral vestibular neuritis, 1 was diagnosed with bilateral vestibular neuritis, and 6 were found to have a history of upper respiratory tract infection before the onset of vestibular neuritis. The 14 pilots were diagnosed as acute onset type and single onset type of vestibular neuritis, and mainly manifested as sudden vertigo companying nausea, vomit and sweating, with no significant tinnitus, hearing loss, and other neurological symptoms. Of the 14 pilots with vestibular neuritis, 12 showed abnormal vestibular function, 11 displayed spontaneous nystagmus in the healthy side. The sumptoms lasted 1-8 weeks. The symptoms improved or disappeared 1-3 months after treatment. The vestibular function was recovered in 10 pilots and remained abnormal in 4 pilots 1 year after the onset of vestibular neuritis. Of the 14 pilots with vestibular neuritis, 13 returned to flight and I was grounded after treatment. Conclusion Vestibular neuritis is a peripheral vertigo disease and can be completely cured. Although pilots with it can finally return to flight after treatment, they should receive a comprehensive medical identification of their vestibular function before they return to flight according to the clinical characteristics of the disease, the recovery of vestibular function, the plane species of aircraft and the flight duty of pilots.