水平半规管良性阵发性位置性眩晕与前庭性偏头痛性眩晕的听-前庭功能比较

Auditory-Vestibular Function in Benign Paroxysmal Positional Vertigo and Vestibular Migraine with Vertigo

目的比较水平半规管良性阵发性位置性眩晕(BPPV)与前庭性偏头痛(VM)性眩晕患者的听-前庭功能差异。方法收集2016年11月-2017年11月潍坊医学院附属医院眩晕中心门诊收治的水平半规管良性阵发性位置性眩晕患者30例及前庭性偏头痛性眩晕患者33例。所有患者均进行听-前庭功能检查,检查项目包括纯音测试、眼震检查、冷热试验及前庭诱发的肌源性电位(VEMP)等。结果 30例水平半规管BPPV患者纯音测听异常率为23.3%(7/30),7例纯音异常患者均属单侧轻度或中度感音神经性聋;中枢性眼动异常率为26.7%(8/30),均为扫视试验异常;冷热试验异常率为83.3%(25/30),均为单侧前庭反应减弱;VEMP异常率为13.3%(4/30),其中7例显示患侧低振幅,2例显示患侧P13波潜伏期延长;接受ABR检查的患者共12例,异常率为58.3%(7/12),均显示为单侧异常。33例MV患者纯音测听异常率为24.2%(8/33),均属单侧感音神经性聋;眼震检查中枢性眼动异常率为48.5%(16/33),冷热试验异常率为21.2%(7/33),VEMP异常率为51.5%(17/33),接受ABR检查的患者共15例,异常率为26.7%(4/15)。经统计分析,二者的冷热试验异常率(t=13.62,P=0.000)、中枢性眼动异常率(t=9.65,P=0.000)、VEMP异常率(t=5.76,P=0.000)均显著高于前庭性偏头痛性眩晕。结论与前庭性偏头痛性眩晕相比,水平半规管良性阵发性位置性眩晕显示出更高的冷热试验异常率和较低的中枢性眼动异常率,可以为二者的诊断与鉴别提供参考。

Objective To compare auditory-vestibular function between patients with benign paroxysmal positional vertigo(BPPV) and vestibular migraine(VM) vertigo. Methods Thirty patients with benign paroxysmal positional vertigo and 33 patients with vestibular migraine vertigo seen at the Vertigo Clinic, Weifang Medical College, from November2016 to November 2017 were enrolled. All patients underwent auditory-vestibular function tests including pure tone audiometry, nystagmus tests, caloric tests and vestibular evoked myogenic potentials(VEMP). Results In the 30 BPPV patients, the rate of abnormal audiometry was 23.3%(7/30), all showing unilateral mild or moderate sensorineural deafness. The rate of central eye movement abnormalities was 26.7%(8/30), the rate of abnormal caloric test was 83.3%(25/30), and the rate of abnormal VEMPs was 13.3%(4/30). Of the 12 patients who underwent ABR testing, the rate of abnormality was 58.3%(7/12). The rate of abnormality was higher in patients with BPPV than in patients with vestibular migraine vertigo for caloric test(t=13.62, P=0.000), eye movement(t=9.65, P=0.000) and VEMP(t=5.76, P=0.000).Conclusions Compared with vestibular migraine, benign paroxysmal positional vertigo is associated with higher rates of abnormal caloric tests, ocular movement, VEMPs and ABRs, which can be used for diagnosis and differential diagnosis.