前庭感受器病——一种尚未认知的外周前庭疾病及航空医学鉴定

Aeromedical evaluation of vestibular receptor disease as an unrecognized peripheral vestibular disease

目的分析飞行员前庭功能检查资料,定义一种尚未认知的前庭感受器病(vestibular receptor disease,VRD),提出航空医学鉴定原则。方法收集空军特色医学中心前庭功能检查异常的8份资料,其中高性能歼击机改装体检飞行员资料7份,因眩晕住院的歼击机飞行员病历资料1份。前庭功能检查包括双温试验、视频头脉冲试验(video head impulse test,v-HIT)、旋转试验、前庭自旋转试验(vestibular autorotation test,VAT)、前庭诱发肌源性电位(vestibular evoked myogenic potentials,VEMP)、感觉统合试验(sensoryorganizationtest,SOT)、视眼动系统检查等,并行纯音和声导抗检查、颅脑MRI及全身系统检查。结果(1)8例歼击机飞行员均排除了全身疾病、耳蜗病变和中枢性眩晕疾病。(2)8例温度试验均有单侧水平半规管功能减低,其中1例为早期资料,旋转试验、VAT均异常,因未行v-HIT和VEMPs检查,无眩晕病史,故不支持前庭神经炎(vestibular neuritis,VN),也不排除VRD诊断;v-HIT检查1例仅有水平半规管增益低,1例水平半规管+上半规管增益低,但该2例VEMPs均正常,其余5例v-HIT均正常,该7例病变在前庭感受器而不在前庭神经,故被定义为VRD。(3)1例不除外VRD者,因拟改单座歼击机,经地面观察3个月后结论为飞行合格(限双座),3个月后返院复查;7例VRD者,2例拟改双座歼击机的飞行员按个别评定,结论为飞行合格,6个月后返院复查;4例拟改单座机的飞行员,按特许医学鉴定,结论为飞行合格,6个月后返院复查;1例急性眩晕者,暂时飞行不合格,地面观察3个月返院复查。结论VRD和VN为不同的外周前庭疾病实体,应根据VRD的分类、分期、分型和分度,对双座机飞行人员进行个别评定,对单座歼击机飞行员进行特许医学鉴定。

Objective To analyse the results of vestibular function examinations of pilots,to define a vestibular receptor disease(VRD)as an unrecognized peripheral vestibular disease,and to propose principles of aeromedical evaluation.Methods The results of eight examinations of abnormal vestibular function at the Air Force Medical Center were collected,including seven related to pilots who had been examined for eligibility to fly upgraded high-performance fighters and one medical record of a fighter pilot who had been recently hospitalized due to vertigo.Vestibular function tests included the coloric test,video head impulse test(v-HIT),rotation test,vestibular autorotation test(VAT),vestibular evoked myogenic potential(VEMP),sensory organization test(SOT),visual eye movement system examinations as well as pure tone audiometry and acoustic immittance test and cranial MRI and systemic examinations.Results①Systemic diseases,cochlear lesions and central vertigo diseases were excluded among the eight fighter pilots.②The coloric test indicated that all the eight cases had had their unilateral horizontal semicircular canal function reduced.The results of the rotation test and VAT were abnormal in one of these cases,but vestibular neuritis(VN)was not confirmed,nor was VRD excluded,because this pilot had not undergone v-HIT or VEMP examination,and without a history of vertigo.One case had only horizontal semicircular canal low gain,one case experienced horizontal semicircular canal+superior canal low gain on v-HITs,but these two cases were normal on VEMP,while the remaining 5 cases were normal on v-HITs.The lesions of seven cases were in vestibular receptors rather than in vestibular nerves.Therefore,they were defined as cases of VRD.③Among the seven cases of VRD,two were permitted to fly two-seater fighters,and four were given the qualifications to fly single-seat fighters.One case of acute vertigo was temporarily grounded,who returned to the hospital for reexamination after three months of ground observation.Conclusion VRD and VN are different diseases.Two-seat aircraft flight personnel should be individually evaluated,while the single-seat fighter pilots should be evaluated for medical waiver according to the classification,staging,typing and grading of VRD.