双侧前庭病病因与诊治分析

Diagnosis of and Management Bilateral Vestibulopathy

目的 分析双侧前庭病的病因 ,并对双侧前庭病的临床表现与诊治进行讨论。方法 本组 10 1例患者均为双侧前庭功能低下 ,对患者现病史、既往史、眼震电图记录、相关的耳科学和听力学检查等进行综合分析。结果 10 1例患者中 ,氨基甙类前庭耳毒 33例 ,占 32 .6 % ;双侧梅尼埃病 18例 ,占 17.8% ;迷路震荡 1例 ,占 1.0 % ;耳硬化症 4例 ,占 4 .0 % ;双侧前庭病 4例 ,占 4 .0 % ;中枢性前庭病 15例 ,占 14 .9% ;原因不明 2 6例 ,占 2 5 .7%。结论 双侧前庭病诊断要根据患者病史、临床表现、体格检查和前庭功能检查 ,尽可能找出病因并对因治疗。如果损害已经产生 ,治疗应该避免应用前庭抑制剂和耳毒性药物 ,并行前庭康复治疗。

Objective To analyze the etiology, discuss the diagnosis and therapy of bilateral vestibulopathy.Methods 101 patients with bilateral vestibulopathy between 1982 and 2002 were reviewed. The diagnosis of bilateral vestibulopathy was made based on history, ENG and related otologic and audiological examination.Results Among the 101 cases,there were 33(33/101) with aminoglycosides intoxication, 18(18/101) bilateral vestibulopathy, 1(1/101) labyrinthe concussion, 4(4/101) otosclerosis, 4(4/101) bilateral vestibulopathy from viral infection, 15(15/101) central vestibulopathy and 26(26/101) with unknown etiology.Conclusion Most of the patients manifested dysequilibrium and oscillopsia. Some of the patients had falling. The otologic symptom included hearing loss,tinnitus and vertigo.In this article, the diagnosis was based on the results of caloric test. And it was of importance to identify the extent of the bilateral vestibulopathy by the references of results of vestibular function tests.Management included finding out the cause and treating it, if possible. The focus of treatment is avoidance of vestibular suppressants and ototoxins.Vestibular rehabilitation is important to promote recovery.