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Clinical, oculographic and vestibular test characteristics of Ménière's disease.
Journal of Neurology ( IF 6 ) Pub Date : 2021-08-22 , DOI: 10.1007/s00415-021-10699-z
Allison S Young 1, 2 , Benjamin Nham 1, 2 , Andrew P Bradshaw 2 , Zeljka Calic 3 , Jacob M Pogson 1 , William P Gibson 4 , G Michael Halmagyi 2 , Miriam S Welgampola 1, 2
Affiliation  

Seventy Ménière's disease (MD) patients with spontaneous vertigo (100%), unilateral aural fullness (57.1%), tinnitus (78.6%), and subjective hearing loss (75.7%) self-recorded nystagmus during their episodes of vertigo using portable video oculography goggles. All demonstrated ictal spontaneous nystagmus, horizontal in 94.3% (n = 66) and vertical in 5.7% (n = 4), with a mean slow-phase velocity (SPV) of 42.8 ± 31.1°/s (range 5.3-160.1). Direction reversal of spontaneous horizontal nystagmus was captured in 58.6%, within the same episode in 34.3%, and over different days in 24.3%. In 18.6%, we observed ipsiversive then contraversive nystagmus, and in 12.9% contraversive to ipsiversive direction reversal. Ictal nystagmus SPV (42.8 ± 31.1°/s) was significantly faster than interictal (1.4 ± 3.1°/s, p < 0.001, CI 34.277-48.776). Compared to age-matched healthy controls, interictal video head impulse test gains in MD ears were significantly lower, cumulative and first saccade (S1) amplitudes were significantly larger, and S1 peak velocities were significantly faster (p = 0.038/0.019/0.008/ < 0.001, CI 0.002-0.071/0.130-1.444/0.138-0.909/14.614-41.506). Audiometry showed asymmetrically increased thresholds in 100% of MD ears (n = 70). Significant caloric, air-conducted (AC) cervical vestibular-evoked myogenic potential (VEMP), and AC ocular VEMP asymmetries were found in 61.4, 37.9, and 44.4% of patients (MD ear reduced). Transtympanic electrocochleography tested in 36 ears (23 patients) showed 81.8% of MD ears had a positive result for hydrops (either a summating potential at 1/2 kHz < - 6 µV, or an SP/AP ratio > 40%). Using ictal nystagmus findings of SPV > 12°/s, and a caloric canal paresis > 25%, we correctly separated a diagnosis MD from Vestibular Migraine with a sensitivity and specificity of 95.7% and 85.1% (CI 0.89-0.97).

中文翻译:

梅尼埃病的临床、眼科和前庭测试特征。

70 名患有自发性眩晕 (100%)、单侧耳闷 (57.1%)、耳鸣 (78.6%) 和主观听力损失 (75.7%) 的梅尼埃病 (MD) 患者在眩晕发作期间使用便携式视频眼动仪自我记录眼球震颤风镜。所有显示发作期自发性眼球震颤,水平 94.3% (n = 66) 和垂直 5.7% (n = 4),平均慢相速度 (SPV) 为 42.8 ± 31.1°/s(范围 5.3-160.1)。自发性水平眼球震颤方向反转的发生率为 58.6%,同一事件中发生率为 34.3%,不同天数发生率为 24.3%。在 18.6% 中,我们观察到同向性然后是反向性眼球震颤,在 12.9% 中观察到同向性反向眼球震颤。发作期眼球震颤 SPV (42.8 ± 31.1°/s) 明显快于发作间期 (1.4 ± 3.1°/s, p < 0.001, CI 34.277-48.776)。与年龄匹配的健康对照组相比,MD 耳的发作间期视频头部脉冲测试增益显着降低,累积和第一次扫视 (S1) 幅度显着更大,S1 峰值速度显着加快 (p = 0.038/0.019/0.008/ < 0.001,CI 0.002-0.071/0.130-1.444/0.138-0.909/14.614-41.506)。测听显示 100% 的 MD 耳朵(n = 70)的阈值不对称增加。在 61.4%、37.9% 和 44.4% 的患者(MD 耳减少)中发现了显着的热量、空气传导 (AC) 颈前庭诱发肌源性电位 (VEMP) 和 AC 眼部 VEMP 不对称。在 36 只耳朵(23 名患者)中测试的经鼓室耳蜗电图显示 81.8% 的 MD 耳朵有水肿阳性结果(1/2 kHz 时的总和电位 < - 6 µV,或 SP/AP 比率 > 40%)。使用 SPV 的发作期眼球震颤结果 >
更新日期:2021-08-22
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