急性前庭综合征后遗姿势症状患者的前庭功能与康复疗效分析
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摘要
目的:探讨外周性急性前庭综合征(AVS)遗留慢性姿势症状患者的前庭功能状况及前庭康复治疗的效果。方法:对37例患者采用冷热试验、摇头试验和颈源性、眼源性前庭诱发肌源性电位(VEMP)进行半规管和耳石器功能评估。采用前庭康复治疗,疗程2个月,根据VEMP结果分为不伴耳石器功能损伤组(A组)和伴耳石器功能损伤组(B组)进行疗效评估,疗效评估采用前庭症状指数(VSI)及Berg平衡量表(BBS)。结果:冷热试验和摇头试验共阳性33例(86.5%),两者均出现阳性结果23例(65.7%),A组22例(59.5%),B组15例(40.5%)。治疗前VSI中的平衡、头晕症状评分B组高于A组,BBS评分A组高于B组,差异有统计学意义(均P<0.05)。两组前庭康复治疗后VSI评分较治疗前明显降低,而BBS评分明显提高,差异均有统计学意义。结论:外周性AVS遗留慢性姿势症状患者均伴不同程度和范围的动态前庭功能损伤,伴耳石器功能损害者平衡功能更差,但通过前庭康复治疗均能获得明显改善。
Objective:To investigate the status of the vestibular function of the patients with chronic positional symptoms after peripheral acute vestibular syndrome(AVS)and the curative effect of the vestibular rehabilitation therapy(VRT).Method:Using caloric test(CT),head shaking nystagmus test(HST),cervical vestibular evoked myogenic potentials as well as ocular vestibular evoked myogenic potentials to estimate the function of semicircular canal and otolith organs.The patients with normal VEMPs are divided as Group A.Otherwise are as Group B.Both groups are treated with VRT.The curative effect is estimated by vestibular symptom index(VSI)and Berg balance scale(BBS).Result:Thirty-three of 37 patients (86.5%)had an abnormal result of CT and HST,with 23 of these patients (65.7%)had an abnormal of both test.Twenty-two patients (59.5%)were in Group A and 15(40.5%)in Group B.Before the therapy,Group B had a higher score of the balance and dizziness symptoms of VSI(P<0.05),and Group A had a higher score of the BBS(P<0.05).After the therapy,the VSI scores of both groups dropped and scores of the BBS raised.Conclusion:Patients with chronic positional symptoms after peripheral AVS have dynamic vestibular lesions to different extents.Those with otolith organs lesions tend to have a worse function of balance.Nevertheless,patients have a better off after VRT.
Objective:To investigate the status of the vestibular function of the patients with chronic positional symptoms after peripheral acute vestibular syndrome(AVS)and the curative effect of the vestibular rehabilitation therapy(VRT).Method:Using caloric test(CT),head shaking nystagmus test(HST),cervical vestibular evoked myogenic potentials as well as ocular vestibular evoked myogenic potentials to estimate the function of semicircular canal and otolith organs.The patients with normal VEMPs are divided as Group A.Otherwise are as Group B.Both groups are treated with VRT.The curative effect is estimated by vestibular symptom index(VSI)and Berg balance scale(BBS).Result:Thirty-three of 37 patients (86.5%)had an abnormal result of CT and HST,with 23 of these patients (65.7%)had an abnormal of both test.Twenty-two patients (59.5%)were in Group A and 15(40.5%)in Group B.Before the therapy,Group B had a higher score of the balance and dizziness symptoms of VSI(P<0.05),and Group A had a higher score of the BBS(P<0.05).After the therapy,the VSI scores of both groups dropped and scores of the BBS raised.Conclusion:Patients with chronic positional symptoms after peripheral AVS have dynamic vestibular lesions to different extents.Those with otolith organs lesions tend to have a worse function of balance.Nevertheless,patients have a better off after VRT.
引文
[1]BISDORFF A R,STAAB J P,NEWMAN-TOKER D E,et al.Overview of the International Classification of Vestibular Disorders[J].Neurol Clin,2015,33:541-550.
[2]崔世磊,马中华,刘欣欣,等.基于头脉冲-眼震-扭转偏斜检查法的急性前庭综合征病因分析[J].中国耳鼻咽喉头颈外科,2015,22(5):239-243.
[3]BISDORFF A,VON BREVERN M,LEMPERT T,et al.Classification of vestibular symptoms:towards an international classification of vestibular disorders[J].J Vestib Res,2009,19:1-13.
[4]冯智英,杨晓岚,沈摇沸,等.前庭症状的分类:迈向前庭疾患的国际分类[J].神经病学与神经康复学杂志,2012,9(3):127-137.
[5]吴子明,张素珍.前庭症状国际分类与解析[J].中华耳科学杂志,2015,13(1):187-189.
[6]CORNA S,NARDONE A,PRESTINARI A,et al.Comparison of Cawthorne-Cooksey exercises and sinusoidal support surface translations to improve balance in patients with unilateral vestibular deficit[J].Arch Phys Med Rehabil,2003,84:1173-1184.
[7]BLACK F O,ANGEL C R,PESZNECKER S C,et al.Outcome analysis of individualized vestibular rehabilitation protocols[J].Am J Otol,2000,21:543-551.
[8]MANZARI L,BURGESS A M,MACDOUGALL H G,et al.Vestibular function after vestibular neuritis[J].Int J Audiol,2013,52:713-718.
[9]DEVEZE A,BERNARD-DEMANZE L,XAVIER F,et al.Vestibular compensation and vestibular rehabilitation.Current concepts and new trends[J].Neurophysiol Clin,2014,44:49-57.
[10]KAMMERLIND A S,LEDIN T E,SKARGREN E I,et al.Long-term follow-up after acute unilateral vestibular loss and comparison between subjects with and without remaining symptoms[J].Acta Otolaryngol,2005,125:946-953.
[11]COUSINS S,CUTFIELD N J,KASKI D,et al.Visual dependency and dizziness after vestibular neuritis[J].PLoS One,2014,9:e105426.
[12]BITTAR R S,LINS E M.Clinical characteristics of patients with persistent postural-perceptual dizziness[J].Braz J Otorhinolaryngol,2015,81:276-278.
[13]CHOI K D,OH S Y,KIM H J,et al.Recovery of vestibular imbalances after vestibular neuritis[J].Laryngoscope,2007,117:1307-1312.
[14]刘波,孔维佳,赖嫦芹,等.单侧外周前庭病变患者亚急性期的半规管轻瘫程度与静态姿势平衡[J].中华耳科学杂志,2008,6(3):306-309.
[15]SLATTERY E L,SINKS B C,GOEBEL J A.Vestibular tests for rehabilitation:applications and interpretation[J].Neuro Rehabilitation,2011,29:143-151.
[16]ADAMEC I,KRBOT SKORIC M,OZRETIC D,et al.Predictors of development of chronic vestibular insufficiency after vestibular neuritis[J].J Neurol Sci,2014,347:224-228.
[17]DEVEZE A,BERNARD-DEMANZE L,XAVIER F,et al.Vestibular compensation and vestibular rehabilitation.Current concepts and new trends[J].Neurophysiol Clin,2014,44:49-57.
[18]MURRAY K J,HILL K,PHILLIPS B,et al.Does otolith organ dysfunction influence outcomes after a customized program of vestibular rehabilitation[J]?J Neurol Phys Ther,2010,34:70-75.
[19]孔维佳,刘波,冷样名,等.眩晕疾病的个体化综合治疗[J].临床耳鼻咽喉头颈外科杂志,2008,22(4):145-149.
[20]王密,卢伟.前庭康复治疗对平衡障碍患者的疗效分析[J].听力学及言语疾病杂志,2015,23(3):230-233.
[2]崔世磊,马中华,刘欣欣,等.基于头脉冲-眼震-扭转偏斜检查法的急性前庭综合征病因分析[J].中国耳鼻咽喉头颈外科,2015,22(5):239-243.
[3]BISDORFF A,VON BREVERN M,LEMPERT T,et al.Classification of vestibular symptoms:towards an international classification of vestibular disorders[J].J Vestib Res,2009,19:1-13.
[4]冯智英,杨晓岚,沈摇沸,等.前庭症状的分类:迈向前庭疾患的国际分类[J].神经病学与神经康复学杂志,2012,9(3):127-137.
[5]吴子明,张素珍.前庭症状国际分类与解析[J].中华耳科学杂志,2015,13(1):187-189.
[6]CORNA S,NARDONE A,PRESTINARI A,et al.Comparison of Cawthorne-Cooksey exercises and sinusoidal support surface translations to improve balance in patients with unilateral vestibular deficit[J].Arch Phys Med Rehabil,2003,84:1173-1184.
[7]BLACK F O,ANGEL C R,PESZNECKER S C,et al.Outcome analysis of individualized vestibular rehabilitation protocols[J].Am J Otol,2000,21:543-551.
[8]MANZARI L,BURGESS A M,MACDOUGALL H G,et al.Vestibular function after vestibular neuritis[J].Int J Audiol,2013,52:713-718.
[9]DEVEZE A,BERNARD-DEMANZE L,XAVIER F,et al.Vestibular compensation and vestibular rehabilitation.Current concepts and new trends[J].Neurophysiol Clin,2014,44:49-57.
[10]KAMMERLIND A S,LEDIN T E,SKARGREN E I,et al.Long-term follow-up after acute unilateral vestibular loss and comparison between subjects with and without remaining symptoms[J].Acta Otolaryngol,2005,125:946-953.
[11]COUSINS S,CUTFIELD N J,KASKI D,et al.Visual dependency and dizziness after vestibular neuritis[J].PLoS One,2014,9:e105426.
[12]BITTAR R S,LINS E M.Clinical characteristics of patients with persistent postural-perceptual dizziness[J].Braz J Otorhinolaryngol,2015,81:276-278.
[13]CHOI K D,OH S Y,KIM H J,et al.Recovery of vestibular imbalances after vestibular neuritis[J].Laryngoscope,2007,117:1307-1312.
[14]刘波,孔维佳,赖嫦芹,等.单侧外周前庭病变患者亚急性期的半规管轻瘫程度与静态姿势平衡[J].中华耳科学杂志,2008,6(3):306-309.
[15]SLATTERY E L,SINKS B C,GOEBEL J A.Vestibular tests for rehabilitation:applications and interpretation[J].Neuro Rehabilitation,2011,29:143-151.
[16]ADAMEC I,KRBOT SKORIC M,OZRETIC D,et al.Predictors of development of chronic vestibular insufficiency after vestibular neuritis[J].J Neurol Sci,2014,347:224-228.
[17]DEVEZE A,BERNARD-DEMANZE L,XAVIER F,et al.Vestibular compensation and vestibular rehabilitation.Current concepts and new trends[J].Neurophysiol Clin,2014,44:49-57.
[18]MURRAY K J,HILL K,PHILLIPS B,et al.Does otolith organ dysfunction influence outcomes after a customized program of vestibular rehabilitation[J]?J Neurol Phys Ther,2010,34:70-75.
[19]孔维佳,刘波,冷样名,等.眩晕疾病的个体化综合治疗[J].临床耳鼻咽喉头颈外科杂志,2008,22(4):145-149.
[20]王密,卢伟.前庭康复治疗对平衡障碍患者的疗效分析[J].听力学及言语疾病杂志,2015,23(3):230-233.