| Vertigo and dizziness are common symptoms in clinical.Its pathogenesis and clinical manifestations related to many disciplines including neurology,ear nose throat department and ophthalmology and some related professional knowledge.This means that doctors should have the high capacity to diagnose the Vertigo and dizziness disease.Certainly relevant vestibular function tests are in important position.However the technology is confined to vestibular function testing which can only assess low-frequency horizontal semicircular canal function but not be able to meet the need for clinical.In recent 20 years,with the development of video head impulse test(vHIT)and vestibular evoked myogenic potentials(VEMPs)for the detection of high frequency function and otolith function,Especially the clinical application of ocular vestibular evoked myogenic potentials(o VEMP),otolith function evaluation measures made great progress.At present,Cervical vestibular evoked myogenic potentials(cVEMP),ocular vestibular evoked myogenic potentials(o VEMP)and video head impulse test(vHIT)have become a routine examinational technology in foreign countries.But it is late in China and the related informations are still lacking.So in order to replenish the relevant knowledge we will assess the value of VEMPs and vHIT in the diagnosis of vertigo and dizziness in this study.Objective Through studing the performance of VEMPs and vHIT in healthy people and the patients with different kinds of vertigo.We will establish establish the normal values of VEMPs and explore the effects of age on VEMPs.Meanwhile we will assess the clinical value of VEMPs and vHIT in vestibular neuritis and vestibular migraine.Otherwise,the applicational values of VEMPs and vHIT are evaluate in the diagnosis of vertigo or dizziness with unknown etiology.Methods Healthy volunteers including the doctors,nurses,graduate students and the families of patients are recruited from our hospital.Patients with vertigo or dizziness are from neurology department at our hospital and they diagonosed from october 2015 to november 2016.All medical histories and examinational data should be recorded in detail.Diagnosis of vertigo or dizziness relied on guideline and the standards which applied internationally.Then we would use the appropriate statistical methods to get the normal value of VEMPs and analyze the influence of age on it.Meanwhile we will assess the clinical value of VEMPs and vHIT in vestibular neuritis and vestibular migraine.Otherwise the applicational value of VEMP and vHIT are evaluated in the diagnosis of vertigo or dizziness with unknown etiology.Results 1.The cVEMP response rates in 176 volunteers who are less than 60 years old,61~70 years old and over 70 years old are 100%,86.90% and 81.81%.And the latter two groups displayed low response rates(P<0.01)significantly.The mean threshold is(83.43±6.48)d Bn HL and the threshold is minimum in the group less than 20 years old and maximum in the group over 70 years(P<0.01).Meanwhile,When increasing 20 years old,the threshold increases significantly(P<0.05).The mean amplitude is(280.93±114.06)μV.Each increase of 10 years old,the amplitude decreased obviously(P<0.05),but there is no significant difference between 41~50 years old and 51~60 years old(P=0.87).The mean P1 latency is(14.07±1.03)ms which prolongs over 70 years old(P<0.01).The mean N1 latency is(22.43±1.88)ms which shows the shortest in the group less than 20 years(P<0.01)and the longest in the group over 70 years(P<0.01).There is no significant difference in asymmetric rate of threshold,amplitude,P1 latency and N1 latency in different age groups(P>0.05).2.The o VEMP response rates in 176 volunteers who are less than 60 years old,61~70 years old and over 70 years old are 100%,82.60% and 68.18%.And the latter two groups displayed low response rates(P<0.01)significantly.The mean threshold is(86.19±5.41)d Bn HL and the threshold is minimum in the group less than 20 years old(P<0.05)and maximum in the group 60~70 years old and over 70 years old(P<0.01).The mean amplitude is(5.61±3.71)μV which is maximum in the group less than 20 years old(P<0.05)and minimum in the group over 60 years old(P<0.05).There is no significant difference between age groups of 21~30,31~40,41~50 and 51~60 years old(P>0.05).The mean P1 latency is(14.68±1.32)ms which prolongs over 70 years old(P<0.01).The mean N1 latency is(10.09±0.82)ms which shows the shortest in the group less than 20 years(P<0.05)and the longest in the group over 70 years(P<0.01).In the 21~30 years old,each increase of 20 years old,the N1 latency prolongs obviously(P<0.05).There is no significant difference in asymmetric rate of threshold,amplitude,P1 latency and N1 latency in different age groups(P>0.05).3.In 59 vestibular neuritis patients,VEMPs is abnormal in 54(91.52%)patients.Abnormal vHIT is founded in 56(94.91%)patients and the Caloric test(CT)is abnormal in 56(94.91%)patients.There is no significant difference in them.There are 28(47.46%)patients acquiring abnormal o VEMP,Anterior canal(AC),Horizontal canal(HC)in vHIT and CT.And there are 24(40.68%)patients acquiring abnormal o VEMP,cVEMP,AC,HC,Posterior canal(PC)in vHIT and CT.And then 1(1.69%)patient is found to have abnormal cVEMP and PC in vHIT.At the same time,2(3.39%)patients are found to have abnormal HC in vHIT and CT.Otherwise,2(3.39%)patients are found to have abnormal HC,AC in vHIT and CT and 2(3.39%)patients are found to have single abnormity in o VEMP.So there are 28(47.46%)patients with a functional impairment of the superior vestibular nerve,24(40.68%)patients with a functional impairment of the superior and inferior vestibular nerve,1(1.69%)patient with a functional impairment of the inferior vestibular nerve and 6(10.17%)patients with a functional impairment of the ending vestibular nerve.the incidence rate of superior vestibular nerve damage and superior and inferior vestibular nerve damage is higher than it of inferior vestibular nerve damage and ending vestibular nerve damage(P<0.01).The incidence rae is no significant difference between superior vestibular nerve damage and superior and inferior vestibular nerve damage(X2=0.55,P=0.45).4.In 52 vestibular migraine patients,there are 42(80.77%)patients carrying abnormal VEMPs,3(5.8%)carrying abnormal vHIT and 16(30.77%)carrying abnormal CT.So the abnormal rate of VEMPs is the highest(P<0.01)and vHIT is the lowest(P<0.01).Among them,there are 18(34.62%)patients getting abnormal o VEMP singlely,4(7.69%)patients getting abnormal cVEMP singlely,9(17.31%)patients getting abnormal cVEMP and o VEMP,7(13.46%)patients getting abnormal o VEMP and CT,1(1.92%)patient getting abnormal cVEMP and CT,3(5.77%)patients getting abnormal cVEMP,o VEMP and CT,2(3.85%)patients getting abnormal vHIT and CT,3(5.77%)patients getting abnormal CT,1(1.92%)patient getting abnormal vHIT and 4(7.69%)patients getting normal VEMPs,vHIT and CT.The abnormal rate of o VEMP is the highest(P<0.05).5.In 143 undiagnosed patients with non central vertigo and dizziness,there are 93(65.03%)obtaining abnormal VEMPs,46(32.17%)obtainng abnormal vHIT,And 48(33.57%)patients obtaining abnormal CT.So the abnormal rate of VEMPs is the highest(P<0.01)and there is no significant difference between abnormal vHIT and abnormal CT(X2=0.06,P=0.80).Among them,there are 18(12.59%)only getting abnormal cVEMP,31(21.68%)patients only getting abnormal o VEMP,24(16.78%)patients getting abnormal cVEMP and o VEMP,17(11.89%)patients only getting abnormal vHIT,19(13.29%)patients only getting abnormal CT,14(9.79%)patients getting abnormal vHIT and CT,7(4.90%)patients getting abnormal o VEMP,vHIT and CT,3(2.10%)patients getting abnormal cVEMP,o VEMP,vHIT and CT,3(2.10%)patients getting abnormal cVEMP,o VEMP and vHIT,2(1.39%)patients getting abnormal cVEMP,o VEMP and CT,2(1.39%)patients getting abnormal o VEMP and vHIT and 3(2.10%)patients getting abnormal o VEMP and CT.The abnormal rate of o VEMP which occur alone is higher than it of cVEMP(X2=4.16,P<0.05)and there is no significant difference among the abnormal rate of vHIT that occur alone,CT that occur alone and the abnormal rate of vHIT combined CT(P>0.05).6.In 143 undiagnosed patients with non central vertigo and dizziness,there are 68(47.55%)patients getting the symptom of experienced vertigo,15(10.49%)patients getting experienced oscillopsia,37(25.88%)patients getting experienced disequilibrium and 23(16.08%)patients getting experienced unsteadiness.The incidence rate of vertigo is the highest in undiagnosed patients with non central vertigo and dizziness(P<0.01).Compared with the incidence rate of vertigo and oscillopsia,the rate of disequilibrium and unsteadiness is the highest in abnormal cVEMP(X2=7.85,P<0.01).And there is no significant difference between the rate of vertigo or oscillopsia and the rate of disequilibrium or unsteadiness in abnormal o VEMP(X2=0.02,P=0.89).Meanwhile,compared with the rate of disequilibrium and unsteadiness,the rate of vertigo and oscillopsia is the higher in abnormal vHIT(X2=12.53,P<0.01).Otherwise,in abnormal CT,the rate of vertigo and oscillopsia is higher than it of disequilibrium and unsteadiness(X2=16.92,P<0.01).Conclusions: 1.With the age growing,the otolith function decreased and would decline more significantly after 60 years old.2.VEMPs conbined vHIT can get exact location in the damage of vestibular nerve,especially the damage of inferior vestibular nerve.3.In vestibular migraine,the main damage is utricular pathway and the low frequency semicircular canal function is also one of the reason.4.In undiagnosed cases with non central vertigo and dizziness,the abnormity of otolith organ are the most common conditions.The main symptoms of the utricular lesions are vertigo or disequilibrium and the most common vestibular symptom is disequilibrium in the saccular lesions. |
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