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Objective To analyze etiology,clinical manifestation and diagnosis process of vertigo and dizziness in children.Method The clinical data of 82 children with vertigo and dizziness treated in our hospital from January 2006 to December 2016 were retrospectively analyzed.Results There were 46 girls and 36 boys with a female:male ration of 1.28:1.The median age of patients was 9.0 years (14 months-18.0 years) and 21 cases were less than 6 years old.The chief complaints were repeatedly falling,crying,walking unsteadily and scratching the ear for unknown reasons.For children aged ＞ 5 years may express " roof or tent rotation";for those aged ＞ 6-＜ 15 years (n =34),the main complaint was more ambiguous "dizziness";for those aged ≥ 15-≤ 18 years (n =27) with the main complaint of " dizziness" may clearly express the " sense of rotation" or " the feeling of feeling drowsy,the top-heavy sense," and the accompanying deafness,earfullness,tinnitus and so on.Among 82 cases,there were 15 cases of benign paroxysmal vertigo (BPV,18.3％),12 cases of secretory otitis media (SOM,14.6％),11 cases of vestibular migraine (VM,13.4％),9 cases of benign paroxysmal positional vertigo (BPPV,11.0％),8 cases of inner ear malformation (9.8％),8 cases of Meniere's disease (9.8％),7 cases of vestibular neuritis (8.5％),6 cases of sudden deafness with vertigo (7.3％),4 cases of central vertigo (4.9％),1 case of rare genetic disease (1.2％) and 1 case of vertigo due to mental psychological (1.2％).The incidence of BPV,VM and Meniere's disease in girls was higher than that in boys.There was a tendency to self heal in BPV with the age increasing,in 15 BPV cases,8 after 12 years of age,3 after 14 years old had no vertigo attacks,and 4 cases were still in follow-up.The attack frequency of VM was decreased,and the extent was reduced with the age.Children older than 6 years were able to cooperate to vestibular function tests,and the majority completed the tests.Conclusion The analysis shows that the etiology of vertigo and dizziness in children is different from that of adults.Central vertigo and rare genetic disorders with dizziness as the first symptom are of great harmfulness,so intensive observation and multidisciplinary consultations are recommended.
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Objective:To analyze the etiology of repeatedly attacks of intractable vertigo and some types of sensorineural deafness whose clinical manifestation were not in conformity with the known spectrum diseases，and explore the screening method to prevent missed diagnosis or misdiagnosis, then provide references for clinical diagnosis and treatment for rare etiology. Method:The authors retrospectively analyzed the clinical manifestations, diagnosis, treatment and prognosis from 4 cases of vertigo sufferers and 2 cases of hearing impairment sufferers whose serological tests were positive for syphilis. All these 6 cases were treated with large doses of penicillin aqueous solutions (24 million U/d), multi-times intravenous infusion, the course of the treatment was 14 d. Result:The clinical manifestations of these 6 patients were lack of characteristic, as well as the results of hearing and vestibular function, imaging diagnosis. Positive syphilis detection of serology and cerebrospinal fluid tests were the main diagnostic basis. After anti-syphilis treatment, 5 cases got satisfied clinical symptoms improvement, 1 case suffered from low-tone sensorineural hearing loss, whose hearing fluctuated recurrently. Conclusion:Syphilis infection may damage the Ⅷ cranial nerve and then lead to vertigo and hearing loss, through chronic syphilitic osteitis of temporal bone, atrophy of organ of corti, osteolytic lesion surrounding the endolymphatic duct, and neurosyphilis. For patients presented with intractable vertigo, and those whose clinical manifestations are not in conformity with the known diseases of unilateral ear or bilateral ears rapidly progressive deafness, syphilis serology screening and validation tests are recommended in case of missed diagnosis or misdiagnosis.
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Objective To investigate the characteristics of ocular movement disorders in patients with multiple sclerosis (MS) and neuromyelitis optica (NMO), and explore the clinical application of videonystagmograph (VNG) exami?nation in the diagnosis and differential diagnosis of MS. Methods Sixteen MS ,10 NMO and 30 control ( sudden deafness ) patients were enrolled prospectively. Ocular movement disorders including saccades, gaze fixation, smooth pursuits, opto?kinetic nystagmus and spontaneous nystagmus were evaluated by using VNG. Results The positive rate of ocular motility disorders in MS patients detected by VGN was 68.75%. The incidences of abnormalities in saccades, smooth pursuits and optokinetic nystagmus were significantly higher in MS than in control groups (P= 0.000, 0.001 and 0.001, respectively). The positive rate of ocular motility disorders in NMO patients detected by VGN was 80.00%. The incidences of abnormal?ities in saccades, gaze fixation, smooth pursuits and optokinetic nystagmus were significantly higher in NMO than control groups (P=0.000, 0.012, 0.000 and 0.002, respectively). The positive rate of ocular motility disorders was not significant? ly different in MS and MS patients (68.5%vs. 80%,P>0.05). Compared with bedside physical examination, VNG showed a notable higher sensitivity in the detection of ocular motility disorders(68.75% vs. 37.50%). Furthermore, VNG disor?ders might indicate brain lesions undetected by MRI. Conclusion This small sample research indicates that VNG is a valuable tool in the detection of ocular motility disorders as well as brain lesions in MS and NMO patients. However, its role in the differential diagnosis between MS and NMO is not confirmed.
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OBJECTIVE@#To analyze social-psychological causes of acute exacerbation or re-decompensation of chronic tinnitus and provide theoretical basis for controlling and preventing tinnitus exacerbation and re-decompensation.@*METHOD@#Systemic audiological tests and tinnitus handicap inventory were performed on 136 chronic tinnitus patients with acuteexacerbation or re-decompensation. For the patients with new hearing loss, a further investigation of living conditions and assessment of social support rating scale were utilized. The patients with relatively definite causes were treated accordingly.@*RESULT@#(1) There were 89 patients complained of new changes of hearing, all of whom could tell the definite time point of tinnitus exacerbation, and 5 of them felt the exacerbation of hearing loss meanwhile. (2) Forty-two patients encountered adverse events on life or working, and tinnitus exacerbation occurred within several weeks to 3 months afterwards. Most of these patients could not tell the definite time point of tinnitus exacerbation or re-decompensation. Five cases of tinnitus exacerbation didn't tell any adverse events on life or working, but showed mood disorders, and the anti-anxiety treatment was effective to them. (3) Forty-seven cases without new hearing loss scored significantly lower in SSRS than healthy adults.@*CONCLUSION@#Emerging hearing loss is the main cause of acute exacerbation of chronic tinnitus. To find it in time and give effective treatment can save newly presented hearing loss, cure or relieve tinnitus. Adverse events in life(or working) and short of social support is another important cause of acute exacerbation of chronic tinnitus or decompensation recurrence, which suggests that social-psychological factors besides of hearing loss should be concerned in diagnosis and treatment of tinnitus.
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Adult , Humans , Disease Progression , Hearing Loss , Social Support , Tinnitus , PsychologyABSTRACT
OBJECTIVE@#To probe the factors that affect the pure-tone threshold glycerol test and the distribution of frequencies in positive glycerol test.@*METHOD@#We tested the pure-tone threshold before and after glycerol intake in patients with Meniere's disease, and then analyzed the positive rates,distribution of positive frequencies and the time when the maximum threshold changes appeared.@*RESULT@#The positive rate of pure-tone glycerol test was 72.09%, of which the threshold descending rate was 47.67%, and the threshold rebounding rate was 24.42%; the pure-tone threshold changes of descending group and rebounding group were (17.41 +/- 9.92) dB, (13.53 +/- 4.64) dB respectively, and the differences were significant. The distribution of positive frequencies were 250 Hz, 125 Hz, 500 Hz, 1 kHz, 4 kHz, 2 kHz, 8 kHz in descending order. The maximum pure-tone threshold changes mostly appeared within 2 or 3 hours after glycerol intake.@*CONCLUSIONS@#Patient selection, test occasion and the judgement criteria may affect the positive rate of glycerol test; the positive frequencies distribute in the low-frequency region mainly; the maximum pure-tone threshold changes mostly appeared within 2 or 3 hours after glycerol intake.