Effects of vestibular spontaneous nystagmus on visual smooth pursuit function / 中华耳鼻咽喉头颈外科杂志

Objective: The aim of the study is to analyze the effects of vestibular spontaneous nystagmus(SN) on the smooth pursuit function of visual ocularmotor system. Methods: A total of 46 patients with acute unilateral peripheral vestibular syndrome with SN (26 cases of vestibular neuritis, 6 cases of Ramsay Hunt Syndrome (RHS) with vertigo, 14 cases of sudden deafness with vertigo) were included in this work. In the study group, the results of SPT and SN test with videonystagmography(VNG) were also reviewed. Taking SPT parameters, the influence of SN intensity on SPT gain, asymmetry and waveform and their correlation were analyzed.SPSS19.0 software was used for statistical analysis. Results: Among the 46 patients, there were 36 cases of SN pointing to the healthy side(SN intensity range of 2.68°/s-32.53°/s), and 10 cases of SN pointing to the affected side (SN intensity range of 2.66°/s-16.54°/s). SN intensity was divided into 3 groups, including light(0.50°/s-5.00°/s), medium(5.01°/s-10.00°/s) and strong(>10.01°/s), accounting for 14 cases(30.4%), 18 cases(39.1%) and 14 cases(30.4%), respectively. The differences of the gain of SPT to the fast phase and slow phase direction in the overall groups and light, medium and strong groups of SN intensity respectively were statistically significant(ttotal=13.338, tlight=6.184, tmedium=8.436, tstrong=8.477, all of P<0.001). The difference of SPT gain in SN fast phase direction between groups with different SN intensity was statistically significant(F=9.639, P<0.001),there was no statistically significant difference in SPT gain between the groups on the SN slow phase direction(F=1.137, P=0.330).The SN intensity significantly negatively correlated with the SPT gain of the fast phase direction of SN (r=-0.433, P=0.003), that was, the SPT gain on the fast phase direction of SN decreased with the increase of SN intensity. There was no significant correlation between SN intensity and the gain of SPT on the slow phase direction of SN (r=-0.061, P=0.687). SPT waveform analysis showed that type I, type II and type III accounted for 8 cases(17.4%), 21 cases(45.6%) and 17 cases(37.0%), respectively. The corresponding mean values of SN intensity were (3.71±0.69)°/s, (7.44±1.88)°/s, (20.04±5.53)°/s, respectively, without type IV wave. The intensity of SN was positively correlated with the asymmetric value of the gain of SPT left and right(r=0.450,P=0.002). That was, with the increase of SN strength, the asymmetric value also increased, and the worse the asymmetry of the gain of SPT left and right pursuit was, the worse the SPT waveform was. Conclusion: SPT gain, asymmetry and SPT waveforms are all affected by SN, and the greater the intensity of SN, the greater the influence on the three. When SN is strong, type III waves may occur, suggesting that acute peripheral vestibular syndrome can also affect the visual ocularmotor systems.

Observation of early clinical effect of percutaneous transforaminal endoscopic technology in treating cervical spondylotic radiculopathy / 中国骨伤

<p><b>OBJECTIVE</b>To explore the early clinical effect and safety of percutaneous transforaminal endoscopic technology for cervical spondylotic radiculopathy.</p><p><b>METHODS</b>From August 2016 to September 2017, 14 patients with cervical spondylotic radiculopathy who responded poorly to non-surgical treatment for at least 6 weeks underwent percutaneous transforaminal endoscopic discectomy via posterior approach. There were 6 males and 8 females, aging from 32 to 68 years old with an average of (40.5±7.6) years. The course of disease ranged from 0.5 to 13.0 months with an average of (6.0±1.33) months. The lesions involved C₄,₅ in 2 cases, C₅,₆ in 8 cases, C₆,₇ in 4 cases. Visual analogue scale (VAS), Japanese Orthopedic Association (JOA), Short Form 36 health survey questionnaire(SF-36) were recorded preoperatively and during the latest follow-up to evaluate the clinical outcome. Horizontal displacement and angular displacement of vertebral body were measured by cervical dynamic X-rays.</p><p><b>RESULTS</b>All operations were successful. No spinal cord injury, nerve root or vascular injuries were found. Operation time was from 60 to 100 min with a median of 75 min;intraoperative bleeding was from 30 to 80 ml with a median of 40 ml. All patients were followed up for 2 to 13 months with a median of 9 months. During the follow-up period, the patients with neck and shoulder pain were significantly relieved without recurrence. No nucleus pulposus protrusion was found in the primary surgical segment, and there was no obvious sign of degeneration in the adjacent vertebral body. At the latest follow-up, VAS, JOA and SF-36 scores were obviously improved(<0.05). There was no significant difference in horizontal displacement and angular displacement of vertebral body before and after the operation (>0.05). The cervical curvature at the latest follow-up was higher than preoperative findings (<0.05). And there was no significant difference in intervertebral disc height preoperatively and postoperatively(>0.05).</p><p><b>CONCLUSIONS</b>Percutaneous transforaminal endoscopic discectomy in treating cervical spondylotic radiculopathy can effectively and safely relieve neck and shoulder pain, improving nerve function, enhance life quality, maintaining cervical stability. It is worthwhile to generalize and apply in clinical settings.</p>

Objective characteristics of nystagmus in horizontal semicircular canal benign paroxysmal positional vertigo / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the objective characteristics and mechanism of nystagmus direction, intensity and time in horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) .</p><p><b>METHODS</b>A total of 233 patients with HSC-BPPV, whereas 179 horizontal semicircular canalithasis (HSC-Can) and 54 horizontal semicircular cupulolithiasis (HSC-Cup) were involved respectively. The induced nystagmus in roll tests recorded by video-nystagmograph(VNG) , whose direction, intensity and time characteristics were compared in various BPPV.</p><p><b>RESULTS</b>Horizontal nystagmus was both induced by turning left or right in HSC-BPPV roll tests. The direction of the induced nystagmus was the same with turning in HSC-Can. The latency, duration time and intensity ([AKx(-)D] ± s) turning to lesion and normal side were (1.922 ± 1.501)s and (1.447 ± 0.855)s, (25.620 ± 10.409)s, and (22.110 ± 10.931)s, (56.441 ± 33.168)°/s and (24.239 ± 13.892) °/s in HSC-Can. The latency, duration time and intensity turning to lesion side were larger than normal side (t = 3.715, 15.219 and 4.070, P < 0.01) , the difference was statistically significant, and the intensity rate was about 2: 1. The direction of the induced nystagmus was opposite to turning in HSC-Cup. The intensity turning to normal side was larger than lesion side obviously. The intensity rate was about 2: 1, the difference was statistically significant (t = -7.634, P < 0.01) . While the latency and intensity of turning to lesion side in HSC-Can were larger than turn to normal side in HSC-Cup, and the difference detected no statistically significant difference (t = 1.554 and 0.305, P > 0.05).</p><p><b>CONCLUSIONS</b>The induced nystagmus intensity of head to two sides in roll tests for HSC-BPPV both follow Ewald's law, and the ratio between stronger and weaker are both 2: 1. These nystagmus parameters of VNG in roll tests are an objective guideline for BPPV diagnosis.</p>

Frequency characteristics of the semicircular canals lesion in Hunt syndrome with vertigo / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To research the frequency characteristics of the semicircular canals lesion in Hunt syndrome with vertigo and the clinical value of the video head impulse test (vHIT) for vestibular function evaluated in this disease.</p><p><b>METHODS</b>Thirty normal persons (control group) accepted the vHIT, 26 patients with Hunt syndrome with vertigo (study group) accepted low, mid and high frequency vestibular function tests, including caloric test (CT), head shaking test (HST) and vHIT. The parameters of the unilateral weakness (UW), head shaking nystagmus (HSN) and video head impulse test gain (vHIT-G) were observed. The correlations and characteristics of the results of the three tests in Hunt syndrome with vertigo deal were analyzed with SPSS 16.0 software.</p><p><b>RESULTS</b>The values of vHIT-G of the six groups semicircular canal in the control group were normal distribution without statistical significance (F = 0.005, P < 0.01), two sides anterior, horizontal and posterior semicircular canals vHIT-G average (x ± s) were (16.80 ± 9.80)%, (16.57 ± 10.30)%, (16.52 ± 11.12)% respectively; in the study group the separately vHIT-G of the three canals of the affected side were (46.96 ± 34.54)%, (75.35 ± 35.29)% and (41.65 ± 32.87)%, in which statistical significance comparing with the control group was detected (all P < 0.01); the positive one of the three tests vHIT, HSN and CT were 23 cases (88.46%), 22 cases (84.61%) and 24 cases (92.31%), bilateral exact probability χ² test all the P > 0.05;there were Positive correlation between UW and the vHIT-G of lateral semicircular canal (r = 0.692, P < 0.01).</p><p><b>CONCLUSIONS</b>The vestibular lesion of Hunt syndrome with vertigo is almost complete or multiple-frequency, which is characterized by the reduced or even aborted nerve conduction. Therefore, vHIT can be ultimately used for the screening test evaluating due to the vestibular function in Hunt syndrome with vertigo.</p>

Analysis of the dysfunction frequency and characteristics of semicircular canal in benign paroxysmal positional vertigo / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the characteristics of the dysfunction of semicircular canal in benign paroxysmal positional vertigo and the relationship with the ectopic otoconia.</p><p><b>METHODS</b>There were 214 patients with benign paroxysmal positional vertigo (BPPV), including 107 cases of posterior semicircular canal canalithiasis (PSC-Can) 80 cases of horizontal semicircular canal canalithiasis (HSC-Can), 27 cases of horizontal semicircular canal cupulolithiasis (HSC-Cup). One hundred and ninety (88.8%) patients were accompany with relevant diseases while 24 (11.2%) cases were not. They accepted low, middle and high frequency vestibular function tests, including caloric test (CT), head shaking test (HST) and video head impulse test (vHIT) respectively. The parameters of the unilateral weakness (UW), head shaking nystagmus (HSN) and video head impulse test gain (vHIT-G) were observed. Patients classified into three groups (PSC-Can, HSC-Can, HSC-Cup) according to the involvement semicircular canal. The results of the three tests were analyzed with SPSS16.0 software.</p><p><b>RESULTS</b>The positive cases of the three tests were vHIT: 15 (7.0%), HST: 52 (24.3%), CT: 152 (71.0%), a statistically significant difference (P < 0.05) was found between the three tests. When compared the Caloric Test, HST and vHIT between the BPPV patients with and without relevant diseases, there were no significant differences (P > 0.05). The variance without statistical significance (P > 0.05) was showed between three tests' results in each groups, it was also showed that the variance between the three groups in each tests reached no statistical significance (P > 0.05). The test of affected side UW between PSC-Can, HSC-Can and HSC-Cup showed the variance without statistical significance (F = 0.970, P = 0.383).</p><p><b>CONCLUSIONS</b>The lesion of semicircular canals has the same etiological factors with the utricle pathological change in benign paroxysmal positional vertigo, and the dysfunction mostly happens in low frequency range of semicircular canal frequency band. The ectopic otoconia is not the main etiological factors for that. HST and vHIT of middle and high frequency can not be ultimately used for the screening test evaluating due to the semicircular canal function in BPPV.</p>

Subjective visual horizontal in peripheral unilateral vestibular dysfunction / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the characteristics of subjective visual horizontal (SVH) and evaluate its clinical value for vestibular function in peripheral unilateral vestibular hypofunction (UVH).</p><p><b>METHODS</b>Eighty-five patients with UVH (study group) and 39 normal persons (control group) accepted vestibular function tests, including SVH, subjective visual vertical (SVV) and caloric test by video-nystagmography. The parameters of the angle of SVH and SVV, directional preponderance (DP) and unilateral weakness (UW) of caloric test were observed. The correlation between SVH/SVV, DP, UW and the course of disease were investigated respectively. SPSS 16.0 software was used to analyze the data.</p><p><b>RESULTS</b>Reference range of SVH and SVV was from -2° to 2° in the control group. Among the 85 patients, 46 cases (54.1%) and 43 cases (50.6%) had the abnormal values of SVH and SVV respectively, with no statistical significance (χ(2) = 12.5, P = 0.481) by chi square test. Fifty-five cases (64.7%) with abnormal DP had no statistical significance when compared with SVH and SVV respectively (χ(2) values were 0.19 and 2.86, respectively, P value were 0.164, 0.067, respectively). In UVH, there were positive correlation between SVH, SVV and DP (r value was 0.939, 0.648, 0.658, all P < 0.05) respectively, but no correlation between UW and SVH or SVV (r value was 0.048, 0.085, all P > 0.05). According to the permutation and combination of the four parameters, positive or negative, three main groups could be defined [SVH(+)DP(+)UW(+), SVH(-)DP(+)UW(+), SVH(-)DP(-)UW(+); SVV(+)DP(+)UW(+), SVV(-)DP(+)UW(+), SVV(-)DP(-)UW(+)]. The course of disease in the three main groups was positively skewed distribution, with median of 5.0, 10.0, 15.0 d and 5.0, 9.5, 14.5 d respectively. By Kruskal-Wallis Test, χ(2) value were 8.80 and 6.26, respectively(P value were 0.012, 0.040, respectively), with statistical significance between the above three main groups.</p><p><b>CONCLUSIONS</b>The SVH value can evaluate the function of the otolithic. The angle of SVH and SVV are changing in the course of disease, SVH and SVV can be used as a guidance of the vestibular compensation evaluation.</p>

Analysis of directional preponderance of caloric test in evaluation of vestibular dynamic compensation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the value of directional preponderance (DP) in vestibular dynamic compensation evaluation.</p><p><b>METHODS</b>One hundred fifty-five patients with sudden deafness accompanied vertigo were asked to accept routine vestibular tests including the spontaneous nystagmus (SN) and caloric test with video-nystagmography. DP, SN and unilateral weakness (UW) were selected as the observation parameters. Then the correlation analysis between DP, SN, UW and course of disease were investigated respectively. The change characteristic of the three parameters was also analyzed in the course of vestibular compensation.</p><p><b>RESULTS</b>Of the 155 patients, there were negative correlations between SN, DP and course of disease (r(s) = -0.386, r(s) = -0.424, P < 0.05), positive correlation between SN and DP (r(s) = 0.543, P < 0.05), but no correlation between UW and course of disease (r(s) = 0.004, P > 0.05), and also positive correlation (r(s) = 0.274, P < 0.05) between DP and UW. According to three parameters were positive or negative, three main groups (DP+UW+SN+, DP+UW+SN- and DP-UW+SN-) in DP, UW, SN. The course of disease in three main groups was positively skewed distribution. Median was 6 days, 10 days and 20 days respectively. Through Kruskal-Wallis Test, chi(2) = 24.63, P < 0.05, there was statistical significance among the above three main groups.</p><p><b>CONCLUSIONS</b>DP keeps on changing in the acute stage, static and dynamic compensation stage of peripheral vestibular disease. This indicates that DP can be considered as an objective evaluation index of vestibular dynamic compensation and as a guidance of the vestibular rehabilitation evaluation.</p>

Clinical research of vestibular autorotation test for patients with vertebrobasilar insufficiency / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the diagnostic values of vestibular autorotation test (VAT) for patients with vertebrobasilar insufficiency (VBI).</p><p><b>METHODS</b>VAT and videonystagmography ( VNG) were performed on 73 patients with VBI and 48 patients with peripheral vestibular lesions (contrast group). Parameters analyzed included Gain, phase and asymmetry of VAT, as well as the canal paresis (CP) of caloric test and results of optokinetic-pursuit tests in VNG. Positive result of the test could be defined if anyone of the parameters was abnormal.</p><p><b>RESULTS</b>For VAT test, Gain was enhanced in VBI group and was reduced in contrast group. In VBI group and contrast group, Gain enhanced showed in 47 (64.4%) cases and 5 (10.4%) cases, respectively (chi2 = 31.19, P < 0.01). Simultaneity, Gain reduced in 11 cases (15.5%) and 22 cases (45.8%), respectively (chi2 = 13.82, P < 0.01). But there was no statistics significant for results of the parameters of phase, asymmetry and integration between two groups. For VNG test, results with optokinetic-pursuit tests were more abnormal in VBI group than that in contrast group, which showed central lesions characteristics. Forty-four cases (60.3%) in VBI group and 10 cases (20.8%) in control group showed central lesions results with optokinetic-pursuit tests and visual fixation test (chi2 = 15.89, P < 0.01). Unilateral or bilateral CP showed in 33 cases (68.6%) in control group and 51 cases (69.9%) in VBI group with caloric test.</p><p><b>CONCLUSIONS</b>Gain of VAT is mostly enhanced in VBI group, and Gain as a main characteristic is reduced in patients with peripheral vestibular lesions. The Gain parameter is availability for assessing characteristics of vestibular lesions. Phase and asymmetry can be used to assess the vestibular function but can not indicate the characteristics of vestibular lesions.</p>