神经耳科检查在持续性姿势-知觉性头晕中的临床意义：一项回顾性研究。

文献信息

中文摘要

背景： 持续性姿势-知觉性头晕（PPPD）是一种慢性功能性前庭疾病，其特征为非旋转性头晕、姿势不稳以及对视觉和运动刺激的超敏反应。虽然Bárány学会标准能够实现诊断，但神经耳科检查的预后价值仍不明确。旨在评估神经耳科检查结果与PPPD短期临床改善之间的关系，阐明其临床意义。
方法： 对2022年至2024年间治疗的103例难治性头晕患者中识别出的24例PPPD患者进行了回顾性审查。所有患者均接受了视频头脉冲试验（vHIT）、颈性前庭诱发肌源性电位（cVEMP）和眼性VEMP（oVEMP）。半规管功能障碍定义为增益降低伴纠正性扫视；耳石功能障碍定义为无反应或不对称比异常。进行了头晕障碍量表（DHI）和医院焦虑抑郁量表（HADS）评估。所有患者均接受选择性5-羟色胺再摄取抑制剂联合结构化前庭康复治疗。在3个月时使用临床总体印象-改善（CGI-I）量表评估临床改善。
结果： 在分析的23例患者中，平均CGI-I评分为2.7 ± 0.9。10例患者预后良好（平均CGI-I评分，1.8 ± 0.4），而13例预后不良（平均CGI-I评分，3.4 ± 0.5）。预后组之间未观察到DHI或HADS评分的显著差异。耳石性眩晕是最常见的诱发疾病。9例患者（38%）发现耳石功能障碍：仅cVEMP异常（n=5）、仅oVEMP异常（n=1）以及两者均异常（n=3）。vHIT未检测到水平半规管功能障碍。伴有（3.1 ± 0.8）和不伴有（2.5 ± 0.9）前庭功能障碍的患者预后无显著差异（P > .05）。精神科就诊史也与预后无关（P > .05）。在症状发作3个月内开始治疗的患者倾向于有更好的结果，尽管差异无统计学意义。
结论： 超过三分之一的PPPD患者表现出耳石功能障碍，提示外周前庭参与发病机制。虽然前庭检查异常与标准化治疗下的短期预后无关，但cVEMP和oVEMP提供了病理生理学见解，并识别出vHIT未检测到的孤立性耳石缺陷。需要更大规模的前瞻性研究来评估其预后效用并指导个性化康复。

英文摘要

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder characterized by non-spinning dizziness, postural instability, and hypersensitivity to visual and motion stimuli. While Bárány Society criteria enable diagnosis, the prognostic value of neuro-otological examinations remains unclear. To assess the relationship between neuro-otological test results and short-term clinical improvement in PPPD, clarifying their clinical significance.
METHODS: A retrospective review was conducted of 24 patients with PPPD identified from 103 patients with intractable dizziness treated between 2022 and 2024. All underwent video head impulse testing (vHIT), cervical vestibular-evoked myogenic potential (cVEMP), and ocular VEMP (oVEMP). Semicircular canal dysfunction was defined as reduced gain with corrective saccades; otolith dysfunction as absent responses or abnormal asymmetry ratios. Dizziness Handicap Inventory (DHI) and Hospital Anxiety and Depression Scale (HADS) were administered. All received selective serotonin reuptake inhibitors plus structured vestibular rehabilitation. Clinical improvement was evaluated with the Clinical Global Impression-Improvement (CGI-I) scale at 3 months.
RESULTS: Among the 23 patients analyzed, the mean CGI-I score was 2.7 ± 0.9. Ten patients had a good prognosis (mean CGI-I score,1.8 ± 0.4), whereas 13 had a poor prognosis (mean CGI-I score, 3.4 ± 0.5). No significant differences in DHI or HADS scores were observed between the prognosis groups. Otolithic vertigo was the most common precipitating condition. Otolith dysfunction was identified in 9 patients (38%): cVEMP only (n=5), oVEMP only (n=1), and both (n=3). No horizontal semicircular canal dysfunction was detected on vHIT. Prognosis did not differ significantly between patients with (3.1 ± 0.8) and without (2.5 ± 0.9) vestibular dysfunction (P > .05). A history of psychiatric consultation was also not associated with prognosis (P > .05). Patients who initiated treatment within 3 months of symptom onset tended to have better outcomes, although the difference was not statistically significant.
CONCLUSION: Over one-third of PPPD patients demonstrated otolith dysfunction, suggesting peripheral vestibular involvement in pathogenesis. While vestibular test abnormalities were not linked to short-term prognosis under standardized therapy, cVEMP and oVEMP provided patho-physiological insights and identified isolated otolith deficits undetected by vHIT. Larger prospective studies are warranted to evaluate their prognostic utility and guide personalized rehabilitation.