The Skull Vibration-Induced Nystagmus Test of Vestibular Function-A Review.
The Skull Vibration-Induced Nystagmus Test of Vestibular Function-A Review.
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DOI：
10.3389/fneur.2017.00041
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发表时间：
2017
影响因子：
3.4
通讯作者：
Schmerber S
中科院分区：
文献类型：
--
作者：
Dumas G;Curthoys IS;Lion A;Perrin P;Schmerber S
100赫兹的骨传导振动应用于任何一个乳突，在单侧前庭缺失(UVL)的患者中，瞬间会导致以水平为主的眼球震颤，并从受影响侧快速跳动。同样的刺激在健康的无症状受试者中几乎没有效果。这是颅骨振动诱发眼球震颤(SVIN)，它是一种有用的、简单的、非侵入性的、可靠的前庭功能不对称和前庭丢失侧的指标。眼球震颤完全是刺激锁定的：它从刺激开始，在刺激抵消时停止，没有刺激后的逆转。它在长时间的刺激中持续存在；它是可重复的；无论哪个乳突受到刺激，它都朝着同一方向跳动；它几乎没有或没有表现出习惯性；它是永久性的--即使补偿良好的UVL患者也显示出SVIN。SVIN是在Frenzel护目镜或视频眼震镜下观察到的，在没有视觉固定和强镇静药物的情况下，在视频眼震图下记录。刺激的频率、位置和强度会影响结果，而人与人之间头骨形态的很大差异可能会改变刺激。对100 赫兹的乳突刺激是一种强健的反应。我们在文献数据的基础上描述了最佳刺激方法，并对18,500多名患者进行了测试。最近的神经证据澄清了哪些前庭感受器受到刺激，它们是如何导致眼球震颤的，以及为什么在半规管裂开(SCD)患者中同样的振动会导致眼球震颤向受影响的耳朵跳动。这篇综述不仅集中在UVL和SCD患者的刺激和反应的最佳参数，而且还展示了其他前庭功能障碍如何影响SVIN。我们的结论是，SVIN的存在是两耳前庭功能不对称的有用指标，但为了识别哪只耳是受影响的耳，还需要其他信息和仔细的临床判断。
A 100-Hz bone-conducted vibration applied to either mastoid induces instantaneously a predominantly horizontal nystagmus, with quick phases beating away from the affected side in patients with a unilateral vestibular loss (UVL). The same stimulus in healthy asymptomatic subjects has little or no effect. This is skull vibration-induced nystagmus (SVIN), and it is a useful, simple, non-invasive, robust indicator of asymmetry of vestibular function and the side of the vestibular loss. The nystagmus is precisely stimulus-locked: it starts with stimulation onset and stops at stimulation offset, with no post-stimulation reversal. It is sustained during long stimulus durations; it is reproducible; it beats in the same direction irrespective of which mastoid is stimulated; it shows little or no habituation; and it is permanent—even well-compensated UVL patients show SVIN. A SVIN is observed under Frenzel goggles or videonystagmoscopy and recorded under videonystagmography in absence of visual-fixation and strong sedative drugs. Stimulus frequency, location, and intensity modify the results, and a large variability in skull morphology between people can modify the stimulus. SVIN to 100 Hz mastoid stimulation is a robust response. We describe the optimum method of stimulation on the basis of the literature data and testing more than 18,500 patients. Recent neural evidence clarifies which vestibular receptors are stimulated, how they cause the nystagmus, and why the same vibration in patients with semicircular canal dehiscence (SCD) causes a nystagmus beating toward the affected ear. This review focuses not only on the optimal parameters of the stimulus and response of UVL and SCD patients but also shows how other vestibular dysfunctions affect SVIN. We conclude that the presence of SVIN is a useful indicator of the asymmetry of vestibular function between the two ears, but in order to identify which is the affected ear, other information and careful clinical judgment are needed.