Patients with vertigo/dizziness of unknown origin during follow-ups by general otolaryngologists at outpatient town clinic
Patients with vertigo/dizziness of unknown origin during follow-ups by general otolaryngologists at outpatient town clinic
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DOI：
10.1016/j.anl.2020.09.012
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发表时间：
2021-04-08
影响因子：
1.7
通讯作者：
Kitahara, Tadashi
中科院分区：
文献类型：
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作者：
Nishikawa, Daisuke;Wada, Yoshiro;Kitahara, Tadashi
目的：本研究的目的是评估眩晕/头晕相关患者在短期住院期间的访谈和检查在确定不明原因眩晕/头晕的准确最终诊断中的贡献。方法：我们回顾了奈良医科大学眩晕/头晕中心的1905例连续眩晕/头晕患者，2014年5月至2020年4月从门诊镇诊所的普通耳鼻喉科医生介绍。然而，244例患者被诊断为不明原因的眩晕/头晕（244/1905; 12.8%）。其中240例患者住院接受各种检查，包括冷热试验（C-test）、视频头脉冲试验（vHIT）、前庭诱发颈肌源性电位（cVEMP）、主观视觉垂直（SVV）、内耳磁共振成像（ieMRI）、Schellong试验（S-test）和抑郁自评量表（SDS）。根据检查资料，结合访谈的眩晕/头晕特征和每日变化的眼震表现，最终诊断为：良性阵发性位置性眩晕（BPPV：107/240; 44.6%），直立失调（OD：56/240; 23.3%），前庭周围性疾病（VPD：25/240; 10.4%），前庭性偏头痛（VM：14/240; 5.8%），梅尼埃病（MD：12/240; 5.0%）、重力知觉障碍（GPD：10/240; 4.2%）、心因性眩晕（精神病：10/240; 4.2%）和未知（未知：6/240; 2.5%）。最终诊断的支持因素包括：性别、诱发性头晕和位置性眼球震颤（BPPV）;诱发性头晕、S试验和高血压（OD）;诱发性头晕、眼球震颤后摇头、C试验和vHIT（VPD）;性别、头痛和S试验（VM）;耳胀和ieMRI（MD）;性别、诱发性头晕和SVV（GPD）; SDS（精神病）。结论：本研究所获得的不明原因眩晕/头晕的回答列表，可帮助未来的普通耳鼻喉科医生在门诊镇诊所更好地获得准确的最终诊断。(C)2020日本耳鼻喉科学会Elsevier B. V.出版，保留所有权利。
Objectives: The purpose of this study was to access the contribution of vertigo/dizziness-related patients' interview and examinations during short-term hospitalization in determining the accurate final diagnosis of vertigo/dizziness of unknown origin.Methods: We reviewed 1905 successive vertigo/dizziness patients at the Vertigo/Dizziness Center of Nara Medical University, who were introduced from general otolaryngologists at outpatient town clinic from May 2014 to April 2020. However, 244 patients were diagnosed with vertigo/dizziness of unknown origin (244/1905; 12.8%). Of these patients, 240 were hospitalized and underwent various examinations, including caloric test (C-test), video head impulse test (vHIT), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV), inner ear magnetic resonance imaging (ieMRI), Schellong test (S-test), and self-rating questionnaires of depression score (SDS).Results: According to the examination data, together with interviewed vertigo/dizziness characteristics and daily changeable nystagmus findings, the final diagnoses were as follows: benign paroxysmal positional vertigo (BPPV: 107/240; 44.6%), orthostatic dysregulation (OD: 56/240; 23.3%), vestibular peripheral disease (VPD: 25/240; 10.4%), vestibular migraine (VM: 14/240; 5.8%), Meniere's disease (MD: 12/240; 5.0%), gravity perception disturbance (GPD: 10/240; 4.2%), psychogenic vertigo (Psycho: 10/240; 4.2%), and unknown (Unknown: 6/240; 2.5%). Supporting factors of final diagnosis was seen in gender, evoked dizziness, and positional nystagmus as BPPV; in evoked dizziness, S-test, and hypertension as OD; in evoked dizziness, head shaking after nystagmus, C-test, and vHIT as VPD; in gender, headache, and S-test as VM; in ear fullness and ieMRI as MD; in gender, evoked dizziness, and SVV as GPD; and in SDS as Psycho. To sum up, the ratios of Unknown were significantly reduced by this short-term hospitalization (244/1905 -> 6/240).Conclusions: The answer lists for vertigo/dizziness of unknown origin obtained in the present study may be helpful for future general otolaryngologists at outpatient town clinic to better attain an accurate final diagnosis. (C) 2020 Oto-Rhino-Laryngological Society of Japan Inc. Published by Elsevier B.V. All rights reserved.