Evaluation of the Video Ocular Counter-Roll (vOCR) as a New Clinical Test of Otolith Function in Peripheral Vestibulopathy
Evaluation of the Video Ocular Counter-Roll (vOCR) as a New Clinical Test of Otolith Function in Peripheral Vestibulopathy
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DOI：
10.1001/jamaoto.2021.0176
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发表时间：
2021-03-25
影响因子：
7.8
通讯作者：
Kheradmand, Amir
中科院分区：
文献类型：
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作者：
Sadeghpour, Shirin;Fornasari, Francesco;Kheradmand, Amir
视频眼科成像(VOG)护目镜已经被整合到前庭疾病患者的半规管功能的评估中。目的评价基于VOG的眼球对侧滚转测量(VOCR)作为耳石功能临床测试的应用。设计、设置和研究对象采用病例对照研究，比较单侧前庭功能丧失不同阶段患者和健康对照组的VOCR测量结果。采用受试者工作特征曲线法测定vOCR试验对耳石功能丧失的诊断准确性。参与者是在包括约翰·霍普金斯门诊诊所和马里兰州巴尔的摩约翰·霍普金斯医院在内的第三级中心招募的。参与者包括56名急性(手术后6个月)单侧前庭缺失的患者和健康对照组。采用简单的床边动作，整体头部和躯干侧倾30度，用于vOCR测量。本研究于2017年2月2日至2019年3月10日进行，每个受试者都在头部和躯干整体静止倾斜时测量vOCR。主要结果和衡量vOCR测量结果和vOCR对健康对照组前庭功能丧失患者的诊断准确性。结果56名参与者中，28名(50.0%)为男性；平均(SD)年龄53.5(11.4)岁。急性单侧前庭消失的平均时间为9(7)d(2~17 d)，亚急性组为61(39)d(28~172 d)，慢性组为985(1066)d(185~4200 d)。VOCR测试显示前庭缺失侧减少，急性和亚急性前庭缺失患者较慢性前庭缺失患者和健康对照组明显减少(急性与慢性：-1.81度；95%CI，-3.45度~-0.17度；急性与对照组：-3.18度；95%CI，-4.83度~-1.54度；亚急性与慢性：-0.63度；95%CI，-2.28度~1.01度；亚急性与对照组：-2.01度；95%可信区间为-3.65度至-0.36度；急性与亚急性区间为-1.17度；95%可信区间为-2.88度至0.52度；慢性区间为-1.37度；95%可信区间为-2.96度至0.21度)。急性与慢性前庭缺失患者前庭缺失侧与健侧的vOCR不对称性显著增加(0.28；95%CI，0.06~0.51)。总体而言，vOCR测试在区分前庭缺失患者和健康对照组方面的表现为0.83(受试者工作特征曲线下的面积)。VOCR检测30度倾斜时前庭功能丧失的最佳阈值为4.5度，敏感性为80%(95%CI，0.62%~0.88%)，特异性为82%(95%CI，0.57%~1.00%)。
IMPORTANCE Video-oculography (VOG) goggles have been integrated into the assessment of semicircular canal function in patients with vestibular disorders. However, a similar bedside VOG method for testing otolith function is lacking.OBJECTIVE To evaluate the use of VOG-based measurement of ocular counter-roll (vOCR) as a clinical test of otolith function.DESIGN, SETTING, AND PARTICIPANTS A case-control study was conducted to compare vOCR measurement among patients at various stages of unilateral loss of vestibular function with healthy controls. The receiver operating characteristic curve method was used to determine the diagnostic accuracy of the vOCR test in detecting loss of otolith function. Participants were recruited at a tertiary center including the Johns Hopkins outpatient clinic and Johns Hopkins Hospital, Baltimore, Maryland. Participants included 56 individuals with acute (6 months after surgery) unilateral vestibular loss as well as healthy controls. A simple bedside maneuver with en bloc, 30 degrees lateral tilt of the head and trunk was used for vOCR measurement. The study was conducted from February 2, 2017, to March 10, 2019.INTERVENTION In each participant vOCR was measured during static tilts of the head and trunk en bloc.MAIN OUTCOMES AND MEASURES The vOCR measurements and diagnostic accuracy of vOCR in detecting patients with loss of vestibular function from healthy controls.RESULTS Of the 56 participants, 28 (50.0%) were men; mean (SD) age was 53.5 (11.4) years. The mean (SD) time of acute unilateral vestibular loss was 9 (7) days (range, 2-17 days) in the acute group, 61 (39) days (range, 28-172 days) in the subacute group, and 985 (1066) days (range 185-4200 days) in the chronic group. The vOCR test showed reduction on the side of vestibular loss, and the deficit was greater in patients with acute and subacute vestibular loss than in patients with chronic loss and healthy controls (acute vs chronic: -1.81 degrees; 95% CI, -3.45 degrees to -0.17 degrees; acute vs control: -3.18 degrees; 95% CI, -4.83 degrees to -1.54 degrees; subacute vs chronic: -0.63 degrees; 95% CI, -2.28 degrees to 1.01 degrees; subacute vs control: -2.01 degrees; 95% CI, -3.65 degrees to -0.36 degrees; acute vs subacute: -1.17 degrees; 95% CI, -2.88 degrees to 0.52 degrees; and chronic vs control: -1.37 degrees; 95% CI, -2.96 degrees to 0.21 degrees). The asymmetry in vOCR between the side of vestibular loss and healthy side was significantly higher in patients with acute vs chronic loss (0.28; 95% CI, 0.06-0.51). Overall, the performance of the vOCR test in discriminating between patients with vestibular loss and healthy controls was 0.83 (area under the receiver operating characteristic curve). The best vOCR threshold to detect vestibular loss at the 30 degrees tilt was 4.5 degrees, with a sensitivity of 80% (95% CI, 0.62%-0.88%) and specificity of 82%(95% CI, 0.57%-1.00%).CONCLUSIONS AND RELEVANCE The findings of this case-control study suggest that the vOCR test can be performed with a simple bedside maneuver and may be used to detect or track loss of otolith function.