Vestibular hypersensitivity to clicks is characteristic of the Tullio phenomenon
Vestibular hypersensitivity to clicks is characteristic of the Tullio phenomenon
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DOI：
10.1136/jnnp.65.5.670
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发表时间：
1998-11-01
影响因子：
11
通讯作者：
Rothwell, JC
中科院分区：
文献类型：
--
作者：
Colebatch, JG;Day, BL;Rothwell, JC
目的：探讨Tullio现象（声音诱发的前庭激活）患者病理降低的前庭激活咔嗒阈值的频率。方法：对7例（8只患耳）对外界声音或自身声音的反应有示波器减退和不稳定症状的患者进行检查。除了一名患者外，所有患者的前庭对声音都过敏，这一事实得到了证实，即强度在110分贝或以下的纯音都能引起眼球运动。所有病例常规诊断影像均正常，其中3例患者手术探查中耳正常。并与一组正常受试者的前庭- collo反射阈值进行比较。电刺激被用作检测前庭反射兴奋性的补充方法。结果：所有患者均表现出由患耳引起的前庭-结肠反射咔嗒激活阈值降低。对咔哒声的短潜伏期肌电图反应也存在于后颈部和腿部肌肉，表明这些肌肉接受前庭投射。电刺激在5名患者中产生了4名正常的身体摇摆模式。病理降低的叩响激活阈值（小于或等于70 dB NHL（平均正常听力水平））似乎是Tullio现象的一致特征，也是一个有用的诊断标准。这反过来又很可能是由于声音能量传输到囊状受体的效率提高了。这些受体的激活可能是导致患者前庭症状的原因。
Objectives-The frequency of pathologically reduced click thresholds for vestibular activation was explored in patients with the Tullio phenomenon (sound induced vestibular activation).Methods-Seven patients (eight affected ears) with symptoms of oscillopsia and unsteadiness in response to loud external sounds or to the patient's own voice were examined. In all but one patient, vestibular hypersensitivity to sound was confirmed by the fact that eye movements could be produced by pure tones of 110 dB intensity or less. Conventional diagnostic imaging was normal in all cases and three of the patients had normal middle ears at surgical exploration. Thresholds for click evoked vestibulocollic reflexes were compared with those of a group of normal subjects. Galvanic stimulation was used as a complementary method of examining the excitability of vestibular reflexes.Results-All the patients showed a reduced threshold for click activation of vestibulocollic reflexes arising from the affected ear. Short latency EMG responses to clicks were also present in posterior neck and leg muscles, suggesting that these muscles receive vestibular projections. Galvanic stimulation produced a normal pattern of body sway in four of the five patients tested.Conclusions-A pathologically reduced threshold to click activation (less than or equal to 70 dB NHL (average normal hearing level)) seems to be a consistent feature of the Tullio phenomenon and a useful diagnostic criterion. This in turn is most likely to be due to an increased effectiveness of the transmission of sound energy to saccular receptors. Activation of these receptors probably contributed to the vestibular symptoms experienced by the patients.