Employing Vestibular Thresholds to Improve Patient Diagnosis

利用前庭阈值改善患者诊断

• 批准号: 8986906
• 负责人: RICHARD F LEWIS
• 金额: $ 57.59万
• 依托单位: MASSACHUSETTS EYE AND EAR INFIRMARY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8986906
• 关键词: Acute; Acute Disease; Affect; Age; Audiometry; Biological Assay; Categories; Chronic; Chronic Disease; Classification; Clinical; Consensus; Data; Data Analyses; Data Collection; Databases; Diagnosis; Diagnostic; Disease; Disorientation; Dizziness; Early Diagnosis; Etiology; Female; Foundations; Frequencies; Functional disorder; Gender; Goals; Hearing Tests; Hearing problem; Hour; Human; Inferior; Label; Measurement; Measures; Meniere' s Disease; Methodology; Migraine; Motion; Patients; Pattern; Perception; Peripheral; Population; Procedures; Process; Qualifying; Quantitative Reasoning; Recording of previous events; Recruitment Activity; Recurrence; Reporting; Research Project Grants; Rotation; Sensitivity and Specificity; Sensory; Societies; Symptoms; Syndrome; Testing; Time; Translations; Vertigo; Vision Disorders; age effect; aged; base; experience; improved; male; meetings; novel diagnostics; public health relevance; vestibulo-ocular reflex

 DESCRIPTION (provided by applicant): Studies show that vestibulo-ocular reflexes can use qualitatively different processing mechanisms than vestibular perception. Given this, it is not surprising that vestibular symptoms correlate poorly with reflexive measures. Yet, quantitative clinical assays of motion-evoked perception are seldom, if ever, performed. Instead, clinicians primarily assay vestibular perception via patient histories, which may help explain why the underlying cause of perceptual symptoms often goes undiagnosed. It has been reported that roughly 30% of patients reporting symptoms of dizziness or disorientation receive an uncertain diagnosis and/or a diagnosis that is unconfirmed by measurements or signs. We reason that quantitative perceptual tests can contribute to our ability to diagnose patients. More specificall, because of high sensitivity and specificity, perceptual thresholds provide a common way to evaluate sensory function clinically (e.g., audiogram), so measuring vestibular thresholds may provide a new diagnostic toolkit that will help diagnose both central (e.g., vestibular migraine) and peripheral (e.g., Meniere's disease) vestibular dysfunction using a single common methodology. In fact, vestibular thresholds mimic the audiogram test of hearing; this takes advantage of clinician experience with audiograms and helps make vestibular threshold interpretation straightforward. We have previously reported measureable threshold differences among various patient classes and normal subjects. These results suggest that thresholds provide graded quantitative measurements that can help confirm a diagnosis (perhaps obviating the need for additional "rule- out" testing) or guide new and/or more refined diagnoses. Furthermore, we have developed automated procedures that reduce test times dramatically. These advances, alongside data analysis improvements, allow us to measure perceptual thresholds across a broad range of conditions in less than 2 hours. We propose to recruit qualifying MEE patients suffering episodic vestibular symptoms to participate in threshold testing, alongside other standard clinical measures like the VOR We specifically propose to evaluate the diagnostic power of threshold testing and existing clinical tests quantitatively - bot individually and when combined - using standard statistical approaches. To provide normative data that is both age and gender-matched, we also propose to measure thresholds in healthy normal subjects between the ages of 18-80.

 描述（由申请人提供）：研究表明，前庭眼反射可以使用与前庭知觉性质不同的处理机制。鉴于此，前庭症状与反射测量的相关性较差也就不足为奇了。然而，很少（如果有的话）对运动诱发知觉进行定量临床分析。相反，临床医生主要通过患者病史来分析前庭知觉，这可能有助于解释为什么知觉症状的根本原因经常未被诊断出来。据报道，大约 30% 的有头晕或迷失方向症状的患者接受了不确定的诊断和/或未经测量或体征证实的诊断。我们认为定量感知测试有助于提高我们诊断患者的能力。 更具体地说，由于高灵敏度和特异性，知觉阈值提供了临床评估感觉功能（例如听力图）的常用方法，因此测量前庭阈值可能提供新的诊断工具包，有助于使用单一通用方法诊断中枢性（例如前庭性偏头痛）和外周性（例如梅尼埃病）前庭功能障碍。事实上，前庭阈值模仿了听力的听力图测试。这利用了临床医生在听力图方面的经验，有助于使前庭阈值解释变得简单。 我们之前报告过不同患者类别和正常受试者之间可测量的阈值差异。这些结果表明，阈值提供分级定量测量，可以帮助确认诊断（也许无需额外的“排除”测试）或指导新的和/或更精确的诊断。此外，我们还开发了自动化程序，可以大大缩短测试时间。这些进步加上数据分析的改进，使我们能够在不到 2 小时的时间内测量各种条件下的感知阈值。我们建议招募符合条件的患有阵发性前庭症状的 MEE 患者参与阈值测试，以及 VOR 等其他标准临床测量。我们特别建议使用标准统计方法定量评估阈值测试和现有临床测试的诊断能力（单独使用或组合使用）。为了提供年龄和性别匹配的规范数据，我们还建议测量 18-80 岁之间健康正常受试者的阈值。