Employing Vestibular Thresholds to Improve Patient Diagnosis

 描述（由申请人提供）：研究表明，前庭眼反射可以使用与前庭感知不同的处理机制。鉴于此，前庭症状与反射性测量的相关性很差也就不足为奇了。然而，运动诱发知觉的定量临床分析很少，如果有的话，进行。相反，临床医生主要通过患者的病史来分析前庭感知，这可能有助于解释为什么感知症状的根本原因往往无法诊断。据报道，大约30%报告头晕或定向障碍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。我们的理由是，定量知觉测试有助于我们诊断病人的能力。 更具体地，由于高灵敏度和特异性，感知阈值提供了临床上评估感觉功能的常用方法（例如，听力图），因此测量前庭阈值可以提供一种新的诊断工具包，其将有助于诊断中枢（例如，前庭性偏头痛）和外周（例如，梅尼埃病）前庭功能障碍的研究。事实上，前庭阈值模仿听力的听力图测试;这利用了临床医生对听力图的经验，有助于使前庭阈值解释简单明了。 我们以前曾报道过各种患者类别和正常受试者之间的可测量阈值差异。这些结果表明，阈值提供分级的定量测量，其可以帮助确认诊断（可能避免需要额外的“排除”测试）或指导新的和/或更精细的诊断。此外，我们还开发了自动化程序，大大减少了测试时间。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发作性前庭症状的患者参与阈值测试，以及其他标准临床措施，如VOR。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-单独和组合时。为了提供年龄和性别匹配的规范性数据，我们还建议测量18-80岁之间的健康正常受试者的阈值。

 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.