Employing Vestibular Thresholds to Improve Patient Diagnosis

 描述(由申请人提供)：研究表明，前庭-眼睛反射可以使用与前庭知觉本质上不同的处理机制。鉴于此，前庭症状与反射性措施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。相反，临床医生主要通过病人的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潜在原因往往没有得到诊断。据报道，报告有头晕或定向障碍症状的患者中，约有30%得到了不确定的诊断和/或未经测量或体征证实的诊断。我们认为，定量知觉测试有助于提高我们诊断病人的能力。更具体地说，由于高灵敏度和高特异度，感知阈值提供了一种在临床上评估感觉功能的通用方法(例如，听力图)，因此测量前庭阈值可能提供一种新的诊断工具包，它将使用单一的通用方法帮助诊断中枢(例如，前庭偏头痛)和外周(例如，梅尼埃病)前庭功能障碍。事实上，前庭阈值模拟了听力的听力图测试；这利用了临床医生对听力图的经验，有助于使前庭阈值的解释变得简单明了。我们之前已经报道了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，阈值提供了分级的定量测量，可以帮助确认诊断(也许不需要额外的“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。我们建议招募有发作性前庭症状的符合条件的MEE患者参与阈值测试，以及其他标准的临床指标，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-BOT单独和组合-的诊断能力。为了提供年龄和性别匹配的标准化数据，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.