ICF: A novel diagnostic for vestibular dysfunction

眩晕和头晕是最常见的临床症状之一，在一般人群中的患病率约为17%，在80岁以上的人群中上升至39%。临床医生可能怀疑前庭功能障碍，建议患者进行热量灌注，这是目前最常见的前庭诊断。这涉及到热/冷水冲入耳朵，激活半规管的液体。然而，它被患者评为最不舒适的听力学程序之一。它有许多健康禁忌症，包括耳垢过多，耳膜损伤，不受控制的心脏病和精神疾病。因此，需要一种耐受性更好、更方便和患者友好的前庭功能测试。我们最近开发了一种新的前庭诊断称为电前庭刺激（EVS）。EVS涉及应用于耳后乳突的小无痛电流（通常为5 mA）。对于前庭功能完整的人来说，这会激活前庭神经，引起眼球运动，这可以很容易地被摄像机记录下来。EVS以前曾被用于研究各种弱势群体的平衡功能，包括中风患者和老年人。它比卡路里更快执行和更好的耐受性。此外，它潜在地提供了更丰富的诊断信息，因为它比卡路里刺激更大比例的外周前庭系统。目前，将EVS引入临床的主要障碍是：a）外周前庭病变的临床验证，以及B）整合到方便的临床就绪的测试设备中。本项目将解决这两个问题。我们将直接比较EVS与热量灌注在被诊断为外周前庭功能障碍的患者中的效果。我们还将应用视频头部脉冲测试（vHIT），另一种常见的诊断测试，进行比较。目的是表明EVS至少与Caloric和vHIT一样有效，同时更方便和患者友好。我们将直接与全球领先的平衡诊断开发商Interacoustics合作，开发EVS测试的商业版本。

Vertigo and dizziness are among the commonest clinical symptoms, with a prevalence of ~17% in the general population, rising to 39% in those over 80 yrs. A clinician may suspect vestibular deficits, referring the patient for caloric irrigation, currently the most common vestibular diagnostic. This involves hot/cold water flushed into the ear, which activates the fluid of the semicircular canals. However, it is rated as one of the least comfortable audiological procedures by patients. It has numerous health contraindications including excess earwax, eardrum damage, uncontrolled heart disease and mental illness. Hence, there is a need for a better-tolerated, more convenient and patient-friendly test of vestibular function. We have recently developed a novel vestibular diagnostic called Electrical Vestibular Stimulation (EVS). EVS involves small painless currents (typically 5mA) applied to the mastoid processes behind the ears. In a person with intact vestibular function this activates the vestibular nerve, evoking an eye movement which can be readily recorded by a video camera. EVS has previously been used to study balance function in a variety of vulnerable groups, including stroke patients and the elderly. It is quicker to perform and better tolerated than Calorics. Furthermore, it potentially offers a greater wealth of diagnostic information since it stimulates a greater proportion of the peripheral vestibular system than Calorics. The main obstacles in bringing EVS to clinic are currently: a) clinical validation in for peripheral vestibular pathologies, and b) integration into convenient clinically-ready test equipment. This project will address both issues. We will directly compare EVS with caloric irrigation in patients who have been diagnosed with peripheral vestibular dysfunction. We will also apply the video Head Impulse Test (vHIT), another common diagnostic test, for comparison. The aim is to show that EVS is at least as effective as Caloric and vHIT, while being more convenient and patient-friendly. We will work directly with Interacoustics, a leading global developer of balance diagnostics, to develop a commercially-available version of the EVS test.