일측 전정기능 저하 환자에서 방향전환 진동유발안진의 임상적 의의와 발생 기전 제안 (Clinical Implication and Proposed Mechanism of Direction Changing Vibration Induced Nystagmus in Unilateral Vestibular Hypofunction)

서지정보

· 발행기관 : 대한이비인후과학회
· 수록지 정보 : 대한이비인후-두경부외과학회지 / 61권 / 11호 / 580 ~ 587페이지
· 저자명 : 이동한, 박무균, 이준호, 오승하, 서명환

초록

Background and Objectives We evaluated the clinical characteristics and vestibular functionof patients with direction changing vibration induced nystagmus (DC VIN) and unilateral vestibularhypofunction and suggest clinical implication and a proposed mechanism of DC VIN.
Subjects and Method The records of 315 patients who underwent the VIN test were reviewedretrospectively. Among these, 18 patients (5.7%) showed DC VIN, and out of whom, 15patients (4.8%) were diagnosed as unilateral vestibular hypofunction by caloric, rotation chair(RCT), and video head impulse test (vHIT). We analyzed the relationship between DC VIN andthe dizziness characteristics, duration of disease, and the outcome of the vestibular function test.
Results The mean age of 15 patients was 67.4±10.7 years and the mean duration of dizzinesswas 13.6±29.7 months. The caloric test revealed 25% of the patients to have significantcanal paresis [Caloric vestibular neuritis (VN)], while 75% showed normal caloric response.
However, unilateral vestibular hypofunction was observed by abnormal results in RCT or vHIT(Non-caloric VN). Seven patients showed ipsilateral DC VIN (nystagmus to vibrated side) andeight patients contralateral DC VIN (nystagmus to opposite side of vibration). Patients with ipsilateralDC VIN were shown to have a significant longer duration of dizziness than those withcontralateral DC VIN.
Conclusion Although rare, DC VIN can also be found in patients with unilateral vestibularhypofunction. Patients with DC VIN had a mild vestibular asymmetry with Non-caloric VNor Caloric VN in the process of compensation. The mechanism of ipsilateral DC VIN seems tobe due to the small amount of vestibular asymmetry, which is smaller than the interaural attenuationof vibration.

영어초록

Background and Objectives We evaluated the clinical characteristics and vestibular functionof patients with direction changing vibration induced nystagmus (DC VIN) and unilateral vestibularhypofunction and suggest clinical implication and a proposed mechanism of DC VIN.
Subjects and Method The records of 315 patients who underwent the VIN test were reviewedretrospectively. Among these, 18 patients (5.7%) showed DC VIN, and out of whom, 15patients (4.8%) were diagnosed as unilateral vestibular hypofunction by caloric, rotation chair(RCT), and video head impulse test (vHIT). We analyzed the relationship between DC VIN andthe dizziness characteristics, duration of disease, and the outcome of the vestibular function test.
Results The mean age of 15 patients was 67.4±10.7 years and the mean duration of dizzinesswas 13.6±29.7 months. The caloric test revealed 25% of the patients to have significantcanal paresis [Caloric vestibular neuritis (VN)], while 75% showed normal caloric response.
However, unilateral vestibular hypofunction was observed by abnormal results in RCT or vHIT(Non-caloric VN). Seven patients showed ipsilateral DC VIN (nystagmus to vibrated side) andeight patients contralateral DC VIN (nystagmus to opposite side of vibration). Patients with ipsilateralDC VIN were shown to have a significant longer duration of dizziness than those withcontralateral DC VIN.
Conclusion Although rare, DC VIN can also be found in patients with unilateral vestibularhypofunction. Patients with DC VIN had a mild vestibular asymmetry with Non-caloric VNor Caloric VN in the process of compensation. The mechanism of ipsilateral DC VIN seems tobe due to the small amount of vestibular asymmetry, which is smaller than the interaural attenuationof vibration.

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