Periferik vestibüler bozuklukların statik postürografi, video head ımpulse test(VHIT) ve suppression head ımpulse paradigm(shımp) testleri ile değerlendirilmesi
Küçük Resim Yok
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Amaç: Bu çalışmada periferik vestibüler bozukluklarının objektif olarak statik postürografi, VHIT ve SHIMP test sonuçları ile değerlendirilmesi, hastaların subjektif baş dönmesi engellilik düzeyinin objektif test sonuçlarıyla korelasyonun incelenmesi ve objektif sonuçların kontrol grubuyla karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Bu çalışma, Ege Üniversitesi Hastanesi Kulak Burun Boğaz Anabilim Dalı veya Nöroloji Anabilim Dalına son bir yıl içinde baş dönmesi şikayetiyle başvurup iki anabilim dalının yer aldığı 'vertigo konseyi'nde meniere hastalığı (MH), vestibüler nörinit (VN) veya Benign Paroksismal Pozisyonel Vertigo (BPPV) tanısı alan 18-65 yaş aralığındaki 45 hasta (her deney grubunda 15 kişi) ile gerçekleştirilmiştir. Baş dönmesi, dengesizlik şikayeti ve başka bir sağlık problemi olmayan 18-65 yaş arasındaki hasta yakınları ve Ege üniversitesi öğrencilerinden oluşan 15 sağlıklı birey ise kontrol grubunda yer almıştır. Olgu Rapor Formu ile deney grubu katılımcılarının demografik bilgileri, vestibüler hastalık öyküsü ve genel sağlıkları değerlendirilmiştir. Deney ve kontrol gruplarına sırasıyla VHIT, SHIMP ve Statik postürografi testleri yapılmıştır. Deney grubuna ayrıca baş dönmesi engellilik envanteri (BDEE) doldurtulmuştur. Bulgular: Çalışmamızda Modifiye Denge Duyu İnteraksiyonu Klinik Testi (mCTSIB) ağırlık merkezi (COG) ortalama salınım hızlarında sert yüzeyde hem gözler açık hem de kapalı durumlarda gruplar arasında istatistiksel olarak anlamlı farklılık bulunmuştur (p<0,05). Tek Taraflı Duruş (US) testi COG ortalama salınım hızlarının sol ve sağ bacak üzerinde gözler kapalı durumlarda gruplar arasında istatistiksel olarak anlamlı farklılık elde edilirken sol ve sağ bacak gözler açık durumda anlamlı fark elde edilmemiştir (p>0,05). Düz Yürüme testi ortalama yürüme hızı ve Tandem Yürüyüş testi ortalama son salınım hızlarında gruplar arasında istatistiksel olarak anlamlı fark bulunmuştur (p<0,05). Etkilenen ile sağlam kulak karşılaştırmasında, VN hasta grubunda lateral VHIT 1. sakkad amplitüdü ve lateral VHIT 1. sakkad tepe hızı, MH grubunda ise sadece lateral VHIT 1. sakkad amplitüd değeri açısından anlamlı farklılık bulunmuş fakat tüm deney grubunda SHIMP sonuçları için anlamlı farklılık IV bulunmamıştır (p>0,05). Deney grubu etkilenen kulak ile kontrol grubu karşılaştırmasında, anterior VHIT VOR kazancı, lateral VHIT ve SHIMP sakkad değerleri açısından istatistiksel olarak anlamlı farklılıklar bulunmuştur (p<0,05). Deney grubu lateral VHIT VOR kazancı ile SHIMP VOR kazancı arasında pozitif yönlü anlamlı bir korelasyon bulunmuştur (p<0,05). VN grubunda anterior VHIT VOR kazancı ile SHIMP VOR kazancı arasında, MH grubunda ise posterior VHIT VOR kazancı ile SHIMP VOR kazancı arasında pozitif yönde anlamlı ilişki bulunmuştur (p<0,05). Deney grubu katılımcılarında BDEE alt puanları, BDEE toplam puanları ve BDEE düzeylerinin hafif(0-30 puan), orta(31-60 puan), ileri(61- 100 puan) olmasına göre gruplar arasında anlamlı bir farklılık elde edilmemiştir (p>0,05). BDEE toplam puanları ile etkilenen kulak VHIT ve SHIMP VOR kazançları arasında anlamlı bir korelasyon elde edilememiştir (p>0,05). MH ve BPPV hastalarında BDEE toplam puanları ile statik postürografi sonuçları arasında anlamlı korelasyon elde edilememiştir (p>0,05). VN hastalarında BDEE toplam puan ile mCTSIB COG ortalama salınım hızı ve BDEE toplam puan ile US COG salınım hızı arasında anlamlı ilişki bulunmuştur (p<0,05). Sonuç: Çalışmada elde edilen sonuçlar, periferik vestibüler bozuklukların tanısı için objektif olarak VHIT'in yanında SHIMP sonuçlarının da değerlendirilmesinin ve VOR kazançlarının yanı sıra sakkadların varlığının (sakkad latansı, amplitüdü ve tepe hızı) incelenmesinin tanıda önemli yer aldığı ve VHIT'in destekleyicisi olarak SHIMP testinin klinik uygulamalarda kullanılmasının avantajlı olacağı düşünülmektedir. Ayrıca, hastaların vestibüler rehabilitasyon süreçlerinde statik postürografi testinin kullanılması yararlı olacaktır. Baş dönmesi engellilik envanteri skorları ile objektif testlerin sonuçları korelasyon göstermediği için hastaların baş dönmesi şikayetleri ile ilişkili engellilik seviyesinin ölçümünde ek subjektif yöntemlerin kullanılmasının gerektiği düşünülmektedir. İleride yapılacak olan çalışmalarda örneklem büyüklüğü arttırılarak ve hastalık süresi bazında daha homojen gruplar kullanılarak daha spesifik sonuçlar elde edilebileceğine inanılmaktadır. Anahtar Kelimeler; meniere hastalığı; vestibüler nörinit; BPPV; Statik postürografi; SHIMP; VHIT
Objectives: In this study, it was aimed to objectively evaluate peripheral vestibular disorders with static posturography, VHIT and SHIMP test results, to examine the correlation of patients' subjective dizziness disability level with objective test results, and to compare objective results with the control group. Materials and Methods: This study was carried out with 45 patients (15 people in each experimental group) between the ages of 18-65 who has applied to Ege University Hospital, Department of Otorhinolaryngology or Neurology Department with a complaint of dizziness in the last year and diagnosed with Meniere's disease (MD), vestibular neurinitis (VN) or Benign Paroxysmal Positional Vertigo ( BPPV) in the 'vertigo council' in which two departments are present. Fifteen healthy individuals, consisting of relatives of patients aged between 18-65 and Ege University students, who did not have dizziness, imbalance or any other health problem, were included in the control group. Demographic information, vestibular disease history and general health of the experimental group participants were evaluated with the Case Report Form. VHIT, SHIMP and Static posturography tests were applied to the experimental and control groups, respectively. The experimental group was also asked to fill in the dizziness handicap inventory (DHI). Results: In our study, a statistically significant difference was found between the groups in the modified Clinical Test of Sensory Interaction Balance (mCTSIB) center of gravity (COG) mean sway velocity on the firm surface in both eyes open and closed conditions (p<0.05). While there was a statistically significant difference between the groups in the Unilateral Stance (US) test COG mean sway velocity on the left and right legs with eyes closed, there was no significant difference between the left and right legs with eyes open (p>0.05). Statistically significant difference was found between the groups in Walk Across test mean walking speed and Tandem Walk test mean final sway velocities (p<0.05). In the comparison of the affected and healthy ear, there was a significant difference in the lateral VHIT 1st saccade amplitude and lateral VHIT 1st saccade peak velocity in the VN patient group, and only the lateral VHIT 1st saccade VI amplitude value in the MD group, but no significant difference was found for the SHIMP results in the whole experimental group ( p>0.05). In the comparison of the affected ear in the experimental group and the control group, statistically significant differences were found in terms of anterior VHIT VOR gain, lateral VHIT and SHIMP saccade values (p<0.05). A significant positive correlation was found between the lateral VHIT VOR gain and the SHIMP VOR gain in the experimental group (p<0.05). A significant positive correlation was found between anterior VHIT VOR gain and SHIMP VOR gain in the VN group and between posterior VHIT VOR gain and SHIMP VOR gain in the MD group (p<0.05). There was no significant difference between the groups according to the DHI sub-scores, DHI total scores, and DHI levels of the experimental group participants as mild (0-30 points), moderate (31-60 points), advanced (61-100 points) (p>0, 05). There was no significant correlation between DHI total scores with VHIT and SHIMP VOR gains in the affected ear (p>0.05). There was no significant correlation between DHI total scores and static posturography results in MD and BPPV patients (p>0.05). A significant correlation was found between DHI total score and mCTSIB COG mean sway velocity and between DHI total score and US COG sway velocity in VN patients (p<0.05). Conclusion: The results obtained in the study suggest that the evaluation of SHIMP results in addition to VHIT objectively for the diagnosis of peripheral vestibular disorders and the examination of the presence of saccades as well as VOR gains (saccade amplitude, latency and peak velocity) are important in the diagnosis and it is thought that it will be advantageous to use the SHIMP test in clinical applications as a supporter of VHIT. In addition, it will be useful to use static posturography test in the vestibular rehabilitation processes of patients. Since the scores of the dizziness handicap inventory and the results of the objective tests do not show a correlation, it is thought that additional subjective methods should be used in the measurement of the disability level associated with the dizziness complaints of the patients. It is believed that more specific results can be obtained by increasing the sample size and using more homogeneous groups on the basis of disease duration in future studies. Keywords; meniere disease; vestibular neuronitis; BPPV; Static Posturography; SHIMP; VHIT
Objectives: In this study, it was aimed to objectively evaluate peripheral vestibular disorders with static posturography, VHIT and SHIMP test results, to examine the correlation of patients' subjective dizziness disability level with objective test results, and to compare objective results with the control group. Materials and Methods: This study was carried out with 45 patients (15 people in each experimental group) between the ages of 18-65 who has applied to Ege University Hospital, Department of Otorhinolaryngology or Neurology Department with a complaint of dizziness in the last year and diagnosed with Meniere's disease (MD), vestibular neurinitis (VN) or Benign Paroxysmal Positional Vertigo ( BPPV) in the 'vertigo council' in which two departments are present. Fifteen healthy individuals, consisting of relatives of patients aged between 18-65 and Ege University students, who did not have dizziness, imbalance or any other health problem, were included in the control group. Demographic information, vestibular disease history and general health of the experimental group participants were evaluated with the Case Report Form. VHIT, SHIMP and Static posturography tests were applied to the experimental and control groups, respectively. The experimental group was also asked to fill in the dizziness handicap inventory (DHI). Results: In our study, a statistically significant difference was found between the groups in the modified Clinical Test of Sensory Interaction Balance (mCTSIB) center of gravity (COG) mean sway velocity on the firm surface in both eyes open and closed conditions (p<0.05). While there was a statistically significant difference between the groups in the Unilateral Stance (US) test COG mean sway velocity on the left and right legs with eyes closed, there was no significant difference between the left and right legs with eyes open (p>0.05). Statistically significant difference was found between the groups in Walk Across test mean walking speed and Tandem Walk test mean final sway velocities (p<0.05). In the comparison of the affected and healthy ear, there was a significant difference in the lateral VHIT 1st saccade amplitude and lateral VHIT 1st saccade peak velocity in the VN patient group, and only the lateral VHIT 1st saccade VI amplitude value in the MD group, but no significant difference was found for the SHIMP results in the whole experimental group ( p>0.05). In the comparison of the affected ear in the experimental group and the control group, statistically significant differences were found in terms of anterior VHIT VOR gain, lateral VHIT and SHIMP saccade values (p<0.05). A significant positive correlation was found between the lateral VHIT VOR gain and the SHIMP VOR gain in the experimental group (p<0.05). A significant positive correlation was found between anterior VHIT VOR gain and SHIMP VOR gain in the VN group and between posterior VHIT VOR gain and SHIMP VOR gain in the MD group (p<0.05). There was no significant difference between the groups according to the DHI sub-scores, DHI total scores, and DHI levels of the experimental group participants as mild (0-30 points), moderate (31-60 points), advanced (61-100 points) (p>0, 05). There was no significant correlation between DHI total scores with VHIT and SHIMP VOR gains in the affected ear (p>0.05). There was no significant correlation between DHI total scores and static posturography results in MD and BPPV patients (p>0.05). A significant correlation was found between DHI total score and mCTSIB COG mean sway velocity and between DHI total score and US COG sway velocity in VN patients (p<0.05). Conclusion: The results obtained in the study suggest that the evaluation of SHIMP results in addition to VHIT objectively for the diagnosis of peripheral vestibular disorders and the examination of the presence of saccades as well as VOR gains (saccade amplitude, latency and peak velocity) are important in the diagnosis and it is thought that it will be advantageous to use the SHIMP test in clinical applications as a supporter of VHIT. In addition, it will be useful to use static posturography test in the vestibular rehabilitation processes of patients. Since the scores of the dizziness handicap inventory and the results of the objective tests do not show a correlation, it is thought that additional subjective methods should be used in the measurement of the disability level associated with the dizziness complaints of the patients. It is believed that more specific results can be obtained by increasing the sample size and using more homogeneous groups on the basis of disease duration in future studies. Keywords; meniere disease; vestibular neuronitis; BPPV; Static Posturography; SHIMP; VHIT
Açıklama
27.06.2023 tarihine kadar kullanımı yazar tarafından kısıtlanmıştır
Anahtar Kelimeler
Kulak Burun ve Boğaz, Otorhinolaryngology (Ear-Nose-Throat)
