Vestibüler migren ve meniere hastalığının tanısında vestibüler testlerin rolü
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ VE AMAÇ: Vestibüler Migren (VM) ve Meniere hastalığının (MH) diagnozu esas itibariyle klinik bilgilere dayalıdır ayırıcı tanıya varmak malesef zordur.Halihazırda bu iki hastalığı güvenilir bir şekilde ayırt edecek kesin tanısal test bulunmamaktadır . VM ve MH farklı şekillerde tedavi edilmektedir, bu nedenle bu iki patolojinin doğru teşhis edilmesi, onların yönetimindeki hatalardan kaçınmamızı sağlayabilir(1). GEREÇ VE YÖNTEM: Bu çalışmada, vestibüler testlerin (fHİT,cVEMP,vHİT) sık rastlanan vertigo nedenlerinden olan Vestibüler Migren (VM) ve Meniere hastalığının (MH) tanısındakı rolü incelenmiştir. Araştırma Ege Üniversitesi Tıp Fakültesi Yerel Etik Kurulu tarafından onaylanmıştır ( 21-2.1T/53). Ege Üniversitesi Tıp Fakültesi Nöroloji Kliniği, Nörosensoriyel Laboratuvarı'nda yaş aralığı 18-65 olan kesin VM tanısı ve MH tanısı bulunan hastalar prospektif olarak değerlendirilmiş ve yukarıda bahsedilen vestibüler testler yapılmıştır. Öyküsünde işitme kaybı, ciddi görsel bozukluk, bilinen ciddi nörolojik, bilişsel problem olan veya belirli sebepler dolayısı ile (boyun problemi, göz problemi) sağlıklı teste tabi tutulamayan hastalar, MSS hastalığı, intratimpanik gentamisin tedavisi alanlar, vestibüler sistemi etkileyecek sistemik hastalığı olanlar, otolojik cerrahi geçirenler ve hastalığı olanlar çalışma dışı bırakılmıştır. Hastalar 3 gruba ayrılmıştır. 1. grupta kesin VM 'li 22 olgu; 2. grupta VM 'ye uymayan ve kesin, muhtemel veya olası MH tanısı alan 21 olgu; 3. grupta normal kontrol (NK) grubu olarak 20 olgu incelenmiştir. BULGULAR: VM grubu kadın cinsiyet oranı diğer iki gruba kıyasla anlamlı düzeyde yüksek, Tüm grupların yaş ortalaması 45,30 ± 13,4 yıldı. cVEMP testinde gruplar arasında P 13 - N 23 latans süresi ,interpeak amplitüd değeri ve asimetri oranı(AO%) açısından istatistiksel olarak anlamlı farklılık saptandı. vHİT testinde gruplararası karşılaştırmada lateral kanal, posterior kanal ve anterior kanal VOR (vestibülooküler refleks) kazançları açısından istatiksel açıdan anlamlı farklılık saptandı. fHİT test, doğru yanıt oranları (DY%) açısından yapılan ikili karşılaştırmalarda VM grubu ile NK, hemde MH1 ve MH2 grupları ile kontrol grubu arasında anlamlı farklılık elde edildi. SONUÇ: Her üç testin hasta gruplarda anormaldi MH'lilerde VM'li olanlara göre daha ciddi derecede etkilenim vardı, cVEMP ve vHİT ile kesin ayırıcı tanı için olmasa da destekleyici laboratuvar testler olarak kullanılabilir. fHİT için hastalar üzerinde yapılmış yeterli sayıda çalışma yoktur, hasta uyumu gerektiren bir testdir, MH hastalarının yaş ortalamasının yüksekliği ve işitme kaybı nedenli kooperasyon yetersizliği de bu gruptakı etkilenmenin yüksek 6 olmasında katkı sağlamış olabilir. Nihayetinde klinik olarak bazı benzer özellikleri olan MH ve VM vestibüler testlerle kıyaslandığında MH'lilerde daha bariz ve ciddi fonksiyonel kayıp çalışmamız sonucunda diğer çalışmalara benzer şekilde görülmüştür. Anahtar kelimeler: Migren, meniere, vestibüler migren, vHIT, fHİT,cVEMP
OBJECTIVE: The diagnosis of Vestibular Migraine (VM) and Meniere's disease (MD) is primarily based on clinical features, and making their differential diagnosis is often quite difficult. There is currently no definitive diagnostic test to reliably distinguish between these two diseases. VM and MH are treated differently, so correct diagnosis of these two pathologies can help us avoid mistakes in their management(1). MATERIALS AND METHODS: In this study, the role of vestibular tests (fHIT, cVEMP, vHIT) in the diagnosis of Vestibular Migraine (VM) and Meniere's disease (MD), which are common causes of vertigo, was investigated. The study was approved by the Ege University Faculty of Medicine Local Ethics Committee (21-2.1T/53). Patients aged 18-65 years with a definite diagnosis of VM and MD were evaluated prospectively in the Neurosensory Laboratory of the Neurology Clinic of the Ege University Faculty of Medicine and the above-mentioned vestibular tests were performed. Those with a history of hearing loss, severe visual impairment, known to have serious neurological or cognitive problems or for various reasons (neck problem, eye problem), CNS disease, those receiving intratympanic gentamicin treatment, systemic diseases that may affect the vestibular system, those who have undergone otological surgery and disease was excluded from work. The patients were divided into 3 groups. In group 1, 22 patients with a definite diagnosis of VM; In group 2, 21 patients who did not meet the diagnostic criteria for VM and were diagnosed with definite, probable or probable MD; In the 3rd group, 20 cases were examined as the normal control (NK) group. RESULTS: The female gender ratio was significantly higher in the VM group compared to the other two groups. The mean age of all groups was 45.30 ± 13.4. In the cVEMP test, statistically significant difference was found between the groups in terms of P 13 - N 23 latency time, interpeak amplitude value and asymmetry ratio (%AO). In the vHIT test, statistically significant differences were found between the groups in terms of lateral canal, posterior canal and anterior canal VOR (vestibuloocular reflex) gains. In the pairwise comparisons made in terms of fHIT test, correct response rates (%CW), a significant difference was found between the VM group and the NK group, and between the MH1 and MH2 groups and the control group. CONCLUSION: The results showed that all three tests were abnormal in the patient groups, with MD patients being affected more frequently and more severely than those with VM. Although it is not possible to make a definitive differential diagnosis with cVEMP and vHIT, 8 they can be used as supportive laboratory tests. There are not enough studies on patients for fHIT, it is a test that requires patient compliance. The high average age of MD patients and the lack of cooperation due to hearing loss may have contributed to the high level of exposure in this group. Finally, when compared to MD and VM vestibular tests, which have some clinically similar features, more obvious and serious functional loss in MD patients was observed in our study, similar to other studies. Keywords: Migraine, meniere, vestibular migraine, vHIT, fHIT, cVEMP
OBJECTIVE: The diagnosis of Vestibular Migraine (VM) and Meniere's disease (MD) is primarily based on clinical features, and making their differential diagnosis is often quite difficult. There is currently no definitive diagnostic test to reliably distinguish between these two diseases. VM and MH are treated differently, so correct diagnosis of these two pathologies can help us avoid mistakes in their management(1). MATERIALS AND METHODS: In this study, the role of vestibular tests (fHIT, cVEMP, vHIT) in the diagnosis of Vestibular Migraine (VM) and Meniere's disease (MD), which are common causes of vertigo, was investigated. The study was approved by the Ege University Faculty of Medicine Local Ethics Committee (21-2.1T/53). Patients aged 18-65 years with a definite diagnosis of VM and MD were evaluated prospectively in the Neurosensory Laboratory of the Neurology Clinic of the Ege University Faculty of Medicine and the above-mentioned vestibular tests were performed. Those with a history of hearing loss, severe visual impairment, known to have serious neurological or cognitive problems or for various reasons (neck problem, eye problem), CNS disease, those receiving intratympanic gentamicin treatment, systemic diseases that may affect the vestibular system, those who have undergone otological surgery and disease was excluded from work. The patients were divided into 3 groups. In group 1, 22 patients with a definite diagnosis of VM; In group 2, 21 patients who did not meet the diagnostic criteria for VM and were diagnosed with definite, probable or probable MD; In the 3rd group, 20 cases were examined as the normal control (NK) group. RESULTS: The female gender ratio was significantly higher in the VM group compared to the other two groups. The mean age of all groups was 45.30 ± 13.4. In the cVEMP test, statistically significant difference was found between the groups in terms of P 13 - N 23 latency time, interpeak amplitude value and asymmetry ratio (%AO). In the vHIT test, statistically significant differences were found between the groups in terms of lateral canal, posterior canal and anterior canal VOR (vestibuloocular reflex) gains. In the pairwise comparisons made in terms of fHIT test, correct response rates (%CW), a significant difference was found between the VM group and the NK group, and between the MH1 and MH2 groups and the control group. CONCLUSION: The results showed that all three tests were abnormal in the patient groups, with MD patients being affected more frequently and more severely than those with VM. Although it is not possible to make a definitive differential diagnosis with cVEMP and vHIT, 8 they can be used as supportive laboratory tests. There are not enough studies on patients for fHIT, it is a test that requires patient compliance. The high average age of MD patients and the lack of cooperation due to hearing loss may have contributed to the high level of exposure in this group. Finally, when compared to MD and VM vestibular tests, which have some clinically similar features, more obvious and serious functional loss in MD patients was observed in our study, similar to other studies. Keywords: Migraine, meniere, vestibular migraine, vHIT, fHIT, cVEMP
Açıklama
Anahtar Kelimeler
Nöroloji, Neurology, Migren, meniere, vestibüler migren, vHIT, fHİT,cVEMP, Migraine, meniere, vestibular migraine, vHIT, fHIT, cVEMP
