어지러움증 환자의 진단에 있어 단일온도안진검사는 냉온교대온도안진검사를 대체할 수 있는가?

신유리,변성완 대한이비인후과학회 2003 대한이비인후과학회지 두경부외과학 Vol.46 No.6

Background and Objectives:The alternative binaural bithermal (ABB) caloric test by Fitzgerald and Hallpike has become a o investigate the efficacy of the monothermal caloric test as a replacement of AB caloric test. Materials and Method:The results of 690 complete AB caloric tests collected from 1997 through 1999 were analyzed retrospectively. We have examined the corelations between canal paresis value (CP) derived from an ABB caloric test and compared with the canal paresis value (CPmono) derived from the monothermal caloric component of a bithermal caloric test. :There was a stronger correlation betwen CP and CPmono of warm monothermal component (Pearson correlation coeficient=0.86) than that of cold monothermal caloric test (Pearson correlation coefficient=0.5). Excluding cases with spontaneous nystagmus (n=553), similar results was observed. A warm monothermal caloric test has higher sensitivity and specificity than a cold monothermal caloric test. When the positive rate was unaceptably high. Conclusion:The monothermal caloric test cannot be used as a replacement of AB caloric test. (Korean J Otolaryngol 2003 ;46 :469-74)

Gilbert 증후군에서 열량 제한 시험과 Phenobarbital 자극 시험의 의의(14예)

이헌영,채경훈,정재훈,강윤세,김연수,문희석,박기오,이엄석,김선문,김석현,성재규,이병석,이강욱 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Gilbert 증후군은 인구의 7%에서까지 나타날 수 있는 매우 흔한 증후군으로서 비진행성인 양성의 만성적 경과를 치하며, 간질환의 증상과 징후가 없는 경한 비포합형 고빌리루빈혈증이 특징인 일종의 체질적인 증상으로서 혈장 빌리루빈 농도에 대한 사춘기의 영향 때문에 10대와 20대에 자주 진단이 된다. 따라서 임상적인 중요성은 미약하지만 높은 빈도가 예상되는 점에 그 중요성이 부여되어야 할 것이다. 따라서 적정한 임상적 진단법으로 기왕에 소개된 열량제한 시험과 phenobarbital 유도 시험을 시행하고 이들의 진단적 가치를 알아보기 위하여 본 연구를 시행하였다. 1990년 7월부터 1999년 4월까지 충남대학교병원에 내원하여 HBsAg, IgG anti-HBc 및 anti-HCV가 음성이고, 간 초음파 스캔에서 이상이 없으며, 혈청 AST, ALT 및 AP가 정상인 비음주자에서 경한 비포합형 고빌리루빈혈증이 있는 14예의 환자들을 대상으로 ^(99m)Tc-DISID 스캔을 시행하였으며, 기저 치 총빌리루빈 및 포합형 빌리루빈 치를 측정한 다음에 하루에 400Kcal로 48시간동안 제한한 열량 제한 시험을 시행하였고, phenobarbital을 하루 60mg씩 5일간 투여한 후에도 각각 총빌리루빈과 포합형 빌리루빈 치를 검사하여 비포합형을 구하였다. 대상 환자들은 모두 14예로서 남자가 11예(78.6%)였고 여자가 3예(21.4%)여서 3.7:1로 남자에서 많았으며, 20대가 6예(42.9%), 30대가 역시 6예(42.9%) 및 40대가 2예(14.2%)로서 2,30대가 대부분(85.8%)이었다. 열량 제한 시험 후의 총빌리루빈 치, 비포합형 및 포합형 빌리루빈 치들은 평균 각각 5.5±2.7, 4.2±2.3 및 1.3±10mg/dL 로서, 시험 전 치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg/dL 보다 유의하게(p=0.001, p=0.001, p=0.023) 상승하였다. 포합형 빌리루빈 치도 유의하게 상승하였으나 비포합형의 상승보다는 훨씬 낮아서 주로 비포합형이 증가하였다. phenobarbital 투여 중 설사가 발생하여 중단한 1예를 제외한 13예에서 열량 제한 시험 후에 상승하였던 총, 비포합형 및 포합형 빌리루빈 치가 phenobarbital 유도 시험후에는 2.0±1.1, 1.5±0.8 및 0.5±0.4mg/dL로서 열량 제한 시험 결과보다 유의하게 낮아졌고(p=0.00, p=0.000, p=0.001), 열량 제한 시험 전의 기초치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg.dL 보다도 더욱 낮아졌으며 유의한 차이(p=0.001, p=0.02, p=0.005)를 나타내었다. 14예에서 시행한 ^(99m)-Tc DISIDA 스캔에서 9예(64.3%)가 정상이었고, 5예(35.7%)에서는 심장 및 신장으로의 간외 섭취가 3예였고, 60분까지 소장 배출이 없는 배설 지연 예와 담낭 수축 불량 예가 각각 1예 씩 발견되었다. Phenobarbital 투여시험에서 민감도가 열량제한시험에 비해 더 높았다(92.3%와 50.0%). Gilbert 증후군에서 1일 400 Kcal로 48시간의 열량제한 시험과 1일 60mg의 phenobarbital을 5일간 투여하는 유도 시험은 편리하고 유용한 임상적인 진단법으로 이용할 수 있다고 생각된다. 그러나 열량 제한 시험에서는 증가 기준의 통일이 필요하다고 유추되며 phenobarbital 유도 시험이 민감도가 더 높은 것으로 생각된다. Gilbert's syndrome is very frequent and benign chronic process characterized by mild, intermittent, unconjugated hyperbilirubinemia without any symptom and sign of liver disease. Previously intoduced caloric restriction test and phenobarbital stimulation test as two appropriate clinical tests had been examined and their diagnostic values were reevaluated. Fourteen patients with mild, persistent, unconjugated hyperbilirubinemia were included. Subsequently caloric restriction has been applicated by 400 Kcal/day for 48 hours and phenobarbital has been prescribed by 60 mg/day for 5 days. Therafter serum levels of total and direct bilirubin were measured. Most of the patients were third and fourth decade(85.8%) and male predominant. Each basal serum levels of total, indirect and direct bilirubin were 3.0±0.8, 2.2±0.8 and 0.7±0.4 mg/dL. After caloric restriction test, each levels were increased significantly to 5.5±2.7, 4.2±2.3 and 1.3±1.0 mg/dL(p=0.001, p=0.001, p=0.023). After phenobarbital stimulation test for 13 patients had been practiced, increased levels of each bilirubin after caloric restriction test were decreased significantly to 2.0±1.0, 1.5±0.8 and 0.5±0.4 mg/dL(p=0.000, p=0.000, p=0.001) and these levels were significantly lower than basal levels(p=0.001, p=0.02, p=0.005). The sensitivities of caloric restriction test were 85.7%, 50.0%, and 71.4%, 35.7%(1.0, 1.5 mg increase of total bilirubin and 1.0, 1.5 mg/dL increase of indirect bilirubin). The sensitivities of phenobarbital stimulation test were 93.2% and 92.3% at criteria of 1.5 mg/dL increase of total bilirubin and indirect bilirubin. On the diagnosis of Gilbert syndrome, caloric restriction test and phenobarbital stimulation test are convenient and useful diagnostic tools in clinical face. And also phenobarbital stimulation test has higher sensitivity than caloric restriction test. Furthermore, standardization of bilirubin increment would be necessary in caloric restriction test.

상반된 결과를 보이는 온도안진검사와 비디오 두부충동검사

양승찬,황준하,김현지,이승철,김규성 대한이비인후과학회 부산,울산,경남 지부회 2016 임상이비인후과 Vol.27 No.2

Background and Objectives:The caloric test has been useful method to recognize the loss of peripheral vestibular function. The video head impulse test (vHIT) is also very simple and useful method to detect the peripheral vestibular loss by observing the corrective saccade as well as by measuring the gain of vestibulo-ocular reflex (VOR). But the results between these two tests can be different, depending on the functional status of clinical entity of dizziness. In this study, cases with different results between two tests were categorized to find out the further diagnostic value of these two tests and have useful insight for pathophysiology of the vestibular disease. Materials and Methods:211 ears from 201 patients of dizziness who both bithermal caloric test and vHIT were performed, were included. vHIT was performed using ICS impulseⓇ (ICS impulseⓇ, Otometrics, Taastrup, Denmark) on horizontal plane and was repeated about 20 times in each direction randomly. Peak head velocity was controlled as 150-200 degree/second by monitoring the recording of head velocity during the test. Canal paresis (CP) more than 25% in caloric test and the presence of corrective saccade with low gain (less than 0.8) in vHIT were decided as abnormal. Clinical findings of the patients with different results between caloric test and vHIT were reviewed and categorized according to the causes of dizziness. Results:The results between caloric test and vHIT were opposite in 32.2% (68/211 ears) which were normal vHIT with canal paresis (‘CP+ & vHIT-’) in 92.6% (63 ears) and abnormal vHIT without canal paresis (‘CP- & vHIT+’) in 7.4% (5 ears). 63 ears of ‘CP+ & vHIT-’ included Meniere’s disease (32 ears, 50.8%), benign recurrent vertigo (12 ears, 19%), positional vertigo of unknown cause (9 ears, 14.3%) and other causes of dizziness (10 ears, 15.9%). In case of 55 ears of Meniere’s disease included in this study, the results were opposite in 32 ears (58.2%) which all of them were ‘CP+ & vHIT-’. ‘CP- & vHIT+’ were only 5 ears, which were acute vertigo syndrome in 2 ears, opposite ears of unilateral vestibular loss in 2 ears, and unknown cause of dizziness in 1 ear. Conclusions:In 32.2% of dizzy patients, the loss of VOR depends on the frequency range of VOR, and ‘CP+ & vHIT-’ is the most common pattern. The most common clinical entity of ‘CP+ & vHIT-’ is Meniere’s disease, but the frequency selective loss of VOR occurs in variety of causes of dizziness..

반고리관 기능의 이학적 검사

채성원 대한평형의학회 2009 Research in Vestibular Science Vol.8 No.2

The semicircular canals sense angular acceleration and are arranged in roughly parallel pairs. The vestibuloocular reflex (VOR) is responsible for maintaining binocular fixation and stabilizing binocular foveal images during head movements. The VORs are divided into two types: angular and linear. Angular reflexes are initiated by activation of the semicircular canals. There are several kinds of test for semicircular canal function such as caloric test, rotation test, and pulse step sine test. Caloric testing remains the most useful laboratory test in determining the responsiveness of a labyrinth. It is one of the few tests that allow one labyrinth to be studied independently of the other. The stimulus can be applied relatively easily with techniques that are commonly available. Caloric testing relies on stimulating or cooling the vestibular system by alternately heating and cooling the external auditory canal with water or air. Rotational tests analyze the responses of both labyrinths together. They require a high-torque motor-driven chair and relatively advanced software to analyze the results. Rotatory chair testing is useful in assessing vestibular function in patients with suspected bilateral vestibular hypofunction and children. Step changes in head velocity can be used instead of sinusoidal rotations to identify vestibular hypofunction. Time constant are determined by the time after onset of the stimulus at which slow phase eye velocity has decreased by 67% of its initial value. The use of a novel “pulse-step-sine” (PSS) rotational stimulus can identify abnormal function of the horizontal semicircular canals in human subjects with unilateral and bilateral vestibular deficits. The semicircular canals sense angular acceleration and are arranged in roughly parallel pairs. The vestibuloocular reflex (VOR) is responsible for maintaining binocular fixation and stabilizing binocular foveal images during head movements. The VORs are divided into two types: angular and linear. Angular reflexes are initiated by activation of the semicircular canals. There are several kinds of test for semicircular canal function such as caloric test, rotation test, and pulse step sine test. Caloric testing remains the most useful laboratory test in determining the responsiveness of a labyrinth. It is one of the few tests that allow one labyrinth to be studied independently of the other. The stimulus can be applied relatively easily with techniques that are commonly available. Caloric testing relies on stimulating or cooling the vestibular system by alternately heating and cooling the external auditory canal with water or air. Rotational tests analyze the responses of both labyrinths together. They require a high-torque motor-driven chair and relatively advanced software to analyze the results. Rotatory chair testing is useful in assessing vestibular function in patients with suspected bilateral vestibular hypofunction and children. Step changes in head velocity can be used instead of sinusoidal rotations to identify vestibular hypofunction. Time constant are determined by the time after onset of the stimulus at which slow phase eye velocity has decreased by 67% of its initial value. The use of a novel “pulse-step-sine” (PSS) rotational stimulus can identify abnormal function of the horizontal semicircular canals in human subjects with unilateral and bilateral vestibular deficits.

전정기능검사에서 양측성 전정기능저하 소견을 보이는 환자의 임상양상 분석

김동현,이정현,김봉직,이정구,정재윤 대한평형의학회 2014 Research in Vestibular Science Vol.13 No.2

Background and Objectives: Caloric test and rotatory chair test have been adopted in diagnosing bilateral vestibulopathy. However, most of patients who were confirmed by the diagnostic testing not complained typical symptoms of bilateral vestibulopathy such as ossilopsia and ataxia. Patients who do not have typical symptoms of bilateral vestibulopathy, were often diagnosed with bilateral vestibulopathy by caloric test and slow harmonic acceleration test (SHA). The aim of this study is to assess the clinical features between groups classified according to the caloric test and SHA test, and possibly to investigate the representative test in the diagnosis of bilateral vestibulopathy. Materials and Methods: Seventy-five patients were divided into three groups: (A) patients diagnosed with the caloric test only, (B) patients diagnosed with SHA test only, (C) patients satisfying the diagnostic criteria of both tests. Clinical characteristics, the results of physical examination, hearing test and vestibular function test (VFT) were compared among three groups. Results: There was no difference in clinical characteristics and results of physical examination among three groups. Regarding VFT results, only in step velocity test, The proportion of patients who showed low gain value on both sides were higher in group C than that of group A and B. No difference was observed in the other VFT results among three groups. Conclusion: We could not predict the clinical features of bilateral vestibulopathy by the results of VFT, and could not find preferable test in diagnosing bilateral vestibulopathy.

Reliability of Air Caloric Response in Healthy Volunteers and Patients With Chronic Otitis Media

홍성광,김지수,최진웅,구자원 대한평형의학회 2012 Research in Vestibular Science Vol.11 No.1

Background and Objectives: To investigate reliability of the air caloric test compared to the water caloric test and to determine whether anatomical alterations due to chronic otitis media (COM) influence air caloric response. Materials and Methods: Fifty-six subjects without vestibulopathy (24 healthy individuals as control group and 32 patients with unilateral COM as experimental group) were included. The bithermal water and air caloric test were sequentially conducted in control group. The bithermal air caloric tests, high-resolution temporal bone computed tomography and endoscopic photography of the ear drum were obtained from experimental group. Results: Although maximal slow phase velocities and time to reach peak velocity using water irrigation were significantly higher and shorter, respectively, than those by air irrigation in normal subjects, caloric parameters on air caloric test agreed well with those of water caloric testing. However, inverted nystagmus occurred in 16 ears of 16 subjects, which was predominantly presented during warm air stimulation in the com patient group. The large tympanic membrane perforation and asymmetrical mastoid pneumatization were significant parameters affecting caloric response. The presented prediction model for cold-induced mspvs corresponded with observed values according to mastoid pneumatization. Conclusion: Although the air caloric stimuli resulted in a reliable response in healthy subjects, air caloric results among com patients affected by anatomical alteration as well as irrigation temperature. Presented mathematical model for cold induced mspv could serve as a good reference in measuring true vestibular function in com patients.

Dissociated Results between Caloric and Video Head Impulse Tests in Dizziness: Prevalence, Pattern, Lesion Location, and Etiology

이주영,권은진,김효정,최정윤,오희종,구자원,김지수 대한신경과학회 2020 Journal of Clinical Neurology Vol.16 No.2

Background and Purpose This study was designed to determine the prevalence, pattern, lesion location, and etiology of dissociation in the results of the bithermal caloric test and the horizontal video head impulse test (vHIT) in dizzy patients with various etiologies and disease durations. Methods We analyzed the results of bithermal caloric tests and vHITs performed over 26 months in 893 consecutive patients who underwent both tests within a 10-day period. Results Dissociation in the results of the two tests was found in 162 (18.1%) patients. Among them, 123 (75.9%) had abnormal caloric tests (unilateral paresis in 118 and bilateral paresis in 5) but normal vHITs. Peripheral lesions were identified in 105 (85.4%) of these patients, with the main underlying diseases being Meniere’s disease (62/105, 59%) and vestibular neuritis/ labyrinthitis (29/105, 27.6%). In contrast, central pathologies of diverse etiologies were found only in 18 (14.6%) patients. Abnormal vHIT (bilaterally positive in 18, unilaterally positive in 19, and hyperactive in 2) and normal caloric responses were found in 39 patients, with an equal prevalence of central (n=19) and peripheral (n=20) lesions. The peripheral lesions included vestibular neuritis/labyrinthitis in seven patients and Meniere’s disease in another seven. The central lesions had diverse etiologies. Conclusions Dissociation in the results between caloric tests and horizontal vHITs is not uncommon. The present patients with abnormal caloric tests and normal vHITs mostly had peripheral lesions, while central lesions were likely to underlie those with abnormal vHITs and normal caloric tests.

급성 일측 전정신경염 진단에 있어 회전의자검사 및 온도안진검사의 유용성

차흥억,임채영,한규철,조창현,윤병기,백민관,이주형 대한평형의학회 2008 Research in Vestibular Science Vol.7 No.1

Background and Objectives: The acute unilateral vestibular neuritis is fairly a common disease and the precise diagnostic tool is needed for the selection of effective treatments. Therefore, we studied the clinical usefulness of the rotatory chair test and caloric test which have been commonly used in patient of acute unilateral vestibular neuritis. Materials and Methods: One hundred and sixty four patients who were diagnosed with acute unilateral vestibular neuritis from August of 2004 to June of 2007 were included. Their medical records of the rotating chair test and caloric test were reviewed retrospectively to study the correlation of the two tests. Results: Of 164 patients, 101 patients (61.6%) and 88 patients (53.7%) showed significant canal paresis (CP) and directional preponderance (DP) on the caloric tests that corresponded with the physical exam. 130 patients (79.3%) and 84 patients (51.2%) showed significant asymmetry and time constant (Tc) on the rotating chair test that corresponded with the predictive direction with spontaneous nystagmus. Conclusions: For acute unilateral vestibular neuritis patients, the asymmetry of the rotatory chair test showed the highest correlation with clinical findings. But physical exam should be preceded because neither rotator chair test nor caloric test yields a specific correlation with the physical exam. Especially, single test only may too many false negative results. For these tests can reduce false positive cases of the physical exam and raise the specificity of the diagnosis, the planning of proper treatments should be followed thereafter. Background and Objectives: The acute unilateral vestibular neuritis is fairly a common disease and the precise diagnostic tool is needed for the selection of effective treatments. Therefore, we studied the clinical usefulness of the rotatory chair test and caloric test which have been commonly used in patient of acute unilateral vestibular neuritis. Materials and Methods: One hundred and sixty four patients who were diagnosed with acute unilateral vestibular neuritis from August of 2004 to June of 2007 were included. Their medical records of the rotating chair test and caloric test were reviewed retrospectively to study the correlation of the two tests. Results: Of 164 patients, 101 patients (61.6%) and 88 patients (53.7%) showed significant canal paresis (CP) and directional preponderance (DP) on the caloric tests that corresponded with the physical exam. 130 patients (79.3%) and 84 patients (51.2%) showed significant asymmetry and time constant (Tc) on the rotating chair test that corresponded with the predictive direction with spontaneous nystagmus. Conclusions: For acute unilateral vestibular neuritis patients, the asymmetry of the rotatory chair test showed the highest correlation with clinical findings. But physical exam should be preceded because neither rotator chair test nor caloric test yields a specific correlation with the physical exam. Especially, single test only may too many false negative results. For these tests can reduce false positive cases of the physical exam and raise the specificity of the diagnosis, the planning of proper treatments should be followed thereafter.

동시 자극 온도 안진 검사의 유용성

정운교,문성균,고윤우,이해성,이주형,윤혜진 대한이비인후과학회 1998 대한이비인후과학회지 두경부외과학 Vol.41 No.9

말초성 전정질환 환자에서의 회전반응 검사와 냉온자극 검사의 비교

원준연,이광선,윤태현,김윤경 대한이비인후과학회 1998 대한이비인후과학회지 두경부외과학 Vol.41 No.1