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目的:分析冷热气刺激下鼓膜穿孔患者的试验结果特点,探讨鼓膜穿孔者冷热气试验的可行性。方法:慢性中耳炎鼓膜穿孔伴眩晕的患者43例(49耳),行双耳冷热气试验,观测眼震特点、慢相角速度(SPV)和眼震不对称比(UW)。结果:穿孔耳冷热气刺激诱发眼震呈现4种类型:①增强型:穿孔耳诱发性眼震SPV增强并超过正常范围,或强于非穿孔耳、UW>15%者15例(17耳);②“正常型”:穿孔、非穿孔耳眼震SPV均在正常范围,UW<15%者7例;③减弱型:穿孔耳眼震SPV弱于非穿孔耳,UW>15%者9例;④反向型:非穿孔耳冷热气刺激眼震正常,穿孔耳热气刺激眼震反向者12例(14耳)。反向型眼震均出现在近期慢性中耳炎复发、鼓膜穿孔且有渗出或潮湿者;其余类型均为慢性中耳炎静止期患者。结论:对于穿孔耳,冷热气成为强刺激,半规管功能正常时诱发的眼震强于非穿孔耳;穿孔耳半规管功能不同程度减弱时,诱发眼震可为正常或减弱反应;活动期的中耳炎患者,穿孔耳热气刺激可转化为冷刺激效应,诱发出反向眼震;冷热气试验可用于鼓膜穿孔伴眩晕患者的前庭功能评定。
OBJECTIVE: To analyze the characteristics of the test results of patients with tympanic membrane perforation under cold-warm gas stimulation and to explore the feasibility of cold-hot gas test of perforation of tympanic membrane. METHODS: Forty-three patients (49 ears) with tympanic membrane perforation and dizziness in chronic otitis media were included in this study. Both ears were exposed to hot and cold gas, and their nystagmus features, slow phase velocity (SPV) and asymmetry of nystagmus (UW) were measured. Results: There were 4 types of nystagmus induced by cold and hot gas stimulation in the perforation ear: (1) enhanced type: the evoked nystagmus SPV of perforation-ear enhancement was beyond the normal range or stronger than that of non-perforation ear, 15 cases (17 ears ); “Normal”: perforation, non-pierced ear nystagmus SPV are in the normal range, UW <15% in 7 cases; ③ weakened type: perforation ear ear vibration SPV weaker than non-pierced ears, UW> 15% 9 Cases; reverse type: non-perforated ear cold and hot gas stimulation nystagmus normal, perforation ear hot gas stimulation of nystagmus in 12 cases (14 ears). Contralateral nystagmus appear in the recent recurrent chronic otitis media, tympanic membrane perforation and oozing or dampness; the remaining types are chronic otitis media in patients with quiescent. CONCLUSIONS: Cold and hot air becomes a strong stimulus to perforation ear, and nystagmus evoked by normal semicircular duct function is stronger than non-perforation ear. When the function of perforation ear and semicircular canal is weakened to different extents, induced nystagmus can be normal or attenuated; active otitis media Patients, perforation ear heat stimulation can be converted to cold stimulation, induced reverse nystagmus; cold gas test can be used for tympanic membrane perforation with dizziness in patients with vestibular function assessment.