前庭功能临床检查的主要进展

前庭功能临床检查的主要进展 解放军总医院 吴子明 本全面介绍了半规管脉冲检查和前庭诱发肌源性电位在前庭功能检查中的应用，以大量的病例资料深入浅出地阐述了前庭功能检查的意义，学员通过本课件的学习，可以掌握主要的前提功能检查方法，熟悉其临床应用。 一、半规管脉冲检查 半规管脉冲检查是一种简单、快速的生理检查，如果 采用视频记录敏感性增加，可以得到客观的结果，在视频 记录后可以进行定量分析。半规管脉冲检查又叫甩头试验。 右图为甩头试验示意图。图示中A、B、C三图模拟正 常情况，当受试者头向左侧转动时，受试者眼球可以盯住 检查者。D、E、F三图为异常情况，受试者右侧有病变时，头快速向右转动，受试者眼球无法盯住目标，出 现眼球扫视动作。根据这种现象可以判断右侧水平半规管功能存在异常。 为什么进行前庭诱发肌源性电位检查时双耳检查更具有实际意 义, 二、前庭诱发的肌源性电位 1. 定义 前庭诱发肌源性电位( vestibular evoked myogenic potentials ,VEMP)是指用高强声刺激球囊并在 integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, 紧张的胸锁乳突肌(SCM)上记录肌源性电位来反映人前庭丘脑 通路完整性的一种客观、无创的电生理检查，对前庭系统及其 相关疾病的诊断与鉴别诊断具有重要价值。 2. VEMP的神经科学基础 左图为前庭诱发肌源性电位的神经科学基础。 首先声音经 过中耳，进入镫骨传到前庭的球囊，经过Scarpa’s神经节，再传到前庭外侧核，再由前庭外侧核传递到 前庭的脊髓前角细胞再到同侧的胸锁乳突肌。也就是说，VEMP检查反映由球囊到前庭外侧核到脊髓前角细 胞到胸锁乳突肌的通路。 检查的电极:?参考电极:位于两侧胸锁乳突肌表面;?接力电极:位于前额正中。 检查体位:受试者要平卧之后抬头，耳机给予声音刺激。 3. VEMP刺激方式与主要参数 前庭诱发肌源电位的刺激方式有短声、短纯音、骨导刺激、电刺激等，目前短声和短纯声是主要刺激 方式。 各种刺激方式主要参数见下表。 引出率 带通滤波 刺激条件 刺激率 刺激强度 10~2000H 98% 短声 3Hz(0.1ms) 100dB nHL z 30~3000H 88% 短纯音 5Hz(500Hz) 95dB nHL z 7ms(250Hz) 112dB SPL 59%(耳机) 骨导刺激 8~1600Hz 64~128次 ,g 91%(敲击) 电刺激 20ms 5mA(2ms) 8~1600Hz 刺激模式 双耳刺激比单耳刺激更有实际应用意义 4. VEMP的命名及功能意义 integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, VEMP各波依次命名为p13、n23、 n34和p44，见下图。n34-p44的振幅低于p13-n23，p13-n23与前 庭传入的完整性有关，n34-p44可能与耳蜗功能有关。 5. VEMP异常的判断 VEMP异常可表现为下列方式:?振幅异常;?阈值;?潜伏期异常;?耳间潜伏期异常。 (1)振幅异常:各个实验室有不同的振幅异常参数，见下表。 作 者 I R-L/R+L I 两侧振幅比 Brandberg K 2001 0.36 Halmagyi GM 2002 2 Young YH 2003 0.33 301前庭室 2004 0.29 1.61 前庭诱发肌源电的强度降低，振幅明显降低，一般阈值在80分贝时无法引出反应。见下图。如果在 80分贝以下还能引出反应的，称为阈值的明显降低，主要见于声音或压力敏感性眩晕。 (2)阈值 integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, 上图为前庭诱发肌源性电位检查。右侧阈值为80分贝，与右侧对比，左侧65分贝时还可引出肌源性 电位，表明左侧阈值明显降低。 (3)潜伏期异常:各个实验室有不同的振幅异常参数，见下表。应用时应根据自己实验室的情况而定。 P13潜伏期(ms)N23潜伏期(ms) 作 者 上限I 上限 Waele CD1999 14.1 22.7 Brandberg K 2001 11.40 19.01 Version M 2002 13.65 25.04 Cheng PW 2003 13.32 22.27 301前庭室 2004 17.30 24.62 (4)耳间潜伏期异常。各个实验室有不同的振幅异常参数。p13、n23耳间潜伏期差异常的判断见下 表。 Δp13?(ms) Δn23?(ms) 301前庭室2005 0.41?0.36 0.54?0.42 1.13 1.38 三、病例介绍 integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, 1. 小脑-脑桥脚占位病变 ? 病例1 患者，男，65岁。发现右耳听力下降3月。 右面部麻木感2月。右耳胀、无眩晕、无平衡障碍。 ABR?-?间期为6.12ms。Caloric示右功能低下。 MRI 示右侧小脑-脑桥脚处1.8 x 2.2cm。患者前庭 诱发肌源电位示两侧P13、N23振幅正常，潜伏期 正常。表明患者主要累及前庭上神经部分，对下神 经部分没有受到影响。 ? 病例2 患者，女，50岁。2004-3-18日出现左耳闷、听 力下降，在当地医院诊为突聋。3-21日出现头晕、呕 吐，左侧周围性面瘫。在当地医院诊:面神经炎和突 聋。左ABR未引出。左侧前庭上神经功能异常。MRI 左内听道占位。确诊:面神经鞘膜瘤。 2. 前庭神经炎 ? 病例3 男，23岁。发作性自身不稳，视物旋转伴 恶心3月。共发作6~7次。左侧前庭功能低下。VEMP:左 侧前庭下神经功能低。ABR、纯音测听正常。MRI正常。 integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, 3. 梅尼埃病 ? 病例4 患者，女，47岁。2001-8出现左耳鸣、眩 晕、呕吐，眩晕时听力下降。右耳无耳鸣。眩晕前耳鸣加重，晕时听力下降明显眩晕持续1/2~ 10余小时。发作频率增加。听力逐渐下降。Caloric 双侧前庭功能障碍。VEMP双侧潜伏期延长，左侧低振幅。 梅尼埃病VEMP异常30~54%，VEMP异常与低频听阈相关，与水平半规管功能无关。VEMP异常的梅尼埃病患者平衡功能较差。应用VEMP试验进行梅尼埃病进行诊断时可结合甘油试验，比较甘油试验前后VEMP的引出了解球囊积水的情况。 4. 迟发性膜迷路积水 1975年，Nadol、Wolfson和Leiberman首先报道了迟发性膜迷路积水。1978年，Schuknecht对其进行了命名和分类。 迟发性膜迷路积水的主要发生机制有:?内淋巴囊破坏或前庭小管阻断;?单疱病毒感染。 迟发性膜迷路积水分类及鉴别见下表。 类型 主要表现 同侧 梅尼埃病样眩晕 前提条件半规管或前 对侧 耳蜗症状明显，眩晕少见 庭功能必须正常或未完全消失 双侧 双耳内淋巴积水的表现 integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, ? 病例5 患者，女，27岁。右耳自幼无听力。可 能是链霉素药物聋。患者2002-11月开始出 现眩晕、1~2小时。2003-10月加重，持续2 小时。2004-3月加重，发作频繁。持续时间 延长，6~7小时。 VEMP对迟发性膜迷路积水的独特作用有: (1)可以进行快速的筛选试验。VEMP异常表现:振幅降低或消失。p13波潜伏期延长。 (2)可进行诊断性定侧。 (3)确定有无残留功能。 (4)对于突聋和重度或全聋患者有必要行前庭功能检查，确定有否发生迟发积水的可能。 VEMP用于无症状积水:球囊积水可以发生在无症状耳。单侧MD临床患者VEMP阈值提高，VEMP调制发生改变。这些现象也可出现在无症状耳。这些梅尼埃病样反应可以见于27%的单侧MD。双侧梅尼埃病可见于大约1/3的MD。球囊积水可能在双侧梅尼埃病中早于其他症状。因此，这些检查指标可能作为梅尼埃病早期受累的指标，用以判断双侧梅尼埃病。 5. Tullio’s 现象-梅尼埃病 ? 病例6 患者，男，45岁。右耳听力下降3年，左耳听力下降1月。甘油试验双侧均改善10dB。前庭功能双侧水平半规管功能低下。VEMP示球囊声敏感。 integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, 小结: (1) VEMP和冷热试验反映2 个不同的前庭器官的功能。 (2) VEMP和冷热试验都有确定病变侧别的作用。 (3) VEMP可补充常规前庭功能检查的不足，可以提供球囊-前庭下神经功能的诊断信息，是眩晕相关 疾病鉴别诊断的重要依据。 (4) 感音神经性聋不影响VEMP的引出。 (5) VEMP 受SCM的肌张力水平、刺激强度以及年龄等诸多因素的影响。 前庭诱发肌源性电位(VEMP)对前庭系统及其相关疾病的诊断与鉴 别诊断具有重要价值，但判断VEMP异常的一些指标没有统一的标准，应 从实验室检查的实际情况厨房，灵活运用获得的指标参数进行判断。 integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed,