Akademik Veri Yönetim Sistemi
Tezin Türü: Tıpta Uzmanlık
Tezin Yürütüldüğü Kurum: Acıbadem Mehmet Ali Aydınlar Üniversitesi, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, Türkiye
Tezin Onay Tarihi: 2019
Tezin Dili: Türkçe
Öğrenci: Zeynep Önerci Altunay
Danışman: Haluk Özkarakaş
Özet:
Comparison of the Efficacy of Video Head Impulse and Bitermal Caloric Tests in Patients Having Vertigo.
ABSTRACT
BACKGROUND: Bitermal caloric tests have been routinely used for a long time in ENT practice. However; it is time consuming, difficult to tolerate and the patients are unwilling for repeated tests. Therefore a reliable test, which can be done in a shorter time and more tolerable by the patient was needed. Video Head Impulse Test (vHIT) was developed for this purpose, it has been used more commonly in recent times. It is easier to perform, can be done even in children without any difficulty, it does not require any special environmental conditions, all semisircular canal functions can be evaluated individually and separately. However it is necessary to compare its reliability and efficacy with other routine vestibular tests.
OBJECTIVE: To investigate whether vHIT can be an alternative diagnostic tool against bitermal caloric test.
METHODS: This retrospective / prospective study was performed in Acıbadem Kadıköy Hospital on 25 patients who presented with the complaint of vertigo for the first time without any preceding symptoms of vertigo and hearing loss before. 16 volunteers without any complaints constituted the control group. The files were reviewed. The matching patients from the files and the new patients who applied between March 2018 and September 2018 complying with our criteria were included in the study.
RESULTS: The difference of VNG values between normal - compansated groups, compansated - decompansated groups were statistically significant (p <0.001, Pearson Pearson X2) . However there was no statistically significant difference between compansated and normal groups regarding to vHIT gain asymmetry values (p=0.087). When VNG was used as the conventional method, vHIT gain asymmetry value sensitivity was 85.71%, specifity was 0% in uncompensated patients; 23.08% sensitivity, and 100% specifity in compensated patients. In the very early stages of the disease with spontaneous nystagmus, vHIT was found consistent over VNG. In the decompensated stage between 10 and 30 days both vHIT and VNG results were similar. When both sides were compared; vHIT gain asymmetry values were very close to VNG asymmetry values. In compensated cases (including small acoustic neuromas), vHIT was insufficient in determining the affected side in contrast to VNG. Two out of three acoustic tumour cases could not be diagnosed with vHIT.
CONCLUSIONS: vHIT was found equal or even consistent over VNG in patients at decompensated stages, whereas VNG is more valuable and reliable after compensation has been restored.
Key words: Vestibulo-ocular reflex, video head impulse test, VNG, bitermal caloric test, vertigo