近30年来,行为方式对空间定位和平衡的认识已有很多进步,功能性和心因性疾病引起前庭症状也越来越普遍,也比结构性(器质性)前庭疾病更常见.目前正在完善中的国际前庭疾病分类瞄准这一迫切解决的问题,在即将发布的ICD-11中,正式命名、定义功能性眩晕这一常见的慢性眩晕类型.功能性眩晕不同于心因性眩晕,但心因性眩晕如果不干预,会影响功能性眩晕的治疗效果.现今,眩晕的诊断模式也将打破二元论的桎梏,呈现结构、功能与心因三方面的格局.今后,动态姿势评价、磁共振成像等新技术手段将进一步推进该领域的认识和发展.功能性眩晕的治疗包括患者教育、前庭康复以及认知行为治疗.功能性眩晕诊治的多学科合作是这一疾病临床诊治的方向.而患者首诊的耳科或神经耳科专家将扮演核心角色.%Over the last 30 years,research on behavioral factors affecting spatial orientation and balance function has made great progress.Functional and psychiatric vertigo are very common and probably more common than structur-al vertigo.A classification system is in preparation for this emerging clinical problem category.In the ICD-11 beta draft and the International Classification of Vestibular Disorders,PPPD will have its proper definition and diagnostic criteria.Functional vertigo is different from psychiatric vertigo,although psychiatric disorders can adversely affect prognosis for patients with structural vestibular diseases.Structural,functional and psychiatric conditions indeed overlap and this will alter the dichotomous thinking in medical diagnostics of vertigo.Fortunately,pharmacologic,psychotherapeutic,and re-habilitative treatments of functional vertigo have improved in recent years.Dynamic posturography and fMRI will play crucial roles to demonstrate the underlying mechanism in the future.Diagnostic and therapeutic approaches are necessar-ily multidisciplinary and likely managed by neurologists and otologists,whom patients usually consult first.
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