耳鼻咽喉科专病门诊8310例眩晕患者的病因学分析

摘要

Objective We aimed to report the spectrum of causes of vertigo and dizziness in patients in an attempt to reduce misdiagnosis and inappropriate treatment.Methods Clinical data from patients complaining of vertigo and diz-ziness seen by the authors were retrospectively reviewed,including medical histories,presenting symptoms,physical ex-amination and lab tests results.Diagnoses were based on standardized diagnostic criteria widely accepted in China and internationally.Results A total of 8,310 cases seen by the authors from January 2013 to July 2017 were included.The male to female ratio was 1:2.09,and the age ranged from 7 to 89 years.Identified etiologies were:benign paroxysmal positional vertigo(n=2,846,34.25%),vestibular migraine(n=2,033,24.46%),Meniere's disease(n=819,9.86%),sud-den deafness (n=650,7.82%),persistent postural-perceptual dizziness (n=407,4.90%),vestibular neuritis(n=325,3.91%),delayed endolymphatic hydrops (n=306,3.68%),other peripheral vestibular vertigo (n=154,1.85%),central vestibular vertigo(excluding vestibular migraine(n=76,0.91)and vertigo of unknown causes(n=694,8.35%).Conclu-sions Our study indicates that the predominant three causes for vertigo or dizziness are benign paroxysmal positional vertigo,vestibular migraine and Meniere's disease,followed by sudden deafness,persistent postural-perceptual dizzi-ness,vestibular neuritis,delayed endolymphatic hydrops and other peripheral vestibular vertigo.Central vestibular verti-go(not counting vestibular migraine)is relatively infrequent.Etiology cannot be determined in a small proportion of pa-tients.%目的 通过对耳鼻咽喉科专病门诊的8310例眩晕患者眩晕进行病因学的统计分析,归纳总结耳鼻咽喉科门诊的常见眩晕疾病及其临床特征,为下一步建立合理有效的眩晕门诊的诊疗流程提供科学依据.方法 对来源于吉林大学第二医院和吉林省人民医院耳鼻咽喉科专病门诊(2013年1月-2017年7月)的以眩晕为主诉患者的临床诊断结果进行回顾性分析,分别依照中国诊断标准或国际通用诊断标准作为依据,综合患者的临床症状和体征、既往史、相应的辅助检查结果,给予临床诊断.结果 符合研究标准的以眩晕为主诉的患者共计8310例,年龄7~89岁,其中男性2634例,女性5496例,男:女=1:2.09;各类头晕眩晕疾病所占比例依次为良性阵发性位置性眩晕2846例(34.25%)、前庭性偏头痛2033例(24.46%)、梅尼埃病819例(9.86%)、突发性聋650例(7.82%)、持续性姿势-知觉性头晕407例(4.90%)、前庭神经炎325例(3.91%)、迟发型膜迷路积水306例(3.68%)、其他前庭周围性眩晕154例(1.85%)、前庭中枢性眩晕(不包括前庭性偏头痛)76例(0.91%)、原因不明694例(8.35%).结论 此组病例的病因学分析结果显示,耳鼻咽喉科专病门诊的病因依次为良性阵发性位置性眩晕、前庭性偏头痛、梅尼埃病、突发性聋、持续性姿势-知觉性头晕、前庭神经炎、其他前庭周围性眩晕、前庭中枢性眩晕(不包括前庭性偏头痛)少见.即使在三甲医院的专病门诊也有超过8%的眩晕患者不能明确病因.