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背景:80岁以上老年人眩晕及跌倒发生率高,且与位、听、视功能减退有关。目的:定量评价80岁以上老年人的位、听、视功能。设计:以老年患者为观察对象,定量评价其位功能(前庭平衡功能)、听功能(语频听阈)、视功能(视动功能)。单位:解放军总医院耳鼻咽喉科。对象:选择1993-03/1994-01解放军总医院康复部因全身系统疾病住院的老年男性41人,年龄80～94岁。有耳鸣症状者12人,有眩晕症状者20人。选择同期本院健康体检60～79岁健康老干部作为对照,男11例,女7例。该组患者均无耳鸣、耳聋等耳部症状及眩晕症状。所有老年人均自愿参加。方法:对患者进行耳鼻喉全面检查。听功能检查包括纯音测听及脑干电反应测听。前庭功能(位功能)用旋转检测试前庭眼反射,1°/s角加速到90°/s后恒速旋转至眼震消失后骤停记录旋转后眼震,先向左转间隔10min后向右转,计算慢相角速度并计算左右不对称比值;前庭脊髓反射(位功能,VSR)用平衡台测试,并计算人体重心晃动的轨迹长度和速度。视动中枢检查(视功能)用光标测试,包括扫视、跟踪、视动3项眼动功能。主要观察指标:语频听阈、前庭眼反射试验、前庭脊髓反射试验及视动功能检查>80岁老年人位、听、视功能结果,并与60～79岁老年人平衡功能、视动功能检查结果进行对比。结果:按实际处理分析,进行语频听阈、前庭眼反射、前庭脊髓反射、平衡功能和视动功能检查的80岁以上老年人分别为41,24,39,40和34人,进行平衡功能和视动功能检查的60～79岁老年人分别为18和10人,脱落者为不愿接受该项检查者。①听功能:80岁以上老年人41人中语频听阈正常者13耳(16%),听力下降者69耳(64%)。②位功能:前庭眼反射正常者15人(62%),异常者9人(38%),前庭脊髓反射正常10人(26%),异常29人(74%)。③平衡功能:人体平衡功能各参数中以重心晃动的轨迹长度与速度最有价值,两个年龄段老年人的闭眼人体重心轨迹长度和晃动速度明显长于和大于睁眼(P<0.01)。>80岁老年人人体重心轨迹长度和晃动速度明显长于和大于60～79岁老年人(P<0.01)。④视动功能:>80岁老年人与60～79岁老年人视动增益相似(P>0.05),扫视潜伏期和跟踪失真度明显长于和大于60～79岁老年人(P<0.05～0.01)。结论:80岁以上老年人大部分存在听力和位功能下降现象;视动和平衡功能较60～79岁老人更加退化。
Background: The incidence of dizziness and falls in the elderly over 80 years old is high, and it is related to the decline of the position, hearing and visual function. Objective: To quantitatively evaluate the position, hearing and visual function of the elderly over 80 years old. Design: The elderly patients as the object of observation, quantitative evaluation of their position function (vestibular balance function), listening function (audio frequency threshold), visual function (visual motor function). Unit: People’s Liberation Army General Hospital of Otorhinolaryngology. PARTICIPANTS: A total of 41 elderly men aged 80-94 years were enrolled in the Rehabilitation Department of PLA General Hospital from March 1993 to January 1994 with systemic diseases. 12 people have tinnitus symptoms, 20 people have vertigo symptoms. Select the same period our hospital healthy physical examination 60 to 79-year-old healthy cadres as a control, 11 males and 7 females. The group of patients without tinnitus, deafness and other ear symptoms and dizziness symptoms. All older people volunteered to participate. Methods: Patients were ENT comprehensive examination. Listening functional tests include pure tone audiometry and brainstem response audiometry. Vestibular function (bit function) with the rotation test test vestibulo-ocular reflex, 1 ° / s angle accelerated to 90 ° / s constant speed rotation to nystagmus disappear after the stop recording rotational nystagmus, turn left after an interval of 10min to Turn right, calculate the slow phase angular velocity and calculate the left and right asymmetry ratio; vestibular spinal reflex (bit function, VSR) with a balance station test, and calculate the human body center of gravity trajectory length and velocity. Visual central examination (visual function) with the cursor test, including saccade, tracking, visual acuity three eye movements. MAIN OUTCOME MEASURES: Audio frequency threshold, vestibulo-ocular reflex test, vestibular spinal reflex test and visual acuity test> 80-year-old patients with positional, auditory and visual function results, and 60-79 years old with balance function, visual acuity test The results are compared. Results: According to the actual treatment analysis, 41, 24, 39, 40 and 34 elderly people over the age of 80 who underwent audiometry, vestibular reflex, vestibular spinal reflex, balance function and visual acuity were balanced, Visual acuity examinations of 60 to 79-year-old were 18 and 10, respectively, who were unwilling to accept the test. (1) Listening function: 13 ears (16%) with normal hearing threshold and 69 ears (64%) with hearing loss were 41 (41%) older than 80 years old. (2) Function: Fifteen (62%) had normal reflexes in the vestibule, 9 (38%) had abnormal reflexes, 10 (26%) had normal reflexes in the vestibular spinal cord and 29 (74%) had abnormal reflexes. (3) Balance function: The trajectory length and speed of the center of gravity swing are the most valuable parameters in the human body balance function. The trajectory length and shaking speed of the closed eyes of the two age groups are significantly longer and wider than the eyes open (P <0.01). > 80-year-old human body center of gravity trajectory length and shaking speed was significantly longer and older than 60 to 79 years old (P <0.01). (4) Visual acuity: The visual acuity gain (P> 0.05) was similar between the 80-year-olds and the 60-79-year-olds, and the glaucoma latency and tracking distortion were significantly longer and older than 60-79 year-olds . Conclusion: Most of people over the age of 80 have decreased hearing and functional status. Visual acuity and balance function are more degenerated than those aged 60-79.