Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
  • A61B5/316—Modalities, i.e. specific diagnostic methods
  • A61B5/389—Electromyography [EMG]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
  • A61B5/316—Modalities, i.e. specific diagnostic methods
  • A61B5/389—Electromyography [EMG]
  • A61B5/395—Details of stimulation, e.g. nerve stimulation to elicit EMG response
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/40—Detecting, measuring or recording for evaluating the nervous system
  • A61B5/4005—Detecting, measuring or recording for evaluating the nervous system for evaluating the sensory system
  • A61B5/4023—Evaluating sense of balance
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/41—Detecting, measuring or recording for evaluating the immune or lymphatic systems
  • A61B5/414—Evaluating particular organs or parts of the immune or lymphatic systems
  • A61B5/415—Evaluating particular organs or parts of the immune or lymphatic systems the glands, e.g. tonsils, adenoids or thymus
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/22—Ergometry; Measuring muscular strength or the force of a muscular blow
  • A61B5/224—Measuring muscular strength

Definitions

• the invention relates to a device for detecting at least one vestibular evoked myogenic
• the invention relates to the use of a device for functional diagnosis of acoustically, mechanically or electrically evoked vestibular reflexes.
• Dizziness is one of the most common complaints in medical practice. Patients use the term "dizziness" for a variety of sensory perceptions: swinging or swaying vertigo, stance and / or gait insecurity, weakness, and oscillopsia.With age, the prevalence increases, so that over 80 years of dizziness is the most commonly deplored disease symptom Vertigo in the medical sense is understood as a subjective sensation of a sense of rotation or wavering or the feeling of impending unconsciousness Dizziness is defined in the medical sense as a perceived apparent movement between itself and the environment Dizziness often arises from contradictory information from sensory organs such as eyes involved in the sense of balance , Equilibrium organs of the inner ear as well as muscle and joint receptors, the equilibrium organ in the inner ear is a sensor for rotational and linear acceleration and closely linked to reflections.
• Receptors also determine the location of the head in the room.
• Dizziness can have many causes. In contrast to malfunctions of the semicircular canals in the organ of equilibrium, which can already be determined with great certainty by the evaluation of nystagms with thermal irritation, little is known about the diagnosis of otolith organs. It can be assumed that a large part of unclear, long-lasting dizziness symptoms on undiagnosed damage to the
• Otolithenorgane Utriculus and Sacculus
• the vestibulo-collar reflex is triggered whose sensory component is the sacculus.
• the motor component can be determined by measuring a myopotential z. B. on the head / neck muscles are registered. This reaction to acoustic signals is independent of the human hearing.
• the test provides the ability to separately examine the function of the saccule on each side of the body.
• acoustic stimuli clicks or sounds
• high intensity usually > 95 dB
• the myopotential is referred to in particular as "vestibular evoked myogenic potential" (VEMP)
• VEMP vestibulobular evoked myogenic potential
• the latencies and the amplitude of the response are used for the evaluation, a sufficient muscle tone is essential for the measurement
• Muscle tone is the state of tension of the musculature. This tone is caused by a continuous contraction. Its expression is proportional to the strength of the contraction.
• the amplitude of the VEMPs is highly dependent on the amount of muscle tone during the measurement as well as the age and sex of the patient. Disadvantageously, the muscle tone is never nearly constant during the measurement, so that the result of the averaging of the potentials is always somewhat distorted.
• the known devices that spend a click or tone and record the activity of the muscles are therefore not suitable to make standardized VEMP measurements depending on the age and sex of the patient.
• the muscle tone required for the measurement is randomly generated in the known devices and usually unevenly by tensing the muscle. The objective, qualitative and quantitative assessment of the saccule function is therefore not possible in everyday clinical practice.
• the object according to the invention is made possible by a device for detecting at least one vestibular evoked myogenic potential (VEMP) in a patient, the device comprising at least one active electrode, a reference electrode, a ground electrode, an acoustic, mechanical and / or electrical signal generator and a feedback system , in particular a galvanometer indicating the muscle tone or a pressure-sensing pressure transducer comprises.
• a device comprising the abovementioned three electrodes, an acoustic, mechanical and / or electrical signal generator and a feedback system, in particular a galvanometer indicating a muscle tone or a pressure transducer indicating pressure, is able to solve the problem according to the invention.
• the feedback system is any device that transmits information about the muscle tone to the persons involved in the measurements.
• the system can be chosen so that the patient receives a direct feedback with respect to the muscle tension or the medical staff receives this information and thus can ask the patient, for example, to modify the muscle tension, ie in particular to strengthen or reduce.
• a particularly efficient feedback system is designed so that the patient receives the corresponding data in his field of view during the measurement. These data may be, for example, the display of the voltage or pressure that produces activation of a muscle.
• a sensor to record information about the amount of muscle tone as pressure. This can be any information that can be reflected by muscle activity in a pressure sensor.
• the acoustic signal transmitter is characterized in particular by enabling parts of the body, in particular in the head region, to oscillate.
• the mechanical signal transmitter can furthermore be characterized in that mechanical energy is transmitted to parts of the body, in particular in the head region, with the aid of moving parts.
• the electrical signal transmitter is characterized by transferring electricity to parts of the human body.
• the galvanometer indicates the change in the amount of available electricity without calibration.
• the output value (zero point) can thus be set individually for each measurement.
• the active electrode is applied to a muscle of the patient.
• the reference and ground electrodes in a preferred embodiment of the invention are connected to a non-muscular one
• the muscle is a cervical, limb or eye muscle.
• the required muscle tone of at least one muscle on the body side to be examined is produced in a further preferred embodiment of the invention by tension or movement.
• the potential arising at the neck muscle is dissipated via the electrodes and fed to a process unit.
• a measuring amplifier with integrated filter function can be located in the process unit.
• the feedback system allows the patient to control the height and the uniformity of muscle tension independently or by instructions of the staff present during the measurement.
• the muscle tone is displayed on a patient display as a perceptible, preferred optical, acoustic or vibrotactile signal.
• the patient can thus either directly or immediately keep the muscle activity or muscle tension constant or modify it to a desired degree.
• the feedback system is a system which visualizes the pressure generated by the rotation or tilting of the head, the pressure transducer being a substantially U-shaped, tubular, gas and / or liquid-filled element
• the pressure transducer being a substantially U-shaped, tubular, gas and / or liquid-filled element
• the tubular, worn around the neck element is designed so that it has a Pressure sensor / pressure transducer has that measures the pressure occurring and displays it in a display - especially for the patient - during the measurement simultaneously.
• With the chin on the U-shaped gas- or liquid-filled element preferably the tube that was placed around his neck.
• the pressure occurring in the tube is measured by a pressure transducer or pressure transducer located therein and displayed on the display preferably located in the field of view of the patient, so as to allow, for example, a check of sufficient muscle tone.
• a potential is detected and derived via the electrode, preferably in a process unit.
• the tubular element is attached to at least one side of the head of the patient to regulate the muscle tone by pressing against a non-moving object. If the measurement is performed while lying down, the muscle tension can be achieved, for example, by lifting the head. In this case, the tubular member is placed under the lying head and the pressure decrease during the head lift is used as the quantity to be regulated.
• the invention also relates to the use of said device for generating, measuring and / or evaluating at least one vestibular evoked myogenic potential or for diagnosing the otolith organs to detect, for example, various forms of dizziness.
• Diagnosis or diagnosis in the sense of the invention relates to the generation of intermediate results necessary for the generation of a diagnosis so that a final diagnosis can be made by further mental activities and comparison with other data.
• a technician with the help of the device according to the invention can provide a working basis for the subsequent diagnostic work of the doctor.
• diagnosis or diagnosis relates to all medical examination methods.
• the use of the device according to the invention preferably also takes place with a process unit in which preferred essential steps of the diagnosis can be carried out.
• a process unit in which preferred essential steps of the diagnosis can be carried out.
• the evaluation of measured data takes place with the aid of a microcontroller, wherein the latter determines the smallest and the largest voltage value of the VEMP within a time window after the stimulus.
• the time of these two data values (latencies) and their size difference (amplitude) is compared in a preferred variant of the invention by a microprocessor in the process unit taking into account the amount of muscle tone present with age and gender-related norm values.
• the value of the muscle tone is divided by the value of the amplitude, so as to determine a diagnostic intermediate result in a particularly preferred embodiment of the invention, which in turn is used for the preparation of a diagnosis.
• the value of the amplitude is divided by the value of the muscle tone in order to determine the diagnostic intermediate result.
• the intermediate result is to be considered as pathological if a higher quotient is found in the examined patient than was calculated with the function described above.
• the latencies are too long when 18 ms is exceeded for the first peak of the VEMP, or 27.6 ms (males) and 25.6 ms (females) for the second peak of the VEMP.
• Amplitude and the latencies represent a measure of the degree of functional impairment of the vestibulo-collar reflex.
• quantitative statements about the function of the sacculus would be diagnostically possible. If no VEMP can be registered despite a present age-dependent minimum muscle tone, there is a failure of the saccule function or another component of the vestibulo-collar reflex (qualitative statement).
• the device compares the existing muscle tone with the internally stored age-dependent minimum muscle tone (93.5 ⁇ V (20-40 years), 104.8 ⁇ V (41-60 years), 110.8 ⁇ V (60-76 years)) and gives a warning when this value is undershot that the measurement is not possible. Thus, the validity of the qualitative statement is significantly increased.
• the neck muscle on which the resulting potential is detected and derived via the electrode is the sternocleidomastoid muscle.
• the measurement can be carried out particularly safely and efficiently on this muscle.
• the muscle tone can be continuously registered by means of the measurement of the potential between the VEMP measurements and displayed to the patient as a signal perceptible to it.
• the potential that arises on the muscle is proportional to the amount of muscle tone.
• the patient is given short acoustic stimuli via air or bone conduction sounders or the sacculus or balance nerve is electrically stimulated.
• VEMPs are preferably derived via the electrodes and fed to the process unit.
• a plurality of VEMPs can be averaged in the process unit in order to increase the signal quality (signal-to-noise ratios).
• the evaluation of the measured data can be carried out automatically.
• at least one auditory evoked brain potential can be measured.
• the teaching according to the invention solves the long felt need for standardized VEMP measurements. Until now it has not been possible to solve this problem despite repeated efforts of the experts.
• the simplicity of the inventive solution of the task speaks for the inventive step, since just simple solutions that have not yet been known to the art, are more difficult to implement than complicated solutions.
• the teaching according to the invention represents a development-firming achievement, with which it comes by a simplification to a saving in time, material, work stages and costs and an increased reliability by a removal of errors is possible.
• the advantageous embodiments of the invention have at least one or more of the advantages mentioned.
• FIG. 1 shows the schematic representation of a preferred embodiment of the invention during the measurement:
• Figure 1 Schematic representation of the application of the invention during a measurement.
• One patient is attached to the sternocleidomastoid, vertex and sternum muscles with dizziness symptoms.
• An acoustic signal generator is inserted into the auditory canal on the side to be examined, on which the electrode on the sternocleidomastoid muscle is also fixed.
• the patient now turns his head to the contralateral shoulder, increasing the muscle tone of the sternocleidomastoid muscle on the side to be tested.
• the field of view of the patient now also reaches the display of the galvanometer, which tells him by means of a pointer rash information on whether the muscle tone in relation to the age of the patient for a functional check of the saccule is sufficient.
• the measurement starts by the acoustic signal generator emitting 5 tones per second with a frequency of 500 Hz and a volume of 95 dB.
• the stimulation is interrupted as soon as the display of the galvanometer is no longer in the required range.
• the potentials occurring in the muscle are combined in one
• the mean potential (VEMP) in the examined male patient (age 36 years) has a latency of the first peak of 14 ms and of the second of 24 ms. These values are in the standard range.
• the size of the potential (amplitude), which is related to the height of the muscle tone during the measurement and the age of the patient, is also to be regarded as normal with a value of 180.1 ⁇ V. The doctor can now with the help of these intermediate results the focus of
• One patient is attached to the vertex, the mastoid and the sternum with the patient with hearing impairment.
• An acoustic signal generator is inserted into the auditory canal on the side to be checked, on which the electrode is also fixed on the mastoid. The patient is asked to sit or lie still.
• the acoustic signal generator now emits 20 acoustic stimuli per second with a defined frequency spectrum and a volume of 70 dB.
• the electrodes conduct the due to the acoustic
• Irritation arising brain potentials are recorded in a time window of 15 ms after the stimulus and averaged over 2000 repetitions.
• the latencies of the averaged brain potentials of the examined patient are 1.8 ms for the wave I, 2, 9 ms for the wave II, 3.8 ms for the wave III, 5.0 ms for the wave IV and 5.8 ms for the wave V in the normal range.

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• 2009
  • 2009-02-23 EP EP09712286A patent/EP2259722A1/de not_active Withdrawn
  • 2009-02-23 JP JP2010547043A patent/JP2011512208A/ja not_active Withdrawn
  • 2009-02-23 WO PCT/DE2009/000264 patent/WO2009103287A1/de not_active Ceased
  • 2009-02-23 US US12/812,356 patent/US20100312145A1/en not_active Abandoned
  • 2009-02-23 CA CA2714021A patent/CA2714021A1/en not_active Abandoned
  • 2009-02-23 DE DE202009018587U patent/DE202009018587U1/de not_active Expired - Lifetime
  • 2009-02-23 DE DE112009000954T patent/DE112009000954A5/de not_active Withdrawn

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