前庭诱发肌源性电位预测突聋患者疗效的临床价值

Clinical value of vestibular evoked myogenic potential to predict prognosis of unilateral idiopathic sudden sensorineural hearing loss

目的分析单侧突发性耳聋患者的疗效,探讨前庭功能与预后的关系。方法回顾性分析59例(59耳)突发性耳聋患者的临床资料,观察临床疗效,根据前庭功能结果探讨对预后的影响。结果59例突发性耳聋患者在治疗前共进行了183项前庭功能检查,眼性前庭诱发肌源性电位(oVEMP)和颈性前庭诱发肌源性电位(cVEMP)异常的突聋患者显示出更低的治疗总有效率;oVEMP和cVEMP正常的突聋患者受损频率听力提高更明显。冷热试验(Caloric Test)和视频头脉冲试验(vHIT)的正常与否对突聋患者的总有效率和受损听力的提高无影响。cVEMP和oVEMP都异常的患者治疗无效率比仅其中一项异常的患者高,受损听力恢复程度也比仅其中一项异常的患者差。结论oVEMP和cVEMP异常的突聋患者疗效较差,oVEMP和cVEMP正常的突聋患者有更好的听力恢复。oVEMP和cVEMP功能可能是预测突发性聋患者预后的有效指标。前庭功能异常提示突发性聋患者的内耳病变范围较大、程度较重。

Objective To analyze the clinical outcomes of patients with unilateral idiopathic sudden sensorineural hearing loss(SSNHL)and explore the relationship between vestibular function and prognosis in patients with SSNHL.Methods A retrospective analysis of 59 patients(59 ears)with SSNHL was performed.A total of 183 vestibular function tests were performed in all patients to assess the influence of vestibular functions on the clinical outcome of SSNHL.Results Treatments were less effective in patients with abnormalities in ocular vestibular evoked myogenic potential(oVEMP)or cervical vestibular evoked myogenic potential(cVEMP).Those with normal oVEMP and cVEMP had relatively better hearing recovery.The outcomes of the caloric test or video head impulse test showed no association with the efficacy of treatment or hearing recovery in patients with SSNHL.Treatment was less effective in patients with abnormalities in both oVEMP and cVEMP,who also had worse hearing recovery than those who had an abnormal finding in only one of the two tests.Conclusions Patients with abnormal oVEMP or cVEMP results had poor clinical outcomes,while those with normal oVEMP and cVEMP demonstrated better hearing recovery with treatment.Thus,oVEMP and cVEMP could be effective indices to predict the prognosis of patients with SSNHL.An abnormal vestibular function is a definite indicator of a wider and more severe pathological change in the inner ear of patients with SSNHL.