声诱发的短潜伏期负反应与前庭诱发的肌源性电位关系初步研究

The Relationship Between Acoustically Evoked Short Latency Negative Response and VEMP

目的 研究声诱发的短潜伏期负反应（acoustically evoked short latency negative response，ASNR）的特点，并初步证实该电位的前庭源性，即与前庭诱发的肌源性电位（vestibular evoked myogenic potentials，VEMP）同源。方法分别检测28例健康成人、16例前庭疾病和1例全聋患者的VEMP和ASNR，比较ASNR与VEMP之间的关系。结果 ASNR正常引出率为87．5％，潜伏期正常值为3．50±0．25ms；2倍标准差作为正常值的上、下限，ASNR潜伏期的范围为3～4ms，阈值为80～90dB nHL。16例前庭疾病患者均行双侧检查，在VEMP消失的9耳（9例）中，ASNR均未引出；VEMP低振幅的8例（8耳）中，5例（5耳）未引出ASNR，3例（3耳）ASNR正常引出。5例梅尼埃病患者接受甘油试验，1例（2耳）甘油试验前后VEMP与ASNR均正常，2例（4耳）双侧VEMP与ASNR甘油试验前异常，甘油试验后正常，1例（1耳）患侧VEMP正常，甘油试验前后无变化，ASNR由异常变为正常；1例（2耳）VEMP甘油试验前双侧异常，甘油试验后正常，但ASNR均未引出。1例听力正常的前庭神经炎患者，患侧VEMP未引出，ASNR电位也未引出。1例先天性全聋患者人工耳蜗植入前，VEMP、ASNR正常引出；植入后，术侧VEMP振幅降低，ASNR未引出。结论 ASNR与VEMP可能均源于球囊。鉴于目前的结果，在不便进行VEMP检测时可用ASNR替代。

Objective To investigate the characteristics of acoustically evoked short latency negative response（ASNR） and to confirm the same origin of ASNR and vestibular evoked myogenic potential（ VEMP）. Methods 28 healthy subjects and 16 patients with vestibular system disorders and 1 patients with total hearing loss were enrolled in this study. The normal values of ASNR were estabhshed and 17 patients were used to confirm the origin of ASNR. In 28 healthy subjects, ASNR was elicited in 87.5%. The latency of ASNR was 3.50±0.25 ms and the normal value of ASNR was 3-4 ms. The threshold of ASNR was 80-90 dB nHL. In 9 ears loss of VEMP, ASNR was disappeared also. In 8 ears with low amplitude of VEMP, ASNR appeared in 3 ears and disappeared in 5 ears. 5 patients with Meniere＇ s disease and were tested with glycerol test, among them 1 ear VEMP and ASNR were normal before and the end of the test; 3 patients VEMP and ASNR convert to normal when glycerol test ended; 1 ear VEMP did not change at all but ASNR return to normal; 1 patient with temporal bone fracture both VEMP and ASNR were all disappeared. In 1 patient with acoustic neuroma, the amphtude of VEMP was low and ASNR disappeared. Both VEMP and ASNR disappeared in 1 patient with vestibular neuritis, lpatient with total loss of bilateral heating had cochlear implant. Before implantation, VEMP and ASNR were normal, but both of them were abnormal at the side of implantation after operation. Conclusion The origin of ASNR may be the saccule just like VEMP. In view of the results, ASNR may take the place of VEMP if the latter could not be performed with routine method.