突发性聋患者前庭耳石器传导通路功能的客观评价

Objective evaluation of otolithic end organs in sudden sensorineural hearing loss patients

目的观察突发性聋（简称突聋）患者耳蜗受损时前庭耳石器传导通路受影响的范围、程度以及客观评价方法。方法选择2011年5月至2012年5月住院接受治疗的单侧突聋患者40例，分别进行气导短纯音诱发的眼肌前庭诱发肌源性电位（ocular vestibular evoked myogenic potential，oVEMP）和颈肌前庭诱发肌源性电位（cervical vestibular evoked myogenic potential，cVEMP）检测，计算两种反射的引出率；分别以突聋对侧相对健康耳和30名健康人（60耳）为对照，分析前庭上成分（椭圆囊／前庭上神经）和前庭下成分（球囊／前庭下神经）功能受损状况。结果突聋组患耳oVEMP引出率为40．0％（16／40），cVEMP引出率为62．5％（25／40）；突聋组对侧健耳oVEMP引出率为57．5％（23／40），cVEMP引出率为75．0％（30／40）；对照组oVEMP引出率为71．7％（43／60），cVEMP引出率为81．7％（49／60）。组问对比显示突聋组患耳与对侧健耳oVEMP和cVEMP引出率差异无统计学意义（X2＝2．452，p=0．117；X2=0．251，P=0．617），突聋组患耳与对照组比较，oVEMP和cVEMP引出率差异均具有统计学意义（X2=9．949，P=0．002；X2=4．582，P=0．032）；突聋组患耳、对侧健耳、对照组正常耳组间比较，oVEMP和cVEMP的阈值、N1潜伏期、P1潜伏期、波问期、振幅等各参数差异均无统计学意义（P值均〉0．05）。结论突聋患者在耳蜗受损的同时可以伴有前庭耳石器传导通路功能受损，这种功能受损的状况可以通过oVEMP和cVEMP检测进行客观评估。

Objective To observe the function of the otolithic end organs and their input pathways in sudden sensorineural hearing loss （SSHL） patients. Methods Forty cases of unilateral SSHL were enrolled as the observing group from May, 2011 to May, 2012. Thirty age- and gender-matched normal subjects were recruited as the control group. Both patients and normal subjects underwent conventional air- conducted ocular vestibular evoked myogenic potential （oVEMP） and cervical vestibular evoked myogenic potential （cVEMP） in bilateral ears. The results were compared between the affected ears, the contralateral ears and the normal controls. Results Overall, oVEMP was elicited in 16 affected ears （ 40. 0% ）, 23 contralateral ears （57. 5% ） and 43 normal ears （71.7%）. cVEMP could be elicited in 25 affected ears （62. 5% ）, 30 contralateral ears （ 75.0% ） and 49 normal ears （ 81.7% ） respectively. Significant statistical significance could be found in the oVEMP response rate between the affected ears and the normal ears （X2 = 9. 949, P = 0. 002） and in the cVEMP response rate between the affected ears and the normal ears （X2 = 4. 582, P = 0. 032 ）. Significant statistical difference could not be found in all oVEMP and cVEMP parameters （threshold, N1 latency, P1 latency, latency interval and amplitude） among groups（ P 〉 0. 05 ）. Conclusions The otolithic vestibular end organs and their input pathways could be damaged in SSHL patients. Such damages could be monitored objectively by cVEMP and oVEMP examinations.