急性低频感音神经性听力损失患者前庭诱发肌源性电位的频率调谐特征

Frequency features of vestibular evoked myogenic potent ials in patients with acute low-frequency sensorineural hearing loss

目的分析急性低频感音神经性听力损失(acute low-frequency sensorineural hearing loss,ALHL)和听力正常健康人前庭诱发肌源性电位(vestibular evoked myogenic potential,VEMP),包括颈肌性前庭诱发电位(cervical vestibular evoked myogenic potential,cVEMP)和眼肌性前庭诱发电位(ocular vestibular evoked myogenic potential,oVEMP)的特征。方法选取33例ALHL患者(实验组)和45名听力正常健康人(对照组),分别分析500 Hz、1000 Hz的cVEMP和oVEMP的引出情况及振幅比值结果。结果对照组500 Hz和1000 Hz的cVEMP引出率分别为100%(45/45)和86.67%(39/45);500 Hz和1000 Hz的oVEMP引出率分别为97.78%(44/45)和84.44%(38/45)。实验组患耳500 Hz和1000 Hz的cVEMP引出率分别为66.67%(22/33)和63.64%(21/33);对侧耳500 Hz和1000 Hz的cVEMP引出率分别为87.88%(29/33)和75.76%(25/33)。实验组患耳500 Hz和1000 Hz的oVEMP引出率分别为84.85%(28/33)和72.73%(24/33);对侧耳500 Hz和1000 Hz的oVEMP引出率分别为84.85%(28/33)和72.73%(24/33)。实验组双耳与对照组500 Hz和1000 Hz的cVEMP和oVEMP引出情况比较,仅500 Hz的cVEMP实验组双耳与对照组差异有统计学意义。实验组cVEMP患耳与对侧耳500 Hz/1000 Hz的AR平均比值(AR1)为1.17和1.52,对照组AR值2.23,患耳与对照组两者比较,差异有统计学意义(t=3.942,P=0.000),对侧耳与对照组两者比较,差异有统计学意义(t=3.27,P=0.001)。实验组oVEMP患耳与对侧耳500 Hz/1000 Hz的AR平均比值(AR2)为1.45和1.59,对照组AR值2.06,患耳与对照组两者比较,差异有统计学意义(t=3.385,P=0.0 01)。结论与对照组相比,ALHL中cVEMP与oVEMP的频率调谐特点均表现为向高频迁移,对侧耳也表现出类似特点。推测ALHL患者患耳与对侧耳球囊及椭圆囊功能均不同程度受到影响,引起cVEMP和oVEMP的共振频率调谐发生改变。

OBJECTIVE To alalyse the vestibular evoked myogenic potentials（including cervical vestibular evoked myogenic potential and ocular vestibular evoked myogenic potential） in acute low-frequency sensorineural hearing loss patients and in healthy individuals. METHODS Thirty-three acute low-tone sensorineural hearing loss patients and 45 healthy individuals were enrolled in this study, to perform oVEMP and cVEMP for normative values. RESULTS The response rate of the 500, 1000 Hz-cVEMP were 100%（45/45）, 86.67%（39/45） for the 45 healthy individuals, the rate for the 500, 1000 Hz-oVEMP were 97.78%（44/45）, 84.44%（38/45）. The response rate of the500, 1000 Hz-cVEMP were 66.67%（22/33）, 63.64%（21/33）for the affected ears of the 33 acute low-tone sensorineural hearing loss patients, the rate of the 500, 1000 Hz-cVEMP were 87.88%（29/33）, 75.76%（25/33） for the offside eras.The response rate of the 500, 1000 Hz-oVEMP were84.85%（28/33）, 72.73%（24/33） for the affected ears of the experimental group, the rate of the 500, 1000 Hz-oVEMP were 84.85%（28/33）, 72.73%（24/33） for the contralateral eras. The statistical analysis show significant difference in the response rate of 500 Hz-cVEMP between both ears of ALHL patients and the healthy individuals. The ratio of amplitudes（AR1 value） for the affected ear and the contralateral ears（oVEMP 500/1000 Hz AR） were1.17 and 1.52, and 2.23 for the control group. There was significant difference in the affected ears and the healthy ears（t =3.942, P =0.000）. There was also statistical significance in contralateral ears and healthy ears（t =3.27, P =0.001）.The AR2（oVEMP 500/1000 Hz AR） value for the affected ears, the contralateral ears and the healthy individuals were 1.45, 1.59, 2.06, respectively, and significant difference only existed between the affected ears and the healthy ears（t =3.385, P =0.001）. CONCLUSION Compared with the healthy ears, the peak amplitudes of cVEMP and oVEMP were at a higher frequency than in the healthy ears,also for the offside eras. We advocate the hypothesis both the sacculus and the utricle of the two ears of the acute low-frequency sensorineural hearing loss were affected cause the changes of the frequency tuning of cVEMP and oVEMP.