突发性聋患者前庭功能的客观评价

Analysis of vestibular function in patients with sudden deafness

目的分析突发性聋患者在耳蜗受损的同时前庭功能受损的范围及客观评价方法,探讨不同听力损伤曲线类型突聋患者前庭功能损伤的差异。方法选取60例2016年8月～2018年8月在我科住院治疗的单侧突发性聋伴眩晕患者为实验组,其中低频下降型11例,平坦下降型15例,高频下降型18例,全聋型16例。健康自愿者60例为对照组,分别进行冷热试验、眼肌前庭诱发肌源性电位(ocular vestibular evoked myogenic potential,oVEMP)、颈肌前庭诱发肌源性电位(cervical vestibular evoked myogenic potential,cVEMP)及视频头脉冲试验(video head impulse test,vHIT)检测,分析前庭功能受损状况,应用SPSS17.0统计软件进行数据分析。结果对照组冷热试验异常阳性率10.3%;oVEMP异常阳性率26.7%;cV EMP异常阳性率16.7%。实验组冷热试验异常阳性率68.3%;oV EMP异常阳性率60.3%;cVEMP异常阳性率43.7%,与对照组相比,差异具有统计学意义。对照组vHIT异常阳性率13.3%,实验组异常阳性率51.6%,与对照组比较,差异具有统计学意义;全聋型及低频下降型突发性聋患者前庭功能异常阳性率比平坦下降型及高频下降型高,差异具有统计学意义,平坦下降型及高频下降型组间比较差异无统计学意义。结论突发性聋伴眩晕患者在耳蜗受损同时可以伴有前庭功能不同范围受损。结合冷热试验、oVEMP、cVEMP及vHIT等相关检查可对突发性聋患者的前庭功能进行有效评估。全聋型及低频下降型突发性聋患者前庭功能损伤的发生率较平坦下降型及高频下降型高。平坦下降型和高频下降型患者比较,前庭功能损伤发生率无明显差别。

OBJECTIVE To analyze the damage range and objective evaluate the vestibular function impairment in patients with sudden deafness at the same time of cochlea damage. To explore the difference of vestibular function damage in patients with sudden deafness with different hearing loss curve types. METHODS Sixty patients with unilateral sudden deafness and vertigo who were hospitalized in our department from August 2016 to August 2018 were selected as experimental group. There were 11 cases of low frequency descending type, 15 cases of flat descending type,18 cases of high frequency descending type and 16 cases of total deafness type. Sixty healthy volunteer as control group.Two groups of patients underwent caloric test, ocular vestibular evoked myogenic potential(oVEMP), cervical vestibular evoked myogenic potential(cVEMP) and video head impulse test(vHIT). RESULTS The abnormal positive rate of caloric test, oVEMP and cVEMP in the control group was 10.3%,26.7%, 16.7% respectively. The abnormal positive rate of caloric test, oVEMP and cVEMP in the experimental group was 68.3%, 60.3%, 43.7% respectively. The difference between the two groups is statistically significant. The abnormal positive rate of vHIT in the control group was 13.3%. The abnormal positive rate of vHIT in the experimental group was 51.6%. The difference between the two groups is statistically significant.The positive rate of vestibular dysfunction in patients with total deafness and ascending type was higher than that of flat type and descending type, but there was no significant difference between f lat type and descending type. CONCLUSION Patients with sudden deafness may be accompanied by impaired cochlea and vestibular function in different ranges.The vestibular function of patients with sudden deafness can be evaluated effectively by combined caloric test, oVemp, cVEMP and vHIT. The incidence of vestibular dysfunction in patients with total deafness and ascending sudden deafness was higher than that of flat type and descending type. And there was no significant difference in the incidence of vestibular function injury between flat type and descending type patients.