突聋伴眩晕患者前庭诱发肌源性电位的临床研究

Vestibular evoked myogenic potentials in patients with sudden deafness and vertigo

目的通过观察突发性聋伴眩晕患者前庭诱发肌源性电位的引出率及各参数,探讨前庭诱发肌源性电位对突聋伴眩晕患者内耳损伤情况的诊断及预后评估。方法收集50例单耳突聋伴眩晕的患者,50例单耳突聋不伴眩晕患者及60例正常听力人作为对照组,分析对比o VEMP及c VEMP的引出率和各参数变化。结果引出率:病例组患耳、对侧耳、突聋不伴眩晕组及正常对照组o VEMP引出率分别为24%、42%、48%、100%,c VEMP引出率分别为:56%、74%、64%、100%,病例组患耳和对侧耳相比,o VEMP及c VEMP引出率差异无统计学意义(P>0.05),病例组患耳及对侧耳分别和正常对照组比较,o VEMP及c VEMP引出率均明显降低(P<0.05),病例组患耳o VEMP引出率明显低于突聋不伴眩晕组(P<0.05)。o VEMP:病例组患耳、对侧耳、突聋不伴眩晕组及正常对照组的各参数(N1潜伏期、P1潜伏期、P1-N1振幅)两两比较,组间不对称比(AR)比较,差异均无统计学意义(P均>0.05)。c VEMP:病例组患耳、对侧耳、突聋不伴眩晕组及正常对照组的各参数比较,患耳及对侧耳P1-N1振幅比突聋不伴眩晕组及正常对照组均明显降低(P<0.05),病例组AR比正常对照组明显增高(P<0.05),o VEMP及c VEMP结果与听力损失分型、听力损失程度分级无明显相关性(P>0.05),但与疗效分级明显相关(P<0.05)。结论突聋伴眩晕患者存在同侧及对侧的椭圆囊(前庭上神经)和球囊(前庭下神经)传导功能障碍,前庭诱发肌源性电位为突聋伴眩晕患者耳石器及前庭神经功能评估提供客观依据。

Objective To report response rates and characteristics of vestibular evoked myogenic potentials in patientswith sudden deafness and vertigo and discuss the diagnostic and prognostic values of vestibular evoked myogenicpotentials.Methods Fifty cases of unilateral sudden deafness with vertigo were included in the study group,while60normal subjects and50cases of unilateral sudden deafness without vertigo were included as the control.oVEMPs andcVEMPs were compared between patients and normal subjects.Results The rate of positive oVEMPs was24%in the affectedear and42%in the contralateral ear in patients with sudden deafness and vertigo,48%in the affected ear in patientswith sudden deafness but no vertigo,and100%in normal subjects;while the rate of positive cVEMPs was56%inthe affected ear and74%in the contralateral ear in patients with sudden deafness and vertigo,64%in the affected ear inpatients with sudden deafness and no vertigo,and100%in normal subjects.There were no significant differences between the affected and contralateral ears(P>0.05).Compared to normal subjects,oVEMPs and cVEMPs in both the affectedand contralateral ears were significantly reduced(P<0.05).The rate of positive oVEMPs in the affected ear wassignificantly lower in patients with sudden deafness and vertigo than in those patients with sudden deafness but no vertigo(P<0.05).oVEMP parameters(N1latency,P1latency,amplitudes)and asymmetry ratio(AR)were not significantlydifferent among the groups(P>0.05).cVEMP N1-P1amplitudes in the affected ear in patients with both sudden deafnessand vertigo were significantly lower than in patients with sudden deafness but no vertigo and normal subjects(P<0.05).The asymmetry ratio(AR)was also different when compared between patients with sudden deafness and vertigoand the normal subjects(P<0.05).oVEMPs,cVEMPs,patterns of audiogram and the degree of hearing loss showed noobvious correlations(P>0.05).However,oVEMPs and cVEMPs appeared to be correlated with therapeutic effects(P<0.05).Conclusions The utricle(superior vestibular nerve)and saccule(inferior vestibular nerves)on both sides may bedysfunctional in patients suffering from sudden deafness with vertigo.The dysfunction and its prognosis may be monitoredobjectively by VEMP examinations.