梅尼埃病患者耳蜗前庭功能检查与内耳MRI关联性研究

Association between cochlear vestibular function examination and inner ear MRI results in Meniere’s disease

目的探讨和比较内耳磁共振成像(magneticresonance imaging,MRI)、耳蜗电图(electrocochleogram,EcochG)、畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)以及颈性前庭诱发肌源性电位(cervical vestibular evoked myogenic potential,cVEMP)诊断梅尼埃病(Meniere’s disease,MD)的价值与关联性。方法我院耳鼻咽喉科2017年6月~2019年6月收治的疑诊梅尼埃病患者41例,根据临床诊断标准,分为30例明确性梅尼埃病(definite Meniere’s disease,DMD)和11例可能性梅尼埃病(probable Meniere’s disease,PMD),共50只患耳。所有患者均接受MRI、EcochG、DPOAE和cVEMP检查,观察两组患者检查结果,评价EcochG,DPOAE和MRI诊断DMD灵敏度与特异度以及相关性与一致性。结果 DMD组EcochG、DPOAE和cVEMP检查阳性率与PMD组无统计学差异(P>0.05),但DMD组MRI阳性率显著高于PMD组(25.71% vs 0.00%,P<0.05);MRI诊断DMD灵敏度显著低于EcochG、DPOAE和cVEMP(P<0.05),但特异度显著高于EcochG、DPOAE和cVEMP(P<0.05);在DMD组,DPOAE与EcochG检查结果间存在显着相关性(χ~2=5.66,P=0.019;κ=0.436,P=0.015),但DPOAE或EcochG与MRI检查结果无显着相关性和一致性(P>0.05);应用EcochG和DPOAE方法确定的内淋巴积水阳性组与阴性组的听力受损比较,差异无统计学意义(P>0.05),但MRI检测到的内淋巴积水阳性组听力受损程度显著高于阴性组(P<0.05)。结论在MD患者中,DPOAE、EcochG和cVEMP等耳蜗前庭功能检查结果与MRI间无显著相关性,MRI仍是诊断MD特异性最高的方法,需要得到临床重视。

OBJECTIVE To explore and compare the diagnostic value of magnetic resonance imaging(MRI), electrocochleogram(EcochG), distortion product otoacoustic emission(DPOAE) and cervical vestibular evoked myogenic potential(cVEMP) in Meniere’s disease(MD). METHODS A total of 41 patients with suspected Meniere’s disease admitted to our hospital from June 2017 to June 2019 were divided into 30 cases of definite Meniere’s disease(DMD) and 11 cases of probable Meniere’s disease(PMD) according to the clinical diagnostic criteria. All patients were examined by MRI, EcochG, DPOAE and cVEMP. The results of the two groups were observed, and the sensitivity and specificity of EcochG, DPOAE and MRI in the diagnosis of DMD were evaluated, as well as the correlation and consistency between them. RESULTS The positive rate of EcochG, DPOAE and cVEMP in DMD group was not significantly different from that in PMD group(P>0.05), but the positive rate of MRI in DMD group was significantly higher than that in PMD group(25.71% vs 0.00%, P<0.05). The sensitivity of MRI in diagnosis of DMD was significantly lower than that of EcochG, DPOAE and cVEMP(P<0.05), but the specificity was significantly higher than that of EcochG, DPOAE and cVEMP(P<0.05). In DMD group, there was a significant correlation between DPOAE and EcochG(χ~2=5.66, P=0.019;κ=0.436, P=0.015), but there was no significant correlation and consistency between DPOAE or EcochG and MRI(P>0.05). There was no correlation between endolymphatic hydrops detected by EcochG and DPOAE and hearing impairment in MD patients(P>0.05), but the degree of hearing impairment in endolymphatic hydrops positive group detected by MRI was significantly severe than that in negative group(P<0.05). CONCLUSIONIn MD patients, DPOAE, EcochG and cVEMP have no significant correlation with the results of MRI. MRI is still the most specific method for the diagnosis of MD, which needs clinical attention.