成人人工耳蜗植入患者前庭功能的客观评价

Impact of Cochlear Implantation on Vestibular Function in Adults

目的探讨人工耳蜗植入术(cochlear implantation,CI)对成人前庭终末器官功能的影响。方法22例接受单侧人工耳蜗植入术的成人患者于术前、术后1月进行颈肌前庭诱发肌源电位(cervical vestibular evoked myogenic potential,cVEMP)、眼肌前庭诱发肌源电位(ocular vestibular evoked myogenic potential,oVEMP)检测(评估球囊、椭圆囊功能),以及冷热试验(评估水平半规管超低频区功能)和视频头脉冲试验(video head impulse test,vHIT)(评估6个半规管高频区功能),分析其前庭功能。结果22例患者术前cVEMP、oVEMP、冷热试验异常率分别为36.36%(8/22)、27.27%(6/22)、45.45%(10/22);术后1月cVEMP、oVEMP、冷热试验异常阳性率分别为72.73%(16/22)、54.55%(12/22)、77.27%(17/22),手术前后比较差异均有统计学意义(P<0.05);vHIT结果显示术前前、外、后半规管异常率分别为22.73%(5/22)、18.18%(4/22)、27.27%(6/22),术后分别为22.73%(5/22)、31.82%(7/22)、45.45%(10/22),手术前后比较差异均无统计学意义(P>0.05);9例(40.91%,9/22)患者术后出现眩晕症状,但与cVEMP、oVEMP、冷热试验、vHIT结果之间无相关性。结论CI术后患者的前庭终末器官不同程度受损,其中球囊受影响最大,其次为椭圆囊及水平半规管低频区,半规管高频区受影响较小。

Objective To investigate the influence of cochlear implantation(CI)on all five vestibular end-organ functions(saccule,utricule and anterior,lateral,posterior semicircular canal)in adults.Methods A total of 22 adult patients who underwent unilateral CI were included in this study.Cervical vestibular evoked myogenic potential(cVEMP)for saccule function,ocular vestibular evoked myogenic potential(oVEMP)for utricule function,caloric test for horizontal semicircular canal function of low frequency area and video head impulse test(vHIT)for semicircular canal functions of high frequency area were performed before and one month after CI.Results The positive rate of cVEMP,oVEMP,caloric test before surgery were 36.36%(8/22),27.27%(6/22),45.45%(10/22)respectively,while the rate after implantation were 72.73%(16/22),54.55%(12/22),77.27%(17/22)respectively.There were significant differences between pre-operation and post-operation(P<0.05).The positive rate of vHIT for anterior,lateral,posterior semicircular canal before surgery were 22.73%(5/22),18.18%(4/22),27.27%(6/22),and the rate after implantation were 22.73%(5/22),31.82%(7/22),45.45%(10/22),rsepectively.There were no significant differences in the vHIT results between pre-and post-operation.Nine patients(40.91%,9/22)had the symptoms of vertigo,while the symptoms had no correlate with the results of vestibular test.Conclusion CI has different degrees of damage to vestibular end-organ.It has the most significant effect on saccule,followed by the utricule and the low frequency area of lateral semicircular canal,and has the least effect on the high frequency area of semicicular canal.