基于镫骨肌声反射的筛选方法在听神经瘤诊断流程中的探索研究

An exploratory study of screening methods based on stapedius acoustic reflex in the diagnosis process of acoustic neuroma

目的 探索基于镫骨肌声反射的筛选方法在非对称性耳鸣、听力下降、眩晕患者中筛选需要进行MRI检查以除外听神经瘤者。方法 回顾88例(88耳)听神经瘤患者的临床资料,分析其镫骨肌声反射的影响因素,假设三种基于镫骨肌声反射的方法筛选患者行MRI检查除外听神经瘤,并对三种筛选方法进行比较。结果 声信号频率为1 kHz时,有镫骨肌声反射22例,其中声反射阈与纯音听阈之差<60 dB者(即Metz试验阳性者)11例,介于60~95 dB之间者9例,≥95 dB者2例;无声反射66例。有无实用听力以及肿瘤分期对是否有镫骨肌声反射有显著影响,而瘤体大小对是否有声反射无显著影响。对非对称性耳鸣、听力下降、眩晕患者,除Metz试验阳性者外,均行MRI检查的筛选方法漏诊率最低(12.5%),且具有统计学意义(χ^(2)=97.682,P=0.000)。结论 建议非对称性耳鸣、听力下降、眩晕患者中除Metz试验阳性者外均行MRI检查以除外听神经瘤。

OBJECTIVE To search a method based on acoustic stapedius reflex to screen asymmetric ’tinnitus,hearing loss,and vertigo ’ patients who should undergo MRI to exclude acoustic neuroma METHODS A total of 88 patients(88 ears) with acoustic neuroma were analyzed to summarize the influencing factors of acoustic stapedius reflex.Three methods based on acoustic stapedius reflex to screen patients who should undergo MRI to exclude acoustic neuroma were compared with each other.RESULTS There were 22 cases with acoustic stapedius reflex at 1 kHz.Among them,the difference between acoustic reflex threshold and puretone threshold was less than 60 dB,which meant a positive Metz test,in 11 cases.That difference was between 60 and 95 dB in 9 cases,while that was more than or equal to 95 dB in 2 cases.There was no acoustic reflex in the last 66 cases.Both the serviceable hearing and tumor stage had significant impacts on the acoustic stapedius reflex,but tumor size didn’t.MRI was suggested for asymmetric ’tinnitus,hearing loss,and vertigo ’patients without positive Metz test.This kind of screening method had a significantly lower rate of misdiagnosis(12.5%)comparing with the other two methods(χ^(2)=97.682,P=0.000).CONCLUSION MRI was suggested for asymmetric’tinnitus,hearing loss,and vertigo ’ patients without positive Metz test to exclude acoustic neuroma.