内耳畸形患儿人工耳蜗植入前后前庭诱发肌源性电位变化

Preoperative and Postoperative Vestibular Evoked Myogenic Potentials Changes in Cochlear Implant Children with Inner Ear Malformation

目的探讨不同内耳畸形患儿人工耳蜗植入前后前庭诱发肌源性电位(vestibular evoked myogenic potential,VEMP)变化及其与前庭损伤症状的关系。方法2021年1月至6月间先天性重度感音神经性聋患儿29例,其中内耳结构正常12例(24耳),前庭水管扩大4例(8耳),Mondini畸形(耳蜗不全分隔II型合并前庭水管扩大)7例(14耳),共同腔畸形6例(12耳)。分别于术前1天及术后1个月CI关闭时进行颈性前庭诱发肌源性电位(cVEMP)和眼性前庭诱发肌源性电位(oVEMP)测试,术后1周内观察并记录患儿前庭功能损伤症状。结果术前cVEMP、oVEMP引出率分别为:内耳结构正常组73.68%(14/19)、88.89%(8/9),前庭水管扩大组100%(7/7)、100%(7/7),Mondini畸形组85.71%(12/14)、100%(10/10),共同腔畸形组22.22%(2/9)、0(0/7)。术后1周内前庭功能损害症状出现率为54.55%(12/22),术后一个月cVEMP和oVEMP引出率为50%(6/12)、45.45%(5/11);VEMP损伤率为88.89%(8/9)。结论VEMP可评估患儿人工耳蜗植入前后前庭功能,内耳畸形是植入前后VEMP变化的重要影响因素,VEMP测试结果可为人工耳蜗植入侧别的选择提供一定参考。

Objective Vestibular evoked myogenic potential(VEMP)was tested in children with inner ear malformation before and after cochlear implantation to study the change of VEMP elicitation before and after cochlear implantation and its relationship with the occurrence of postoperative vestibular symptoms.Methods From January to June,2021,a total of 29 children were enrolled and diagnosed with congenital severe sensorineural hearing loss in our center.There were 17 cases(34 ears)with inner ear malformation,including 4 cases with enlarged vestibular aqueduct,7 cases with Mondini malformations,6 cases with common cavity and 12 cases(24 ears)without inner ear malformation.Cervical vestibular evoked myogenic potential(cVEMP)and ocular vestibular evoked myogenic potential(oVEMP)tests were performed on the children 1 day before and 1 month after surgery.Within 1 week after the operation,the symptoms and signs of vestibular dysfunction were observed,examined and recorded.Results The cVEMP/oVEMP elicitation rate was 73.68%(14/19)/88.89%(8/9),100%(7/7)/100%(7/7),85.71%(12/14)/100%(10/10),22.22%(2/9)/0(0/7)in the group without inner ear malformation,the group with enlarged vestibular aqueduct,Mondini malformation and the group with common cavity deformity,respectively.The elicitation rate at 1 month after operation was 50%(6/12)/45.45%(5/11),and VEMP damge rate was 88.89%(8/9).Conclusion VEMP can be applied to evaluate vestibular function before and after cochlear implantation in children.Inner ear malformation is an important factor influencing the VEMP elicitation rate,and the VEMP results can provide effective reference for the selection of cochlear implant side and the symptoms of postoperative vestibular injury.