评估前庭神经炎患者前庭上下神经损伤的检测方法对比研究

A comparative study of detection methods for assessing superior and inferior vestibular nerve damages in patients with vestibular neuritis

目的对比前庭神经炎患者前庭诱发肌源性电位技术(vestibular evoked myogenic potential,VEMP)与视频头脉冲技术(video head impulse test,vHIT)测试结果,探讨前庭神经炎患者前庭上下神经损伤的区分方法与可行性。方法2018年5月-2021年7月在秦皇岛市第一医院耳科就诊的25例单侧前庭神经炎患者,分别给予oVEMP、cVEMP和vHIT测试,并对数据进行分析。结果oVEMP:24例(96%)患者一侧异常(振幅下降或未引出波形);1例(4%)患者双侧波形未引出,总异常率为100%(26/26);cVEMP:9例(36%)患者一侧异常(振幅下降或未引出波形);1例(4%)患者双侧波形未引出,总异常率为40%(10/25);15例(60%)患者双侧波形正常。vHIT:25例(100%)患者存在一侧水平半规管增益下降;23例(92%)患者存在一侧前半规管增益下降;9例(36%)患者存在一侧后半规管增益下降。VEMP与vHIT对比:根据VEMP的测试结果,25例前庭神经炎患者前庭上神经损伤占60%(15/25),前庭上下神经均损伤占40%(10/25);根据vHIT的测试结果,26例前庭神经炎患者前庭上神经损伤占64%(16/25),前庭上下神经均损伤占36%(9/25);两种测试方法的前庭神经炎前庭上下神经损伤比例差异无统计学意义(χ^(2)=0.085,P>0.05)。VEMP与vHIT结果匹配的比例为80%(20/25),不匹配的比例为20%(5/25)。结论当VEMP与vHIT结果相符时可以初步确定前庭神经损伤类型,不相符时建议不细分前庭上下神经损伤范围。

Objective This study aims to compare the examination results of the vestibular evoked myogenic potential(VEMP)and video head impulse testing(vHIT)in patients with vestibular neuritis(VN),thus exploring the methods to distinguish superior and inferior vestibular nerve damages in VN patients,and their feasibility.Methods A total of 25 patients with unilateral VN treated in the Otology Department of the First Hospital of Qinhuangdao from May 2018 to July 2021 were recruited.They were respectively tested for ocular VEMP(oVEMP),cervical VEMP(cVEMP)and vHIT,and the examination results were analyzed.Results Examination results of oVEMP showed that 96%(24/25)patients had one-ear abnormalities with the amplitude decline or no waveform introduced,and 4%(1/25)patient had no waveform introduced of both ears.The overall abnormal rate examined by oVEMP was 100%(26/26).Examination results of cVEMP showed that 36%(9/25)patients had one-ear abnormalities with the amplitude decline or no waveform introduced,and 4%(1/25)patients had no waveform introduced of both ears.The overall abnormal rate examined by cVEMP was 40%(10/25),and 60%(15/25)patients had normal waveforms of both ears.Examination results of vHIT showed that 100%(25/25)patients had semicircular canal gain decline of one side,92%(23/25)had anterior Semicircular canal decline of one side,and 36%(9/25)had posterior semicircular canal decline of one side.VEMP and vHIT results were compared.Examination results of VEMP showed that 60%(15/25)VN patients had superior vestibular nerve damage,and 40%(10/25)had both superior and inferior vestibular nerve damages.Examination results of vHIT showed that 64%(16/25)VN patients had superior vestibular nerve damage,and 36%(9/25)had both superior and inferior vestibular nerve damages.There was no significant difference in the ratio of VN patients with superior and inferior vestibular nerve damages examined by VEMP or vHIT(χ^(2)=0.085,P>0.05).The matching ratio of VEMP and vHIT results was 80%(20/25),and the non-matching ratio was 20%(5/25).Conclusion Consistent results obtained from both VEMP and vHIT can preliminarily identify the type of vestibular nerve damage.If their results are not consistent,it is recommended not to identify the scope of the vestibular nerve damage.