人工耳蜗植入对内耳畸形患儿前庭功能影响的纵向研究:基于前庭诱发肌源性电位测试的比较分析

A longitudinal study on the impact of cochlear implantation on vestibular function in children with inner ear malformations:a comparative analysis based on the test of vestibular evoked myogenic potentials

目的分析人工耳蜗植入(cochlear implantation,CI)术对先天性感音神经性聋(sensorineural hearing Loss,SNHL)儿童前庭诱发肌源性电位(vestibular evoked myogenic potentials,VEMPs)的影响。方法收集2021年1月至2023年2月于首都医科大学附属北京同仁医院就诊并行CI的SNHL患儿78例,其中内耳结构正常患儿39例,内耳畸形组39例,包含前庭水管扩大6例,Mondini畸形13例,前庭蜗神经发育不良5例,前庭囊发育畸形2例及内听道狭窄2例。所有患儿分别于术前1周内(T0)、术后1个月(T1)、术后6个月(T2)及术后1年(T3)进行VEMPs测试。使用卡方检验和方差分析比较了所有患者术前和术后各个随访时间节点VEMPs引出率、潜伏期和幅值等各个参数的差异,以及内耳畸形和非内耳畸形组上述参数的差异。结果78例患儿完成术后颈性前庭诱发肌源性电位(cervical VEMP,cVEMP)随访,术前(T0)cVEMP引出率为69.23%。T1期、T2期和T3期引出率分别为46.15%、41.03%和58.97%。CI前后整体cVEMP引出率差异有统计学意义(χ^(2)=4.768,P=0.003)。T1的P1和N1潜伏期显著缩短(P=0.07,P=0.046),48例患儿完成术后眼性前庭诱发肌源性电位(ocular VEMP,oVEMP)随访,术前总体引出率为75%,T1期、T2期和T3期引出率分别为81.25%、62.5%和62.5%。CI前后整体oVEMP引出率差异有统计学意义(χ^(2)=9.720,P=0.021)。CI植入时长对cVEMP的P1潜伏期、幅值及校正幅值的影响有统计学意义(P=0.0434、P=0.041、P=0.041,P<0.001),对oVEMP的幅值的影响具有统计学意义(P=0.043)。T3时,cVEMP引出率和潜伏期幅值等参数与T0相比,差异无统计学意义;T2和T3的oVEMP的幅值和T0相比,差异有统计学意义(P=0.038)。内耳畸形和非内耳畸形组在T1~T3时各测试参数差异无统计学意义。结论VEMPs可评估患儿CI术前、术后前庭功能,CI植入时长是VEMPs变化的重要影响因素;内耳畸形可能影响CI术后耳石器功能,且CI植入时长对内耳畸形患儿的耳石器功能影响更为显著。VEMP测试结果可为CI侧别的选择提供一定参考。

Objective To analyze the impact of cochlear implantation(CI)on vestibular evoked myogenic potentials(VEMPs)in children with congenital sensorineural hearing loss(SNHL),focusing on the potential changes in vestibular function after surgery.Methods A total of 78 pediatric patients with SNHL,who were treated at Beijing Tongren Hospital,Capital Medical University between January 2021 and February 2023,were enrolled.The cohort was divided into two groups based on inner ear anomalies:39 SNHL patients with normal inner ear structure and 39 patients with inner ear malformations,including 6 patients with large vestibular aqueduct syndrome,13 patients with Mondini malformation,5 patients with vestibulocochlear nerve deficiency,2 patients with vestibular sac malformation,and 2 with narrow internal auditory canal.All patients underwent VEMPs test was performed preoperatively(T0)within one week,and at 1 month(T1),6 months(T2),and 1 year(T3)post-CI.Chi-square tests and analysis of variance were applied to compare the differences in VEMPs parameters,including response rate,latencies,and amplitude,across all follow-up time and between the two groups.Results Complete postoperative follow-up of cervical VEMP(cVEMP)was achieved in all 78 patients,The T0 cVEMP response rate was 69.23%,which significantly declined to 46.15%,41.03%,and 58.97%at T1,T2,and T3,respectively(χ^(2)=4.768,P=0.003).Notably,the P1 and N1 latencies significantly shortened at T1(P=0.07,P=0.046).Among 48 patients who completed postoperative ocular VEMP(oVEMP)follow-up,the overall preoperative response rate was 75%,increasing to 81.25%at T1 but decreasing to 62.5%at both T2 and T3.The overall oVEMP response rate also showed a statistically significant difference pre-and post-CI(χ^(2)=9.720,P=0.021).The duration of CI significantly influenced cVEMP-P1 latency,amplitude,and rectified amplitude(P=0.0434,P=0.041,P=0.041,P<0.001),as well as oVEMP amplitude(P=0.043).No significant differences were observed in cVEMP response rates,latencies,or amplitudes at T3 compared to T0.However,oVEMP amplitudes at T2 and T3 were significantly different from T0(P=0.038).No significant differences were observed in VEMP parameters between the inner ear malformation and non-malformation groups across T1-T3.Conclusions VEMPs serve as a valuable tool for assessing vestibular function before and after CI in children with SNHL.The duration of CI is a crucial factor influencing VEMPs changes.Inner ear malformations may impact otolithic function post-CI,with a more pronounced effect observed over time.The VEMP test results could provide insights for selecting the optimal side for CI placement.