Clinical characteristics and analysis of vestibular-evoked myogenic potentials in patients with sudden sensorineural hearing loss in different ages

BACKGROUND Numerous studies have found that patients experiencing sudden sensorineural hearing loss(SSHL),with or without accompanying vertigo,often show impaired vestibular function.However,there is a dearth of studies analyzing vestibularevoked myogenic potentials(VEMPs)in SSHL patients across various age groups.AIM To investigate vestibular condition in SSHL patients across various age demographics.METHODS Clinical data of 84 SSHL patients were investigated retrospectively.Audiometry,cervical vestibular evoked myogenic potentials(c-VEMPs),and ocular vestibular evoked myogenic potentials(o-VEMPs)were conducted on these patients.Parameters assessed included the latencies of P1 and N1 waves,as well as the amplitudes of P1–N1 waves.Moreover,the study evaluated the influence of factors such as sex,affected side,configuration of hearing loss,and presence of accompanying vertigo.RESULTS Among the 84 SSHL patients,no significant differences were observed among the three groups in terms of gender,affected side,and the presence or absence of vertigo.Group II(aged 41–60 years)had the highest number of SSHL cases.The rates of absent o-VEMPs in the affected ears were 20.83%,31.58%,and 22.72%for the three age groups,respectively,with no statistically significant difference among them.The rates of absent c-VEMPs in the affected ears were 8.3%,34.21%,and 18.18%for the three age groups,respectively,with significant differences.In the unaffected ears,there were differences observed in the extraction rates of o-VEMPs in the unaffected ears among the age groups.In the three age groups,no significant differences were noted in the three age groups in the latencies of P1 and N1 waves or in the amplitude of N1–P1 waves for c-VEMPs and o-VEMPs,either on the affected side or on the unaffected side,across the three age groups.CONCLUSION The extraction rate of VEMPs is more valuable than parameters.Regardless of the presence of vertigo,vestibular organs are involved in SSHL.Notably,SSHL patients aged 41–60 appear more susceptible to damage to the inferior vestibular nerve and saccule.

Masseter Vestibular evoked myogenic potentials: A new tool to assess the vestibulomasseteric reflex pathway

Purpose: This review article provides the readers with an in-depth insight in understanding and interpreting various research literatures on the masseter vestibular evoked myogenic potentials(mVEMP). The article also reviews the contemporary researches involving the clinical applications of the mVEMP. Conclusions: Masseter VEMP is an evolving yet clinically promising neuro-otology test tool that has recently gained more research interest and is considered an additional tool to diagnose various vestibular disorders. Masseter VEMP assesses the functional integrity of the acoustic-masseteric and vestibulo-masseteric reflex pathways. The mVEMP could be used as a complementary test to evaluate the same peripheral generator as the cervical VEMP but a different central pathway i.e., vestibulo-trigeminal pathway. Various research studies that have experimented on parameters such as the effect of different electrode montages(zygomatic vs mandibular configurations), stimulation rates, filter settings and stimuli used to evoke mVEMP have been discussed in this article that could assist in the optimization of a comprehensive clinical protocol. The latency and the amplitude of mVEMP waveforms serve as significant parameters in differentiating normals from those of the clinical populations. Along with the cVEMPs and oVEMPs, mVEMP might help diagnose brainstem lesions in REM Sleep behaviour disorders, Multiple Sclerosis and Parkinson's disease. However, further studies are required to probe in this area of research.

Evaluation of ocular and cervical vestibular evoked myogenic potentials in a conductive hearing loss model

Objective:To investigate the effects of conductive hearing loss (CHL) on vestibular evoked myogenic potentials (VEMPs) using a simulated CHL model, and to provide the basis for future studies. Methods:Twenty-one healthy subjects were recruited in this study. We measured ocular VEMPs (oVEMPs) and cervical VEMPs (cVEMPs) in these subjects by air-conduction sound (ACS) stimulation. CHL was simulated later by blocking the right external auditory canal with a soundproof earplug to evaluate its impacts on VEMPs. Subjects' responses before simulated CHL served as the control, and were compared to their responses following simulated CHL. Results: oVEMPs following simulated CHL showed decreased response rate, elevated thresholds, attenuated amplitudes and prolonged N1 latencies compared with those before simulated CHL, and the differences were statistically significant. Similarly, cVEMPs following simulated CHL also showed decreased response rate, elevated thresholds and attenuated amplitudes, with prolonged P1 latencies compared with those before simulated CHL, although only differences in response rate, threshold and amplitude were significant. Conclusions:Conductive hearing loss affects the response rate and other response parameters in oVEMPs and cVEMPs.

Vestibular-evoked myogenic potentials recorded from miniature pigs and rats

Objective:To report vestibular evoked myogenic potentials from different recording sites(neck extensor or masseter muscles) in miniature pigs and rats.Methods:Potentials were recorded using 1000 Hz tone bursts from the neck extensor muscle or masseter muscle in normal adult Bama miniature pigs and rats anesthetized with 3%pentobarbital sodium and Sumianxin Ⅱ.Results:At 80 dB SPL,the first positive wave(P wave) of VEMPs was recognizable in 58%of rats with a latency of 6.45±0.23 ms and an amplitude of 1.45±0.49 μV when recorded from the neck extensor muscle,and in 50%of rats with a latency of 6.38±0.34 ms and an amplitude of 1.57±0.35 μV when recorded from the masseter muscle.In miniature pigs,at the same stimulus intensity,P wave was recognizable in 58%of the animals with a latency of 7.65±0.64 ms and an amplitude of 1.66±0.34 μV when recorded from the neck extensor muscle,and in 50%of the animals with a latency of 7.65±0.64 ms and an amplitude of 0.31±0.28 μV when recorded from the masseter muscle.Conclusion:VEMP can be induced from both neck extensor and masseter muscles in the miniature pig and rat.For a given species,the site of recording affects P wave induction rate and amplitude but not latency.Consistency and repeatability analysis suggests that the masseter muscle is a better recording site in miniature pigs while the cervical extensor is a better recording site in rats.For a given recording site,both latency and amplitude of the P wave are slightly greater in miniature pigs than in rats.

A study on vestibular-evoked myogenic potentials via galvanic vestibular stimulation in normal people

Objectives: The aim of our study is to examine vestibular-evoked myogenic potentials(VEMPs) elicited by the galvanic vestibular stimulation in the sternocleidomastoid muscle(SCM) in healthy subjects for clinical applications of auditory neuropathy or vestibular neuropathy in the future.Methods: We enrolled sixteen healthy subjects to record the average responses of SCM to galvanic vestibular stimulation(GVS) [current 3 mA;duration 1 ms] by electromyography(EMG). SPSS 18.0 software was used to analyze the obtained data for mean and standard deviation.Results: In all healthy subjects mastoid-forehead galvanic vestibular stimulation produced a positive-negative biphasic EMG responses on SCM ipsilateral to the cathodal electrode. The latency of p13 was 11.7 ± 3.0 ms. The latency of n23 was 17.8 ± 3.4 ms. The amplitude of p13-n23 was147.0 ± 69.0 μV. The interaural asymmetry ratio(AR) of p13, n23 latency and the amplitude was respectively 0.12 ± 0.09, 0.08 ± 0.08 and0.16 ± 0.10.Discussions: Galvanic vestibular stimulation could elicit biphasic EMG responses from SCM via the vestibular nerve but not from the otolith organs. Galvanic stimulation together with air conducted sound(ACS) or bone conducted vibration(BCV) can elicit VEMPs and may enable the differentiation of retrolabyrinthine lesions from labyrinthine lesions in vestibular system.

Vestibular evoked myogenic potentials in patients with diabetes mellitus

Although the exact mechanism and most involved region of the vestibular system have not yet been fully clarified, vestibular dysfunction has been demonstrated in patients with diabetes mellitus (DM). Vestibular evoked myogenic potential (VEMP) is a short latency electromyographic response to sound or vibration stimuli that may reflect otolith organ or related reflex functions. Since its first description in 1992, VEMP has become a significant part of the vestibular test battery as an objective measurement tool. In diabetic patients, VEMP responses have been studied in order to determine any otolith organ or related reflex dysfunctions. Here, we review the literature with regard to VEMP findings representing any peripheral vestibular end-organ dysfunction in patients with DM. Distinctive vestibular end-organ impairments seem to be demonstrated in patients with DM either with or without DNP via objective vestibular testing tools including VEMP recordings according to relevant studies. However, further studies with larger sample sizes are required to reveal the more definitive findings of VEMP recordings regarding the vestibular pathologies in patients with DM.

Vestibular-evoked myogenic potentials in miniature pigs

Objective:To report detection of vestibular-evoked myogenic potentials (VEMPs) in the miniature pig. Methods:Potentials evoked by 1000 Hz tone bursts were recorded from neck extensor muscles and the masseter muscles in normal adult Bama miniature pigs anesthetized with 3%pentobarbital sodium and Carbachol II. Results:The latency of the first positive wave P from neck extensor muscles was 7.65 ± 0.64 ms, with an amplitude of 1.66 ± 0.34 uv and a rate of successful induction of 75%at 80 dB SPL. The latency of potentials evoked from the masseter muscles was 7.60 ± 0.78 ms, with an amplitude of 1.31 ± 0.28 uv and a rate successful induction of 66%at 80 dB SPL. Conclusion:The latencies and thresholds of VEMPs recorded from the neck extensor muscle and the masseter muscle appear to be comparable in normal adult Bama miniature pigs, although the amplitude recorded from the neck extensor muscle seems to be higher than that from the masseter muscle. However, because of their usually relatively superficial and easily accessible location, as well as their large volume and strong contractions, masseter muscles may be better target muscles for recording myogenic potentials.

Vestibular function for children with insulin dependent diabetes using cervical vestibular evoked myogenic potentials testing

BACKGROUND Healthy vestibular system adjusts balance during static and dynamic conditions.This is important for normal development(standing up and walking).Vestipulopathies(central and peripheral)are common complications of diabetes in adult population.Related studies are scare in children with type 1 diabetes(T1D).AIM To assess saccular function of otolith organ in children with T1D and predictors for its dysfunction.METHODS Cervical vestibular evoked myogenic potential(cVEMP)was used for objective evaluation.RESULTS The study included 40 patients(boys=15;girls=25).Patients had mean age of 13.63±1.50 years,duration of diabetes of 5.62±2.80 years,frequent attacks of diabetic ketoacidosis(55%)and hypoglycemia(30%),hyperlipidemia(20%),hypertension(12.5%)and peripheral neuropathy(40%).Dizziness was found in 10%.Compared to healthy children(n=25),patients had prolonged cVEMP P1 and N1 latencies and reduced P1-N1 amplitude.Bilateral cVEMP abnormalities were found in 60%(vs 25%for unilateral abnormalities).Higher frequencies and severe vestibulopathies were found with chronic diabetes of>5 years,hemoglobin A1c values>7%,frequent diabetic ketoacidosis and hypoglycemic attacks and presence of dizziness.Regression analyses showed that predictors for prolonged P1 latencies and reduced P1-N1 amplitudes were only chronic diabetes(>5 years){odds ratio(OR)=2.80[95%confidence interval(CI):1.80–5.33],P=0.01;OR=3.42(95%CI:2.82–6.81)}and its severity(hemoglobin A1c>7%)[OR=3.05(95%CI:2.55–6.82),P=0.01;OR=4.20(95%CI:3.55–8.50),P=0.001].CONCLUSION Dysfunction or injury of the saccular macula and its pathways is prevalent in children with T1D.Optimum glycemic control is important to prevent diabetes related vestipulopathies.

The effect of EMG magnitude on the masseter vestibular evoked myogenic potential(mVEMP)

Introduction:The masseter vestibular evoked myogenic potential(mVEMP)is a bilaterally generated,electromyographically(EMG)-mediated response innervated by the trigeminal nerve.The purpose of the present investigation was to 1)determine whether subjects could accurately achieve and maintain a range of EMG target levels,2)to examine the effects of varied EMG levels on the latencies and amplitudes of the mVEMP,and 3)to investigate the degree of side-to-side asymmetry and any effects of EMG activation.Methods:Subjects were nine neurologically and otologically normal young adults.A high-intensity tone burst was presented monaurally while subjects were seated upright and asked to match a range of EMG target levels by clenching their teeth.Recordings were made from the ipsilateral and contralateral masseter muscles referenced to the ear being monaurally stimulated.Results:We found that the tonic EMG target had no effect on mVEMP latency.Additionally,although mVEMP amplitudes“scaled”to the EMG target,there was a tendency for the subjects’EMG level to“undershoot”the EMG target levels greater than 50 mV.While some individuals did generate differences in EMG activation between sides,there were no significant differences on average EMG activation between sides.Further,while average corrected amplitude asymmetry was similar across EMG targets,some individuals demonstrated large,corrected amplitude asymmetry ratios.Conclusions:The results of this investigation suggest that,as with cVEMP recordings,the underlying EMG activation may vary between subjects and could impact mVEMP amplitudes,yet could be mitigated by amplitude correction techniques.Further it is important to be aware that even young normal subjects have difficulty maintaining large,tonic EMG activity during the mVEMP recording.

Vestibular evoked myogenic potential

Vestibular evoked myogenic potential （VEMP）, is an electromyographic response of vestibular origin evoked by sound, vibration or electrical stimulation. VEMP is widely used as a clinical test of the otolith organs. Now-adays, two kinds of VEMP, cervical VEMP （cVEMP） and ocular VEMP （oVEMP） are clinically used. cVEMP is a test of sacculo-collic refex while oVEMP is a test of utri-culo-ocular refex. Absence of responses, large interau-ral asymmetry of amplitudes, prolonged peak latencies, and abnormal thresholds of responses are regarded as abnormal responses. Clinical application to various diseases of the vestibular system was performed. Using VEMP, a new type of vestibular neuritis, inferior ves-tibular neuritis was established. A prominent feature of VEMP in Meniere’s disease is a shift of a preferred fre-quency in cVEMP. The whole aspects of VEMP fndings in patients with benign paroxysmal positional vertigo are not clarifed yet. Sensitivity of cVEMP to vestibular schwannoma was 80.0%, while specifcity was 52.7%. Concerning diagnosis of superior canal dehiscence syn-drome （SCDS）, oVEMP to air-conducted sound is the most helpful. Augmentation of oVEMP responses is a prominent feature in SCDS. I also presented “idiopathic otolithic vertigo”, which I proposed as a new clinical en-tity based on VEMP fndings. Some patients complained of lateral tilting sensation in the roll plane, or tilting or translational sensation in the pitch plane without rota-tory vertigo. Majority of patients with these symptoms had absent or decreased responses of oVEMP and/or cVEMP. I proposed that these patients could be diag-nosed as having “idiopathic otolithic vertigo”.

OVEMP在梅尼埃病和前庭性偏头痛鉴别诊断中的应用

目的研究眼肌前庭诱发肌源性电位(ocular vestibular-evoked myogenic potential,oVEMP)频率振幅比在单侧梅尼埃病(Meniere disease,MD)患者中的特异性以及在梅尼埃病诊断、鉴别诊断中的意义。方法对我科2018年1月至2019年1月确诊的单侧梅尼埃病患者34例(34患耳、34对耳)、前庭性偏头痛(vestibular migraine,VM)患者17例(34耳)和年龄相仿的健康志愿者15例(30耳)行oVEMP测试,分别用500Hz、1000Hz短纯音刺激,统计引出率;比较MD患耳组与其他各组oVEMP的振幅大小;计算并比较MD患耳组与其他各组的频率振幅比(在1000Hz频率刺激时引出的振幅与500Hz处引出振幅的比值);描述梅尼埃病患侧耳频率振幅比分别基于健康对照组、前庭性偏头痛组的受试者工作特征曲线(Receiver Operating Characteristic Curve,ROC)并行分析;计算频率振幅比与年龄、听力、病程的相关性系数并分析。结果梅尼埃病组有26例能引出oVEMP(引出率为76.47%),前庭性偏头痛组有14例(引出率为82.35%),健康对照组有13例(引出率为86.67%);振幅比较:500Hz频率刺激下引出的振幅在MD患耳组分别与MD对耳组、健康对照组、VM组的差异均无统计学意义(P>0.05)。1000Hz频率处引出的振幅在MD患耳组分别与MD对耳组、健康对照组、VM组之间的差异也均无统计学意义(P>0.05);频率振幅比比较:MD患耳组分别与MD对耳组、VM组、健康对照组相比频率振幅比均显著增大且有统计学意义(P<0.05);MD患耳频率振幅比基于健康对照组ROC曲线所得ROC曲线下的面积(Area Under Curve,AUC)数值为0.84,临界点为0.86,灵敏度为0.96,特异度是0.65;MD患耳基于VM组所得AUC为0.89,临界点为0.93,灵敏度为0.77,特异度为0.93;MD患耳频率振幅比与年龄、听力及病程相关性系数分别为0.05、0.13和0.31,显著性均无统计学差异(P>0.05)。结论梅尼埃病患者患耳oVEMP 1000/500频率振幅比无论与MD对耳组、健康对照组还是前庭性偏头痛组比较都存在较显著的增高,且与年龄、听力、病程无明显相关性,是一种较稳定的辅助工具用于MD的诊断以及与VM的鉴别诊断。

良性阵发性位置性眩晕残余症状的影响因素及oVEMP分析

目的分析良性阵发性位置性眩晕(BPPV)患者耳石复位治疗后残余症状的影响因素,并探讨患者眼肌前庭诱发肌源性电位(oVEMP)对残余症状的预测价值。方法选取2018年1至12月中国人民武装警察部队海警总队医院收治的BPPV患者274例,均采用耳石复位方法治疗。根据复位治疗成功后第3天有无残余头晕症状,患者分为残余症状组107例和无残余症状组167例。分析患者残余症状的独立危险因素,比较两组患者耳石复位治疗前后眩晕残障量表(DHI)评分和oVEMP各项参数。结果BPPV病程及发病月份为患者残余症状的独立危险因素(均P<0.05)。耳石复位治疗前、治疗1周、治疗半个月时,两组患者DHI评分比较差异均无统计学意义(均P>0.05);复位治疗1个月后,残余症状组DHI评分低于无残余症状组(P<0.05),oVEMP患侧的振幅比健侧增高(P<0.05)。结论耳石复位治疗后部分BPPV患者会有残余症状,残余症状可能与病程、发病月份、复位次数、是否合并内科疾病等因素有关,在临床工作中应重视并对其进行适当的干预。患者oVEMP的耳间振幅增高与残余症状有关,临床或可把oVEMP检测作为残余症状的预测方法。

Assessment of Balance and Vestibular Functions in Patients with Idiopathic Sudden Sensorineural Hearing Loss

This study investigated the relationship among the severity of hearing impairment,vestibular function and balance function in patients with idiopathic sudden sensorineural hearing loss（ISSNHL）.A total of 35 ISSNHL patients（including 21 patients with vertigo） were enrolled.All of the patients underwent audiometry,sensory organization test（SOT）,caloric test,cervical vestibular-evoked myogenic potential（cV EMP） test and ocular vestibular-evoked myogenic potential（o VEMP） test.Significant relationship was found between vertigo and hearing loss grade（P=0.009）,and between SOT VEST grade and hearing loss grade（P=0.001）.The abnormal rate of o VEMP test was the highest,followed by the abnormal rates of caloric and c VEMP tests,not only in patients with vertigo but also in those without vertigo.The vestibular end organs were more susceptible to damage in patients with vertigo（compared with patients without vertigo）.Significant relationship was found between presence of vertigo and SOT VEST grade（P=0.010）.We demonstrated that vestibular end organs may be impaired not only in patients with vertigo but also in patients without vertigo.The cochlear and vestibular impairment could be more serious in patients with vertigo than in those without vertigo.Vertigo does not necessarily bear a causal relationship with the impairment of the vestibular end organs.SOT VEST grade could be used to reflect the presence of vertigo state in the ISSNHL patients.Apart from audiometry,the function of peripheral vestibular end organs and balance function should be evaluated to comprehensively understand ISSNHL.Better assessment of the condition will help us in clinical diagnosis,treatment and prognosis evaluation of ISSNHL.

Inferior vestibular neuritis in a fighter pilot:A case report

Pilot spatial disorientation is a leading factor contributing to many fatal flying accidents. Spatial orientation is the product of integrative inputs from the proprioceptive, vestibular, and visual systems. Vestibular neuritis (VN) can lead to sudden pilot incapacitation in flight. VN is commonly diagnosed by demonstration of unilateral vestibular failure, as unilateral loss of caloric response. As this test reflects the function of the superior part of the vestibular nerve only, cases of pure inferior nerve neuritis will be lost. This paper describes a fighter pilot with symptoms suggestive of VN but with normal caloric test results. Further test showed unilateral loss of vestibular evoked myogenic potential. We believe that the pilot suffered from pure inferior nerve vestibular neuritis. VEMP plays a major role in the diagnosis of inferior nerve vestibular neuritis in pilots. Aeromedical concerns are also discussed.

突发性聋耳石器损伤情况及眼性前庭诱发肌源性电位与主观视觉垂直线相关性分析

目的 观察突发性聋患者耳石器损伤情况及其对预后的影响,探讨眼性前庭诱发肌源性电位(ocular vestibular evoked myogenic potential,oVEMP)与主观视觉垂直线(subjective visual vertical,SVV)的相关性。方法 选取2021年10月至2022年3月广西医科大学第二附属医院耳鼻咽喉头颈外科收治的单侧突发性聋患者66例,根据是否伴发眩晕,分为不伴眩晕组38例和伴眩晕组28例;根据耳石功能是否正常,分为耳石功能正常组37例和耳石功能异常组29例。选取同期30例无耳科疾病健康志愿者为对照组。治疗前后分别行纯音听阈、oVEMP、颈性前庭诱发肌源性电位(cervical vestibular evoked myogenic potential,cVEMP)及SVV检查,分析结果及oVEMP与SVV相关性。结果 伴眩晕组oVEMP、cVEMP、SVV异常率均高于不伴眩晕组、对照组,差异均有统计学意义(P<0.05);不伴眩晕组耳石器功能异常率均高于对照组,差异均有统计学意义(P<0.05)。突发性聋患者oVEMP与SVV无相关性,差异无统计学意义(P>0.05)。治疗后,不伴眩晕组总有效率高于伴眩晕组,差异有统计学意义(P<0.05);耳石器功能正常组总有效率高于耳石器功能异常组,差异均有统计学意义(P<0.05)。结论 突发性聋患者存在一定程度的耳石器功能损伤,突发性聋伴眩晕患者预后较不伴眩晕者差,耳石器功能对突发性聋患者的预后有一定的评估价值,oVEMP与SVV作为相对独立的两项耳石器功能检查,二者可相互补充,不能相互替代。

良性阵发性位置性眩晕患者的耳石器及半规管功能分析

目的探讨良性阵发性位置性眩晕(BPPV)对耳石器及半规管功能的影响及其可能的发病因素。方法选择2022年12月-2023年6月本院收治的单管良性阵发性位置性眩晕患者作为研究对象,分别行视频头脉冲试验(vHIT)、前庭肌源诱发电位(VEMP)、听性脑干反应(ABR),分析其检测结果。结果后半规管BPPV患者与水平半规管BPPV患者vHIT、cVEMP、oVEMP、ABR检查结果异常侧别分布情况比较,差异无统计学意义(P>0.05),但在老年水平半规管BPPV患者的oVEMP双侧异常率(41.2%)比后半规管BPPV患者的oVEMP双侧异常率(10.3%)高,两组差异存在统计学意义(P<0.05)。青中年BPPV患者的ABR双侧异常率(15.2%)低于老年BPPV患者的ABR双侧异常率(33.9%),差异存在统计学意义(P<0.05);青中年BPPV患者与老年BPPV患者vHIT、cVEMP、oVEMP检查结果异常侧别分布情况比较,差异无统计学意义(P>0.05)。结论BPPV可见于半规管弥漫性损伤,内耳循环障碍可引起耳石器功能障碍,其可能是BPPV的发病因素。

直流电刺激诱发的前庭诱发肌源性电位儿童检测方法的建立

目的 建立健康儿童直流电刺激诱发(galvanic vestibular stimulation,GVS)的颈肌前庭诱发肌源性电位(cervical vestibular evoked myogenic potential,cVEMP)和眼肌前庭诱发肌源性电位(ocular vestibular evoked myogenic potential,oVEMP)的检测方法,并确定正常范围。方法 对健康儿童20例(3~14岁)和健康成人24例(18~30岁)分别进行GVS-cVEMP和GVS-oVEMP检测,儿童组直流电刺激强度不超过3 mA,成人组最大刺激强度5 mA,记录两组GVS-cVEMP和GVS-oVEMP的引出率和特点,并进行不同刺激强度下的疼痛评分。结果 GVS-cVEMP和GVS-oVEMP在儿童组和成人组的引出率均为100.0%。儿童组GVS-cVEMP的p1潜伏期、n1潜伏期和p1-n1波间期分别为10.46±1.84 ms、16.98±2.12 ms和6.52±1.42 ms,n1潜伏期和p1-n1波间期较成人组明显缩短(P<0.05)。儿童组GVS-oVEMP的n1潜伏期、p1潜伏期和p1-n1波间期分别为8.87±1.40 ms、12.25±1.80 ms和3.39±1.07 ms,与成人组无明显差异。儿童组GVS-cVEMP和GVS-oVEMP的阈值均明显低于成人组(P<0.01),但振幅和振幅不对称比无明显差异。本文健康儿童检测结果可作为其正常范围。随着电流刺激强度的增加,受试者的疼痛评分增高,其对应的GVS-cVEMP和GVS-oVEMP的引出率也增加。结论 采取3 mA刺激强度和适宜的记录方法,可在3岁以上儿童及青少年人群中进行GVS-cVEMP和GVS-oVEMP检测并引出波形,并得到了其正常范围,儿童GVS-cVEMP潜伏期略短于成人,进行评估时,建议选取同年龄段健康儿童进行比较。

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

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。

0~14岁儿童前庭诱发肌源性电位研究进展

在儿童中,平衡及前庭功能受损发生率较高,影响患儿听力和平衡能力,不及早干预将会影响其身心发展和正常生活学习。由于较小患儿不能准确表达他们的症状,且注意力保持时间短,需要一种安全有效的前庭测试评估患儿前庭功能。前庭诱发肌源性电位(vestibular evoked Myogenic potentials,VEMP)是一种耳石器功能评估方法,主要反映球囊和前庭上神经通路以及椭圆囊和前庭下神经通路功能,操作简便,安全有效,适用于儿童前庭功能评估。本文主要综述0~14岁儿童VEMP的检测方法和临床应用。

帕金森病患者前庭诱发肌源性电位特点及其与姿势平衡障碍及非运动症状的相关性

目的:探讨帕金森病(PD)患者前庭诱发肌源性电位(VEMP)特点并分析其与姿势平衡障碍及非运动症状的相关性。方法:纳入2022年6月至2023年6月河北医科大学第一医院神经内科收治的65例原发PD患者及性别、年龄相匹配的60例健康体检者(HC),均进行VEMP检查,采用统一帕金森病评定量表(UPDRS)、Hoehn-Yahr分期量表(H-Y)评估患者的运动症状及疾病严重程度,采用蒙特利尔认知评价量表(MOCA)、简易智能状态检查量表(MMSE)、汉密尔顿抑郁量表24项(HAMD-24)、汉密尔顿焦虑量表14项(HAMA-14)、匹兹堡睡眠量表(PSQI)、快速眼动睡眠期行为障碍相关量表(RBD-SQ)、帕金森病睡眠障碍量表(PDSS)、自主神经功能量表(SCOPA-AUT)、简易疲劳量表(BFI)、国际不宁腿综合征量表(IRLS)、帕金森病疼痛量表(KPPS)、Wexner便秘评分(WCGS)评价患者的非运动症状,采用Berg平衡量表(BBS)、平衡信心量表(ABC)、Tinetti平衡与步态量表(Tinetti-POMA)评估患者的姿势平衡障碍。采用Spearman相关性分析探讨VEMP与其姿势平衡障碍及非运动症状的相关性。结果:PD患者VEMP异常率显著高于HC[72.31%(47/65)vs. 33.33%(20/60),χ^(2)=19.056,P<0.001],异常模式以反应缺失为主[58.46%(38/47)]。VEMP评分与PD患者病程、LEDD及各量表评分间的Spearman相关性分析显示,VEMP评分与BBS评分(r=-0.307,P=0.013)、Tinetti-POMA评分(r=-0.255,P=0.042)呈负相关关系,与HAMA-14评分(r=0.323,P=0.009)、RBD-SQ(r=0.476,P=0.001)评分呈正相关关系。结论:PD患者的VEMP异常率会显著升高,且异常模式以反应缺失为主,VEMP异常与PD患者的姿势平衡障碍、焦虑情绪严重程度及RBD严重程度具有显著相关性。VEMP作为一种无创、客观的神经电生理学指标,可为诊断PD的脑干功能受损情况提供依据,为前庭刺激及前庭康复等辅助治疗PD奠定理论基础。