前庭神经炎的颈-眼诱发肌源电位临床研究
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摘要
目的评估前庭神经炎(vestibular neuritis,VN)的临床分类及前庭上神经(superior vestibular nerve,SVN)和下神经(inferior vestibular nerve,IVN)的受累情况。方法选择本院60例诊断为前庭神经炎的患者(前庭神经炎组)和30例健康人(健康对照组)行颈肌前庭诱发肌源电位(ervical vestibular evoked myogenic potential,c VEMP)、眼肌前庭诱发肌源电位(ocular vestibular evoked myogenic potential,oVEMP)、前庭双温试验检查。双温试验用于评估水平半规管,oVEMP用于评估椭圆囊及前庭上神经功能,c VEMP用于评估球囊及前庭下神经功能。结果前庭神经炎组中,前庭上神经炎46例,前庭下神经炎12例,全前庭神经炎2例,VEMPs异常率较对照组明显增高,两组相比异常率差异有统计学意义(P<0.05)。前庭上神经患者患侧oVEMP潜伏期与健康对照组比较,差异无统计学意义,振幅及不对称比差异有统计学意义,而健侧与健康对照组比较,差异无统计学意义,双温试验与健康对照组差异有统计学意义;前庭下神经炎患者oVEMP潜伏期及振幅与健康对照组差异均无统计学意义;前庭下神经炎患者oVEMP振幅及不对称比与对照组比较,差异无统计学意义。前庭双温试验CP值与前庭神经无明显相关。前庭双温试验前庭c VEMP异常的患者oVEMP及前庭双温试验结果正常时代表前庭下神经。结论前庭神经炎主要表现前庭上神经炎,部分可累及前庭下神经,c VEMP和oVEMP及双温试验提供更详细的前庭神经损伤定位。
Objective To evaluate the classification of vestibular neuritis( VN) and involvement of the superior vestibular nerve( SVN) and inferior vestibular nerve( IVN). Methods Sixty patients diagnosed with vestibular neuritis in our department and 30 normal persons as healthy control group were included in our study. Ocular vestibular-evoked myogenic potential( oVEMP) test,cervical vestibular-evoked myogenic potential( c VEMP) test and caloric test were carried out in all the patients and healthy control group.Caloric test was used to measure the horizontal semicircular canal,oVEMPs were used to measure the function of the utricular and superior vestibular nerve,while c VEMPs were used to evaluate the function of the saccule and inferior vestibular nerve. Results VN selectively involved the superior vestibular nerve in 46 patients,affected the inferior vestibular nerve in twelve and damaged both superior and inferior vestibular nerve branches in two. The abnormal extraction rate of VEMPs of vestibular neuritis group was higher than in control group,and the difference was statistically significant. There was no significant difference in the latency of oVEMPs between patients in superior vestibular nerve group and healthy control group,whereas the amplitude and asymmetry ratio were significantly different. There was no significant difference between the healthy side and the healthy control group,but the difference was statistically significant in caloric test. However,there was no significant difference in the latency and amplitude of oVEMPs between patients in inferior vestibular nerve group and healthy control group. There was no correlation between the CP value of caloric test and the vestibular nerve. Patients with abnormal c VEMPs and normal oVEMPs and caloric test represented the inferior vestibular nerve.Conclusions Vestibular neuritis mostly involves the superior portion of the vestibular nerve. c VEMPs,oVEMPs and caloric test can provide more detailed localization of vestibular nerve damage.
Objective To evaluate the classification of vestibular neuritis( VN) and involvement of the superior vestibular nerve( SVN) and inferior vestibular nerve( IVN). Methods Sixty patients diagnosed with vestibular neuritis in our department and 30 normal persons as healthy control group were included in our study. Ocular vestibular-evoked myogenic potential( oVEMP) test,cervical vestibular-evoked myogenic potential( c VEMP) test and caloric test were carried out in all the patients and healthy control group.Caloric test was used to measure the horizontal semicircular canal,oVEMPs were used to measure the function of the utricular and superior vestibular nerve,while c VEMPs were used to evaluate the function of the saccule and inferior vestibular nerve. Results VN selectively involved the superior vestibular nerve in 46 patients,affected the inferior vestibular nerve in twelve and damaged both superior and inferior vestibular nerve branches in two. The abnormal extraction rate of VEMPs of vestibular neuritis group was higher than in control group,and the difference was statistically significant. There was no significant difference in the latency of oVEMPs between patients in superior vestibular nerve group and healthy control group,whereas the amplitude and asymmetry ratio were significantly different. There was no significant difference between the healthy side and the healthy control group,but the difference was statistically significant in caloric test. However,there was no significant difference in the latency and amplitude of oVEMPs between patients in inferior vestibular nerve group and healthy control group. There was no correlation between the CP value of caloric test and the vestibular nerve. Patients with abnormal c VEMPs and normal oVEMPs and caloric test represented the inferior vestibular nerve.Conclusions Vestibular neuritis mostly involves the superior portion of the vestibular nerve. c VEMPs,oVEMPs and caloric test can provide more detailed localization of vestibular nerve damage.
引文
[1]易洋,付青梅,李昊.常见头晕、眩晕的分类与诊断[J].武警医学,2015,26(12):1269-1272.
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[3]Todd N P,Rosengren S M,Aw S T,et al.Ocular vestibular evoked myogenic potentials(OVEMPs)produced by air-and bone-conducted sound[J].Clin Neurophysiol,2007,118:381-390.
[4]Chihara Y,Ushio M,Iwasaki S,et al.Vestibular evoked extraocular potentials by air-conducted sound:another clinical test of the vestibular function[J].Clin Neurophysiol,2007,118(12):2745-2751.
[5]Piker E G,Jacobson G P,Mccaslin D L,et al.Normal characteristics of the ocular vestibular evoked myogenic potential[J].J Am Acad Audiol,2011,22(4):222-230.
[6]徐志伟,赵鹏,杨旭,等.原发性良性阵发性位置性眩晕的听力及前庭诱发肌源电位研究[J].临床耳鼻咽喉头颈外科杂志,2015,29(1):20-22.
[7]Yoshie N,Okudaira T.Myogenic evoked potential responses to clicks in man[J].Acta Otolaryngol Suppl,1969,252:89-103.
[8]Zhou Na,Wu Ziming,Zhang Suzhen,et al.Characteristics of the response of vestibular evoked myogenic potentials to different stimulus modes[J].Chinese J Clin Otorhinolaryngol Head Neck Surg,2004,39(8):483-485.
[9]Shin B S,Oh S Y,Kim J S,et al.Cervical and ocular vestibular evoked myogenic potentials in acute vestibular neuritis[J].Clin Neurophysiol,2012,123(2):369-375.
[10]Taylor R L,Mc Garvie L A,Reid N.Vestibular neuritis affects both superior and inferior vestibular nerves[J].Neurology,2016,87(16):1704-1712.
[11]Lesmas M J,Perez H,Morera C,et al.Contribution of the vestibular evoked myogenic potentials to the study of the vestibular neuritis[J].Acta Otorrinolaringol Esp,2009,60(1):49-53.
[12]Viciana D,Lopez-Escamez J A.Vestibular evoked myogenic potentials and health-related quality of life in patients with vestibular neuritis[J].Otol Neurotol,2010,31(6):954-958.
[13]Gianoli G,Goebel J,Mowry S,et al.Anatomic differences in the lateral vestibular nerve channels and their implications in vestibular neuritis[J].Otol Neurotol,2005,26(3):489-494.
[14]Goebel J A,O’Mara W,Gianoli G.Anatomic considerations in vestibular neuritis[J].Otol Neurotol,2001,22(4):512-518.
[15]Halmagyi G M,Karlberg M,Curthoys I S,et al.Inferior vestibular neuritis[J].Ann N Y Acad Sci,2002,956:306-313.
[16]Walther L E,Repik I.Inferior vestibular neuritis:diagnosis using VEMP[J].HNO,2012,60(2):126-131.
[17]Zhang D,Fan Z,Han Y,et al.Inferior vestibular neuritis:a novel subtype of vestibular neuritis[J].J Laryngol Otol,2010,124(5):477-481.
[18]Monstad P,Okstad S,Mygland A.Inferior vestibular neuritis:3 cases with clinical featuers of acute vestibular neurtitis,normal calorics but indicate of saccular failuer[J].BMC Neurol,2006,6:45.
[19]Chiarovano E,Zamith F,Vidal P P,et al.Ocular and cervical VEMPs:a study of 74 patients suffering from peripheral vestibular disorders[J].Clin Neurophysiol,2011,122(8):1650-1659.
[20]Murofushi T.Vestibular evoked myogenic potential[J].Otolaryngol Head Surg,2003,75:165-169.
[21]Iwasaki S,Chihara Y,Smulders Y E,et al.The role of the superior vestibular nerve in generating ocular vestibular-evoked myogenic potentials to bone conducted vibration at Fz[J].Clin Neurophsiol,2009,120(3):588-593.
[22]Manzari L,Burgess,A M,Curthoys I S,Dissociation between c VEMP and o VEMP responses:different vestibular origins of each VEMP?[J].Eur Arch Otorhinolaryngol,2010,267(9):1487-1489.
[23]Xie S J.Comment on:Dissociation between c VEMP and o VEMP responses:different vestibular origins of each VEMP?[J].Eur Arch Otorhinolaryngol,2011,268(1):157.
[24]Manzari L,Burgess A M,Mc Garvie L A,et al.Ocular and cervical vestibular-evoked myogenic potentials to500 Hz Fz bone-conducted vibration in superior semicircular canal dehiscence[J].Ear Hear,2012,33(44):508-520.
[25]Curthoys I S,Iwasaki S,Chihara Y,et al.The ocular vestibular-evoked myogenic potential to air-conducted sound;probable superior vestibular nerve origin[J].Clin Neurophysiol,2011,122(3):611-616.
[26]Manzari L,Burgess A M,Curthoys I S.Effect of bone conducted vibration of the midline forehead(Fz)in unilateral vestibular loss(u VL).Evidence for a new indicator of unilateral otolithic function[J].Acta Otorhinolaryngol Ital,2010,30(4):175.
[27]Govender S,Colebatch J G.Ocular vestibular evoked myogenic potential(o VEMP)responses in acute vestibular neuritis[J].Clin Neurophysiol,2012,123(5):1056-1057.
[28]Iwasaki S,Smulders Y E,Burgess A M,et al.Ocular vestibular evoked myogenic potentials in response to bone-conducted vibration of the midline forehead at Fz.A new indicator of unilateral otolithic loss[J].Audiol Neurotol,2008,13(6):396-404.
[2]Murofushi T.Clinical application of vestibular evoked myogenic potential(VEMP)[J].Auris Vasus Larynx,2016,43(4):367-376.
[3]Todd N P,Rosengren S M,Aw S T,et al.Ocular vestibular evoked myogenic potentials(OVEMPs)produced by air-and bone-conducted sound[J].Clin Neurophysiol,2007,118:381-390.
[4]Chihara Y,Ushio M,Iwasaki S,et al.Vestibular evoked extraocular potentials by air-conducted sound:another clinical test of the vestibular function[J].Clin Neurophysiol,2007,118(12):2745-2751.
[5]Piker E G,Jacobson G P,Mccaslin D L,et al.Normal characteristics of the ocular vestibular evoked myogenic potential[J].J Am Acad Audiol,2011,22(4):222-230.
[6]徐志伟,赵鹏,杨旭,等.原发性良性阵发性位置性眩晕的听力及前庭诱发肌源电位研究[J].临床耳鼻咽喉头颈外科杂志,2015,29(1):20-22.
[7]Yoshie N,Okudaira T.Myogenic evoked potential responses to clicks in man[J].Acta Otolaryngol Suppl,1969,252:89-103.
[8]Zhou Na,Wu Ziming,Zhang Suzhen,et al.Characteristics of the response of vestibular evoked myogenic potentials to different stimulus modes[J].Chinese J Clin Otorhinolaryngol Head Neck Surg,2004,39(8):483-485.
[9]Shin B S,Oh S Y,Kim J S,et al.Cervical and ocular vestibular evoked myogenic potentials in acute vestibular neuritis[J].Clin Neurophysiol,2012,123(2):369-375.
[10]Taylor R L,Mc Garvie L A,Reid N.Vestibular neuritis affects both superior and inferior vestibular nerves[J].Neurology,2016,87(16):1704-1712.
[11]Lesmas M J,Perez H,Morera C,et al.Contribution of the vestibular evoked myogenic potentials to the study of the vestibular neuritis[J].Acta Otorrinolaringol Esp,2009,60(1):49-53.
[12]Viciana D,Lopez-Escamez J A.Vestibular evoked myogenic potentials and health-related quality of life in patients with vestibular neuritis[J].Otol Neurotol,2010,31(6):954-958.
[13]Gianoli G,Goebel J,Mowry S,et al.Anatomic differences in the lateral vestibular nerve channels and their implications in vestibular neuritis[J].Otol Neurotol,2005,26(3):489-494.
[14]Goebel J A,O’Mara W,Gianoli G.Anatomic considerations in vestibular neuritis[J].Otol Neurotol,2001,22(4):512-518.
[15]Halmagyi G M,Karlberg M,Curthoys I S,et al.Inferior vestibular neuritis[J].Ann N Y Acad Sci,2002,956:306-313.
[16]Walther L E,Repik I.Inferior vestibular neuritis:diagnosis using VEMP[J].HNO,2012,60(2):126-131.
[17]Zhang D,Fan Z,Han Y,et al.Inferior vestibular neuritis:a novel subtype of vestibular neuritis[J].J Laryngol Otol,2010,124(5):477-481.
[18]Monstad P,Okstad S,Mygland A.Inferior vestibular neuritis:3 cases with clinical featuers of acute vestibular neurtitis,normal calorics but indicate of saccular failuer[J].BMC Neurol,2006,6:45.
[19]Chiarovano E,Zamith F,Vidal P P,et al.Ocular and cervical VEMPs:a study of 74 patients suffering from peripheral vestibular disorders[J].Clin Neurophysiol,2011,122(8):1650-1659.
[20]Murofushi T.Vestibular evoked myogenic potential[J].Otolaryngol Head Surg,2003,75:165-169.
[21]Iwasaki S,Chihara Y,Smulders Y E,et al.The role of the superior vestibular nerve in generating ocular vestibular-evoked myogenic potentials to bone conducted vibration at Fz[J].Clin Neurophsiol,2009,120(3):588-593.
[22]Manzari L,Burgess,A M,Curthoys I S,Dissociation between c VEMP and o VEMP responses:different vestibular origins of each VEMP?[J].Eur Arch Otorhinolaryngol,2010,267(9):1487-1489.
[23]Xie S J.Comment on:Dissociation between c VEMP and o VEMP responses:different vestibular origins of each VEMP?[J].Eur Arch Otorhinolaryngol,2011,268(1):157.
[24]Manzari L,Burgess A M,Mc Garvie L A,et al.Ocular and cervical vestibular-evoked myogenic potentials to500 Hz Fz bone-conducted vibration in superior semicircular canal dehiscence[J].Ear Hear,2012,33(44):508-520.
[25]Curthoys I S,Iwasaki S,Chihara Y,et al.The ocular vestibular-evoked myogenic potential to air-conducted sound;probable superior vestibular nerve origin[J].Clin Neurophysiol,2011,122(3):611-616.
[26]Manzari L,Burgess A M,Curthoys I S.Effect of bone conducted vibration of the midline forehead(Fz)in unilateral vestibular loss(u VL).Evidence for a new indicator of unilateral otolithic function[J].Acta Otorhinolaryngol Ital,2010,30(4):175.
[27]Govender S,Colebatch J G.Ocular vestibular evoked myogenic potential(o VEMP)responses in acute vestibular neuritis[J].Clin Neurophysiol,2012,123(5):1056-1057.
[28]Iwasaki S,Smulders Y E,Burgess A M,et al.Ocular vestibular evoked myogenic potentials in response to bone-conducted vibration of the midline forehead at Fz.A new indicator of unilateral otolithic loss[J].Audiol Neurotol,2008,13(6):396-404.