双侧大前庭水管综合征患儿的前庭诱发肌源性电位特征
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摘要
目的探讨儿童双侧大前庭水管综合征(large vestibular aqueduct syndrome, LVAS)患者的前庭诱发肌源性电位(vestibular evoked myogenic potential, VEMP)的波形特征。方法对双侧大前庭水管综合征患儿21例(42耳)(LVAS组)、年龄和性别相匹配的非LVAS聋哑症患儿14例(28耳)(非LVAS聋哑症组)及健康儿童12例(24耳)(健康对照组)进行眼肌前庭诱发肌源性电位(ocular VEMP, oVEMP)和颈肌前庭诱发肌源性电位(cervical VEMP, cVEMP)检测,比较三组各波的引出率及波形特点。结果与非LVAS聋哑症组比较,LVAS组oVEMP的引出率较高(P<0.001),阈值较低(P<0.001)、振幅较高(P=0.003),n1、p1波潜伏期、n1-p1波间期组间差异无统计学意义(P>0.05)。与非LVAS聋哑症组患儿相比较,LVAS组患儿cVEMP的引出率较高(P=0.017),阈值较低(P=0.001),p1波潜伏期较短(P=0.009);其余指标两组间差异无统计学意义(P>0.05)。与健康对照组比较,LVAS组患儿的oVEMP振幅较高(P=0.027),其余指标两组间差异无统计学意义(P>0.05);cVEMP的各项指标差异均无统计学意义(P>0.05)。结论 LVAS患儿oVEMP及cVEMP引出率较非LVAS聋哑组高,与健康对照组无统计学差异;VEMP可用于评估LVAS患儿的前庭耳石器功能状态,但是并不恒定地都表现为阈值低、振幅高的特点。
Objective To study the characteristics of vestibular evoked myogenic potential(VEMP) in children with bilateral large vestibular aqueduct syndrome(LVAS).Methods A retrospective analysis of 21 children diagnosed with bilateral large vestibular aqueduct syndrome(LVAS group) was carried out. Fourteen children with non-LVAS deafness were selected as non-LVAS deaf-mutism group, and 12 healthy children with no statistical difference between age and gender were selected as normal control group. The oVEMP and cVEMP parameters were compared.Results There were significant differences in the oVEMP response rates(P<0.001), thresholds(P<0.001), and amplitudes(P=0.003) between the LVAS group and the deaf-mutism group. The LVAS group had a higher prevalence of oVEMP, a low threshold and high amplitude performance. There was no significant difference between n1 wave latency, p1 wave latency, and n1-p1 interval(P>0.05). There was a statistically significant difference in the cVEMP response rates(P=0.017), thresholds(P=0.001), and p1 wave latencies(P=0.009) between the LVAS group and the deaf-mutism group. The LVAS group had a higher prevalence of cVEMP, a low threshold and shorter latency of p1 wave. However, there were no significant differences between the two groups in the remaining parameters(P>0.05).There was a statistically significant difference in the amplitudes of oVEMP between the LVAS group and the healthy control group(P=0.027). The oVEMP in the LVAS group had a high amplitude. There was no significant difference between the two groups in the remaining parameters(P>0.05). There was no significant difference in cVEMP parameters between LVAS group and healthy control group(P>0.05).Conclusion The response rates of oVEMP and cVEMP were higher in LVAS group than in non-LVAS deaf-mutism group, but there was no statistical difference between LVAS group and control group. VEMP can be used to assess the functional status of vestibular otoliths in children with LVAS. However, it does not always exhibit the characteristics of low threshold and high amplitude.
Objective To study the characteristics of vestibular evoked myogenic potential(VEMP) in children with bilateral large vestibular aqueduct syndrome(LVAS).Methods A retrospective analysis of 21 children diagnosed with bilateral large vestibular aqueduct syndrome(LVAS group) was carried out. Fourteen children with non-LVAS deafness were selected as non-LVAS deaf-mutism group, and 12 healthy children with no statistical difference between age and gender were selected as normal control group. The oVEMP and cVEMP parameters were compared.Results There were significant differences in the oVEMP response rates(P<0.001), thresholds(P<0.001), and amplitudes(P=0.003) between the LVAS group and the deaf-mutism group. The LVAS group had a higher prevalence of oVEMP, a low threshold and high amplitude performance. There was no significant difference between n1 wave latency, p1 wave latency, and n1-p1 interval(P>0.05). There was a statistically significant difference in the cVEMP response rates(P=0.017), thresholds(P=0.001), and p1 wave latencies(P=0.009) between the LVAS group and the deaf-mutism group. The LVAS group had a higher prevalence of cVEMP, a low threshold and shorter latency of p1 wave. However, there were no significant differences between the two groups in the remaining parameters(P>0.05).There was a statistically significant difference in the amplitudes of oVEMP between the LVAS group and the healthy control group(P=0.027). The oVEMP in the LVAS group had a high amplitude. There was no significant difference between the two groups in the remaining parameters(P>0.05). There was no significant difference in cVEMP parameters between LVAS group and healthy control group(P>0.05).Conclusion The response rates of oVEMP and cVEMP were higher in LVAS group than in non-LVAS deaf-mutism group, but there was no statistical difference between LVAS group and control group. VEMP can be used to assess the functional status of vestibular otoliths in children with LVAS. However, it does not always exhibit the characteristics of low threshold and high amplitude.
引文
1 Madden C,Halsted M,Benton C,et al.Enlarged vestibular aqueduct syndrome in the pediatric population[J].Otol Neurotol,2003,24:625.
2 田勇泉,韩东一,迟放鲁,等.耳鼻咽喉头颈外科学[M].第8版.北京:人民卫生出版社,2013.309～310.
3 Kentaro O,Hajime S,Makitol O.Long-term observation of three cases of large vestibular aqueduct syndrome[J].Practica Otorhino-Laryngologica,2017,148(Suppl):14.
4 Bal KK,Ismi O,Bucioglu H,et al.Sudden sensorineural hearing loss in the only hearing ear:large vestibular aqueduct syndrome[J].Case Reports in Otolaryngology,2016,2016:1.
5 胡娟,许珉,张青.眼肌前庭诱发肌源性电位的研究现状及展望[J].临床耳鼻咽喉头颈外科杂志,2013,27:388.
6 Rosengren SM,Welgampol MS,Colebatch JG.Vestibular evoked myogenic potentials:past,present and future[J].Clinical Neurophysiology,2010,121:636.
7 Chihara Y,Iwasaki S,Ushio M,et al.Vestibular-evoked extraocular potentials by air-conducted sound:another clinical test for vestibular function[J].Clin Neurophysiol,2007,118:2745.
8 Iwasaki S,Mc Garvie LA,Halmagyi GM,et al.Head taps evoke a crossed vestibulo-ocular reflex[J].Neurology,2007,68:1227.
9 杨引通,张青,张睿,等.不同种类刺激声对国人青年正常人群气导声刺激诱发的颈肌前庭诱发肌源性电位的影响[J].临床耳鼻咽喉头颈外科杂志,2015,29:1175.
10 牛晓蓉,韩鹏,陈耔辰,等.前庭耳石器通路功能评价在梅尼埃病分期中的初步研究[J].中华耳鼻咽喉头颈外科杂志,2017,52:195.
11 Bemettomos SF,Forli F,Bogazzi F,et al.Large vestibular aqueduct syndrome:audiological,radiological,clinical,and genetic features [J].Am J Otolaryngology,2005,26:363.
12 张宇丽,刘军.大前庭水管综合征的临床表现、诊断及防治策略[J].听力学及言语疾病杂志,2014,22:436.
13 Sheykholeslami K,Schmerber S,Habiby KM,et al.Vestibular-evoked myogenic potentials in three patients with large vestibular aqueduct[J].Hear Res,2004,190:161.
14 Manzari L.Vestibular signs and symptoms of volumetric abnormalities of the vestibular aqueduct[J].J Laryngol Otol,2008,122:557.
15 Taylor RL,Bradshaw AP,Magnussen JS,et al.Augmented ocular vestibular evoked myogenic potentials to air-conducted sound in large vestibular aqueduct syndrome[J].Ear Hear,2012,33:768.
16 Zhou YJ,Wu YZ,Cong N,et al.Contrasting results of tests of peripheral vestibular function in patients with bilateral large vestibular aqueduct syndrome[J].Clinical Neurophysiology,2017,128:1513.
17 Zhou G,Gopen Q.Characteristics of vestibular evoked myogenic potentials in children with enlarged vestibularaqueduct[J].Laryngoscope,2011,121:220.
18 张青,许信达,牛晓蓉,等.年龄因素对气导声刺激诱发的眼肌和颈肌前庭诱发肌源性电位的影响[J].中华耳鼻咽喉头颈外科杂志,2014,49:897.
2 田勇泉,韩东一,迟放鲁,等.耳鼻咽喉头颈外科学[M].第8版.北京:人民卫生出版社,2013.309～310.
3 Kentaro O,Hajime S,Makitol O.Long-term observation of three cases of large vestibular aqueduct syndrome[J].Practica Otorhino-Laryngologica,2017,148(Suppl):14.
4 Bal KK,Ismi O,Bucioglu H,et al.Sudden sensorineural hearing loss in the only hearing ear:large vestibular aqueduct syndrome[J].Case Reports in Otolaryngology,2016,2016:1.
5 胡娟,许珉,张青.眼肌前庭诱发肌源性电位的研究现状及展望[J].临床耳鼻咽喉头颈外科杂志,2013,27:388.
6 Rosengren SM,Welgampol MS,Colebatch JG.Vestibular evoked myogenic potentials:past,present and future[J].Clinical Neurophysiology,2010,121:636.
7 Chihara Y,Iwasaki S,Ushio M,et al.Vestibular-evoked extraocular potentials by air-conducted sound:another clinical test for vestibular function[J].Clin Neurophysiol,2007,118:2745.
8 Iwasaki S,Mc Garvie LA,Halmagyi GM,et al.Head taps evoke a crossed vestibulo-ocular reflex[J].Neurology,2007,68:1227.
9 杨引通,张青,张睿,等.不同种类刺激声对国人青年正常人群气导声刺激诱发的颈肌前庭诱发肌源性电位的影响[J].临床耳鼻咽喉头颈外科杂志,2015,29:1175.
10 牛晓蓉,韩鹏,陈耔辰,等.前庭耳石器通路功能评价在梅尼埃病分期中的初步研究[J].中华耳鼻咽喉头颈外科杂志,2017,52:195.
11 Bemettomos SF,Forli F,Bogazzi F,et al.Large vestibular aqueduct syndrome:audiological,radiological,clinical,and genetic features [J].Am J Otolaryngology,2005,26:363.
12 张宇丽,刘军.大前庭水管综合征的临床表现、诊断及防治策略[J].听力学及言语疾病杂志,2014,22:436.
13 Sheykholeslami K,Schmerber S,Habiby KM,et al.Vestibular-evoked myogenic potentials in three patients with large vestibular aqueduct[J].Hear Res,2004,190:161.
14 Manzari L.Vestibular signs and symptoms of volumetric abnormalities of the vestibular aqueduct[J].J Laryngol Otol,2008,122:557.
15 Taylor RL,Bradshaw AP,Magnussen JS,et al.Augmented ocular vestibular evoked myogenic potentials to air-conducted sound in large vestibular aqueduct syndrome[J].Ear Hear,2012,33:768.
16 Zhou YJ,Wu YZ,Cong N,et al.Contrasting results of tests of peripheral vestibular function in patients with bilateral large vestibular aqueduct syndrome[J].Clinical Neurophysiology,2017,128:1513.
17 Zhou G,Gopen Q.Characteristics of vestibular evoked myogenic potentials in children with enlarged vestibularaqueduct[J].Laryngoscope,2011,121:220.
18 张青,许信达,牛晓蓉,等.年龄因素对气导声刺激诱发的眼肌和颈肌前庭诱发肌源性电位的影响[J].中华耳鼻咽喉头颈外科杂志,2014,49:897.