oVEMP评估良性阵发性位置性眩晕患者耳石复位效果的临床价值
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摘要
目的:探讨眼性前庭诱发肌源性电位(oVEMP)对于评估良性阵发性位置性眩晕(BPPV)患者耳石复位效果的临床价值。方法:对2015-10-2016-03期间就诊的53例原发性单侧后半规管BPPV患者进行耳石复位前后的oVEMP测试,并根据复位效果分为痊愈组和有效组,比较各组复位前后oVEMP的引出率、N1振幅和N1-P1波幅以及不对称率的差异,应用SPSS 20.0软件进行统计学分析。结果:53例患者复位治疗前oVEMP引出率为84.9%,复位后引出率为88.7%。复位前后均可引出oVEMP者45例,按照疗效分为痊愈组(28例)和有效组(17例)。痊愈组:治疗前后相比,患侧N1振幅从(3.16±0.64)μV增长到(3.99±0.67)μV;患侧N1-P1波幅从(3.08±1.14)μV增长到(4.22±0.87)μV,均差异有统计学意义(P<0.05);健侧N1振幅平均增长0.02μV,健侧N1-P1波幅平均增长0.01μV,均差异无统计学意义(P>0.05);不对称率治疗后降低0.10,差异有统计学意义(P<0.05)。有效组:治疗前后相比,患侧N1振幅平均增长0.13μV,患侧N1-P1波幅平均增长0.01μV;健侧N1振幅前后水平一致,健侧N1-P1波幅平均增长0.04μV,不对称率前后水平一致,各项均差异无统计学意义(P>0.05)。结论:有效的耳石复位可使BPPV患者脱落的耳石回归椭圆囊,复位后oVEMP波幅增长,引出率提高;oVEMP可用于评估BPPV患者耳石复位后椭圆囊的功能恢复情况,评判该病的预后。
Objective:To evaluate whether oVEMP amplitudes increase after successful repositioning of otoconia in patients diagnosed as benign paroxysmal positioning vertigo(BPPV).Method:Fifty-three cases of unilateral pc-BPPV were prospectively examined with air-conducted oVEMP at two time points:before,and 1week after reposition.A commercially available software package SPSS 20.0was used for statistical analysis.Result:Prevalence was 84.9% before treatment,and it changed to 88.7% 1week after reposition.During one week follow-up,28 out of 45 cases were asymptomatic(healing group);vertigo could still be induced in the other 17(effective group)cases.In healing group the mean N1 amplitude on the affected side increased from(3.16±0.64)μV at baseline(before the treatment)to(3.99±0.67)μV at 1week after treatment;the mean N1-P1 amplitudes on the affected side increased from(3.08±1.14)μV at baseline(before the treatment)to(4.22±0.87)μV at 1week after treatment,and this increase was significant(P<0.05).However there is no significantly statistical difference on the no-affected side in the healing group(P>0.05).And no significantly statistical difference was found in the effective group(P>0.05).Conclusion:A repositioning of otoconia to the utricle may occur during the repositioning maneuver in BPPV,an increasing oVEMP amplitudes was found after the repositioning maneuver,oVEMP examinations could be useful to evaluate the the effect of repositioning in BPPV.
Objective:To evaluate whether oVEMP amplitudes increase after successful repositioning of otoconia in patients diagnosed as benign paroxysmal positioning vertigo(BPPV).Method:Fifty-three cases of unilateral pc-BPPV were prospectively examined with air-conducted oVEMP at two time points:before,and 1week after reposition.A commercially available software package SPSS 20.0was used for statistical analysis.Result:Prevalence was 84.9% before treatment,and it changed to 88.7% 1week after reposition.During one week follow-up,28 out of 45 cases were asymptomatic(healing group);vertigo could still be induced in the other 17(effective group)cases.In healing group the mean N1 amplitude on the affected side increased from(3.16±0.64)μV at baseline(before the treatment)to(3.99±0.67)μV at 1week after treatment;the mean N1-P1 amplitudes on the affected side increased from(3.08±1.14)μV at baseline(before the treatment)to(4.22±0.87)μV at 1week after treatment,and this increase was significant(P<0.05).However there is no significantly statistical difference on the no-affected side in the healing group(P>0.05).And no significantly statistical difference was found in the effective group(P>0.05).Conclusion:A repositioning of otoconia to the utricle may occur during the repositioning maneuver in BPPV,an increasing oVEMP amplitudes was found after the repositioning maneuver,oVEMP examinations could be useful to evaluate the the effect of repositioning in BPPV.
引文
[1]林少莲,林有辉,舒博.眼性前庭诱发肌源电位对迷路积水定位诊断的价值探讨[J].中华耳科学杂志,2015,13(1):115-118.
[2]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,201l,122:611-616.
[3]张青,宋辉,胡娟,等.气导短纯音诱发的眼肌前庭诱发肌源性电位在健康青年人群中的波形特征[J].中华耳鼻咽喉头颈外科杂志,2012,47(1):15-18.
[4]WALTHER L E,BLODOW A.Ocular vestibular evoked myogenic potential to air conducted sound stimulation and video head impulse test in acute vestibular neuritis[J].Otol Neurotol,2013,34:1084-1089.
[5]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉科学分会.BPPV的诊断依据和疗效评估(2006年,贵阳)[J].中华耳鼻咽喉头颈外科杂志,2007,42(3):163-164.
[6]MICHAEL B,SCHMIDT T,SCHONFELD U,et al.Utricular dysfunction in patients with benign paroxysmal positional vertigo[J].Otol Neurol,2005,27:92-96.
[7]MUROFUSHI T,NAKAHRA H,YOSHIMURA E,et al.Association of air-conducted sound oVEMP findings with cVEMP and caloric test findings in patients with unilateral peripheral vestibular disorders[J].Acta Laryngol,2011,131:945-950.
[8]IWASAKI S,SMULDERS Y E,BURGESS A M,et al.Ocular vestibular evoked myogenic potentials to bone conducted vibration of the midline forehead at Fz in healthy subjects[J].Clin Neurophysiol,2008,119:2135-2147.
[9]CHIHARA Y,IWASAKI S,USHIO M,et al.Ocular vestibular-evoked myogenic potentials(oVEMPs)require extraocular muscles but not facial or cochlear nerve activity[J].Clin Neurophysiol,2009,120:581-587.
[10]AMIKULEC A,KOWALCZYK K A,PFITZINGER M E,et al.Negative association between treated osteoporosis and benign paroxysmal positional vertigo in women[J].Laryngol Otol,2010,124:374-376.
[11]毕潇,周慧芳,苏娟,等.不同年龄段前庭诱发肌源性电位参数的正常值[J].临床耳鼻咽喉头颈外科杂志,2016,30(13):1016-1020.
[12]马晓彦,吴子明,刘兴健.梅尼埃病合并良性阵发性位置性眩晕患者的临床特征[J].听力学及言语疾病杂志,2016,24(4):347-350.
[13]BREMOVA T,BAYER O,AGRAWAL Y,et al.Ocular VEMPs indicate repositioning of otoconia to the utricle after successful liberatory maneuvers in benign paroxysmal positioning vertigo[J].Acta Otolaryngol,2013,133:1297-1303.
[14]XU H,LIANG F Y,CHEN L,et al.Evaluation of the utricular and saccular function using oVEMPs and cVEMPs in BPPV patients[J].J Otolaryngol Head Neck Surg,2016,45:12-16.
[15]林细康,李晓璐.眼性前庭诱发肌源电位与眩晕诊断[J].中华耳鼻咽喉头颈外科杂志,2012,47(1):77-79.
[16]LEE J D,PARK M K,LEE B D,et al.Abnormality of cervical vestibular-evoked myogenic potentials and ocular vestibular-evoked myogenic potentials in patients with recurrent benign paroxysmal postitional vertigo[J].Acta Otolaryngol,2013,133:150-153.
[17]李婧,杨旭,吴子明.眼源性前庭诱发肌源性电位[J].中华耳科学杂志,2014,12(2):231-234.
[18]张道宫,樊兆民.前庭功能检查在眩晕症诊断中的意义及临床应用[J].临床耳鼻咽喉头颈外科杂志,2015,29(1):5-8.
[19]王碌,余菁,顾峻.外周性眩晕前庭功能检查时机的选择[J].中国眼耳鼻喉科杂志,2015,15(6):388-390.
[2]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,201l,122:611-616.
[3]张青,宋辉,胡娟,等.气导短纯音诱发的眼肌前庭诱发肌源性电位在健康青年人群中的波形特征[J].中华耳鼻咽喉头颈外科杂志,2012,47(1):15-18.
[4]WALTHER L E,BLODOW A.Ocular vestibular evoked myogenic potential to air conducted sound stimulation and video head impulse test in acute vestibular neuritis[J].Otol Neurotol,2013,34:1084-1089.
[5]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉科学分会.BPPV的诊断依据和疗效评估(2006年,贵阳)[J].中华耳鼻咽喉头颈外科杂志,2007,42(3):163-164.
[6]MICHAEL B,SCHMIDT T,SCHONFELD U,et al.Utricular dysfunction in patients with benign paroxysmal positional vertigo[J].Otol Neurol,2005,27:92-96.
[7]MUROFUSHI T,NAKAHRA H,YOSHIMURA E,et al.Association of air-conducted sound oVEMP findings with cVEMP and caloric test findings in patients with unilateral peripheral vestibular disorders[J].Acta Laryngol,2011,131:945-950.
[8]IWASAKI S,SMULDERS Y E,BURGESS A M,et al.Ocular vestibular evoked myogenic potentials to bone conducted vibration of the midline forehead at Fz in healthy subjects[J].Clin Neurophysiol,2008,119:2135-2147.
[9]CHIHARA Y,IWASAKI S,USHIO M,et al.Ocular vestibular-evoked myogenic potentials(oVEMPs)require extraocular muscles but not facial or cochlear nerve activity[J].Clin Neurophysiol,2009,120:581-587.
[10]AMIKULEC A,KOWALCZYK K A,PFITZINGER M E,et al.Negative association between treated osteoporosis and benign paroxysmal positional vertigo in women[J].Laryngol Otol,2010,124:374-376.
[11]毕潇,周慧芳,苏娟,等.不同年龄段前庭诱发肌源性电位参数的正常值[J].临床耳鼻咽喉头颈外科杂志,2016,30(13):1016-1020.
[12]马晓彦,吴子明,刘兴健.梅尼埃病合并良性阵发性位置性眩晕患者的临床特征[J].听力学及言语疾病杂志,2016,24(4):347-350.
[13]BREMOVA T,BAYER O,AGRAWAL Y,et al.Ocular VEMPs indicate repositioning of otoconia to the utricle after successful liberatory maneuvers in benign paroxysmal positioning vertigo[J].Acta Otolaryngol,2013,133:1297-1303.
[14]XU H,LIANG F Y,CHEN L,et al.Evaluation of the utricular and saccular function using oVEMPs and cVEMPs in BPPV patients[J].J Otolaryngol Head Neck Surg,2016,45:12-16.
[15]林细康,李晓璐.眼性前庭诱发肌源电位与眩晕诊断[J].中华耳鼻咽喉头颈外科杂志,2012,47(1):77-79.
[16]LEE J D,PARK M K,LEE B D,et al.Abnormality of cervical vestibular-evoked myogenic potentials and ocular vestibular-evoked myogenic potentials in patients with recurrent benign paroxysmal postitional vertigo[J].Acta Otolaryngol,2013,133:150-153.
[17]李婧,杨旭,吴子明.眼源性前庭诱发肌源性电位[J].中华耳科学杂志,2014,12(2):231-234.
[18]张道宫,樊兆民.前庭功能检查在眩晕症诊断中的意义及临床应用[J].临床耳鼻咽喉头颈外科杂志,2015,29(1):5-8.
[19]王碌,余菁,顾峻.外周性眩晕前庭功能检查时机的选择[J].中国眼耳鼻喉科杂志,2015,15(6):388-390.