突发性耳聋患者眼肌前庭诱发肌源性电位特点
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摘要
目的观察突发性耳聋患者眼肌前庭诱发肌源性电位(oVEMP)的引出率和各参数指标,并探讨其临床诊断价值。方法选取2014年10月到2015年3月诊断为单侧突发性耳聋的患者36例,进行气导短纯音诱发的眼肌前庭诱发肌源性电位检测,分析对比oVEMP的引出率和各参数指标。分别以突聋对侧耳和25名年龄、性别匹配的健康人25例(50耳)为对照,分析前庭功能受损状况。结果突聋组患耳oVEMP引出率为44.4%(16/36),突聋组对侧健耳oVEMP引出率为52.7%(19/36);对照组oVEMP引出率为100%(50/50)。组间对比显示突聋组患耳和对侧耳与对照组oVEMP引出率比较,差异均有统计学意义(P值均<0.05),突聋组患耳和对侧耳oVEMP引出率比较,差异无统计学意义(P>0.05);突聋组患耳、对侧耳、对照组正常耳组间比较,oVEMP的N1潜伏期、P1潜伏期、波间期、振幅等参数差异均无统计学意义(P值均>0.05)。结论突聋患者在耳蜗受损的同时可以伴有椭圆囊及前庭上神经传导功能障碍,这种功能障碍可以通过oVEMP检测进行客观评估。
Objective To report the response rate and characteristics of various parameters of ocular vestibular evoked myogenic potentials in patients with sudden sensorineural hearing loss(SSHL).Methods Thirty six cases of unilateral SSHL examined between October 2014 and March 2015 were included as the study group.Twenty five age-and gender-matched normal subjects were recruited as the control group.Both patients and normal subjects underwent conventional air conduction ocular vestibular evoked myogenic potential(oVEMP) tests in bilateral ears.The results were compared between the affected and contralateral ears and with the normal controls.Results oVEMPs were elicited in 16 affected ears(44.4%),19 contralateral ears(52.7%) and 50 normal ears(100%)(P<0.05).oVEMP parameters(N1 latency,P1 latency,latency intervals and amplitudes) were not significantly different among the groups(P>0.05).Conclusions The utricle and superior vestibular nerves may be damaged in SSHL patients.Such damages may be monitored objectively by oVEMP examinations.
Objective To report the response rate and characteristics of various parameters of ocular vestibular evoked myogenic potentials in patients with sudden sensorineural hearing loss(SSHL).Methods Thirty six cases of unilateral SSHL examined between October 2014 and March 2015 were included as the study group.Twenty five age-and gender-matched normal subjects were recruited as the control group.Both patients and normal subjects underwent conventional air conduction ocular vestibular evoked myogenic potential(oVEMP) tests in bilateral ears.The results were compared between the affected and contralateral ears and with the normal controls.Results oVEMPs were elicited in 16 affected ears(44.4%),19 contralateral ears(52.7%) and 50 normal ears(100%)(P<0.05).oVEMP parameters(N1 latency,P1 latency,latency intervals and amplitudes) were not significantly different among the groups(P>0.05).Conclusions The utricle and superior vestibular nerves may be damaged in SSHL patients.Such damages may be monitored objectively by oVEMP examinations.
引文
1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头颈外科分会.突发性聋诊断和治疗指南(2015).中华耳鼻咽喉头颈外科杂志.2015.50(6):443-447.Chinese Journal of Otorhinolaryngology Head and Neck Surgery editorial committee.Chinese medical association of Otorhinolaryngology Head and Neck surgery branch.Sudden sensorineural hearing loss diagnosis and treatment guidelines(2015).Chinese Journal of Otorhinolaryngology Head and Neck Surgery.2015,50(6):443-447.
2李婧,杨旭,吴子明.眼源性前庭诱发肌源性电位.中华耳科学杂志.2014,12(2):231-234.Jing Li,Xu Yang,Ziming Wu.Ocular vestibular evoked myogenic potential.Chinese Journal of Otology,2014,12(2):231-234.
3 Welgampola(2008)Evoked potential testing in neuro-otology.Curr Opin Neurol 21:29-35.
4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.临床耳鼻咽喉头颈外科杂志.2015.29(1):5-8.Daogong Zhang,Zhaoming Fan.The clinical application and significance of vestibular fuction tests in the diagnosis of vertigo disease.Clinical Journal of Otorhinolaryngol Head and Neck Surgery.2015,29(1):5-8.
5 Rauch SD.Idiopathic sudden sensoreinerual hearing loss.New Engl L Med.2008,359(8):833-840.
6许教远,区永康,郑亿庆,等.突发性聋患者前庭功能分析.听力学及言语疾病杂志.2014.22(2):135-138.Jiaoyuan Xu,Yongkang Qu,Yiqing Zheng.et al.Analysis of vestibular function in patients with sudden deafness.Journal of Audiology and Speech Pathology.2014,22(2):135-138.
7张青,胡娟,许信达,等.突发性聋患者前庭耳石器传导通路功能的客观评价.中华耳鼻咽喉头颈外科杂志.2013.48(5):389-393.Qing Zhangjuan Hu,Xingda Xu,et al.Objective evaluation of otolithic end organs in sudden sensorineural hearing loss patients.Chinese Journal of Otorhinolaryngology Head and Neck Surgery.2013,48(5):389-393.
8牛晓蓉,张青,韩鹏,等.不伴眩晕的突发性感音神经性耳聋患者隐匿的前庭机能障碍研究.四川大学学报(医学版).2015.46(3):426-430.Xiaorong Niu,Qing Zhang,Peng Han,et al.Vestibular dysfunctionin patients with sudden sensorineural hearing loss without vertigo.J Sichuan Univ(Med Sci Edi).2015,46(3):426-430.
9张青,胡娟,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.中华耳鼻咽喉头颈外科杂志.2014,49(11):897-901.Qing Zhangjuan Hu,Xiaorong Niu,et al.Effects of aging on air-conducted sound elicited ocular vestibular-evoked myogenic potential and cervical vestibular-evoked myogenic potential.Chinese Journal of Otorhinolaryngology Head and Neck Surgery.2014,49(11):897-901.
10谢溯江,贾宏博,毕红哲,等.健康飞行员与飞行学员气导声诱发的在眼外肌上记录的前庭诱发肌源性电位.中华耳科学杂志.2011,9(1):4-7.Sujiang Xie,Hongbo Jia,Hongzhe Bi,et al.Ocular vestibular evoked myogenic potentials(oVEMPs)in healthy Chinese Air Force pilots and student piolots.Chinese Journal of Otology.201 l,9(1):4-7.
11 Nagai N1.Ogavva Y,Hagiwara A,et al.Ocular vestibular evoked myogenic potentials induced by bone-conducted vibration in patients with unilateral inner ear disease.Acta Otolaryngol.2014,134:151-158.
2李婧,杨旭,吴子明.眼源性前庭诱发肌源性电位.中华耳科学杂志.2014,12(2):231-234.Jing Li,Xu Yang,Ziming Wu.Ocular vestibular evoked myogenic potential.Chinese Journal of Otology,2014,12(2):231-234.
3 Welgampola(2008)Evoked potential testing in neuro-otology.Curr Opin Neurol 21:29-35.
4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.临床耳鼻咽喉头颈外科杂志.2015.29(1):5-8.Daogong Zhang,Zhaoming Fan.The clinical application and significance of vestibular fuction tests in the diagnosis of vertigo disease.Clinical Journal of Otorhinolaryngol Head and Neck Surgery.2015,29(1):5-8.
5 Rauch SD.Idiopathic sudden sensoreinerual hearing loss.New Engl L Med.2008,359(8):833-840.
6许教远,区永康,郑亿庆,等.突发性聋患者前庭功能分析.听力学及言语疾病杂志.2014.22(2):135-138.Jiaoyuan Xu,Yongkang Qu,Yiqing Zheng.et al.Analysis of vestibular function in patients with sudden deafness.Journal of Audiology and Speech Pathology.2014,22(2):135-138.
7张青,胡娟,许信达,等.突发性聋患者前庭耳石器传导通路功能的客观评价.中华耳鼻咽喉头颈外科杂志.2013.48(5):389-393.Qing Zhangjuan Hu,Xingda Xu,et al.Objective evaluation of otolithic end organs in sudden sensorineural hearing loss patients.Chinese Journal of Otorhinolaryngology Head and Neck Surgery.2013,48(5):389-393.
8牛晓蓉,张青,韩鹏,等.不伴眩晕的突发性感音神经性耳聋患者隐匿的前庭机能障碍研究.四川大学学报(医学版).2015.46(3):426-430.Xiaorong Niu,Qing Zhang,Peng Han,et al.Vestibular dysfunctionin patients with sudden sensorineural hearing loss without vertigo.J Sichuan Univ(Med Sci Edi).2015,46(3):426-430.
9张青,胡娟,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.中华耳鼻咽喉头颈外科杂志.2014,49(11):897-901.Qing Zhangjuan Hu,Xiaorong Niu,et al.Effects of aging on air-conducted sound elicited ocular vestibular-evoked myogenic potential and cervical vestibular-evoked myogenic potential.Chinese Journal of Otorhinolaryngology Head and Neck Surgery.2014,49(11):897-901.
10谢溯江,贾宏博,毕红哲,等.健康飞行员与飞行学员气导声诱发的在眼外肌上记录的前庭诱发肌源性电位.中华耳科学杂志.2011,9(1):4-7.Sujiang Xie,Hongbo Jia,Hongzhe Bi,et al.Ocular vestibular evoked myogenic potentials(oVEMPs)in healthy Chinese Air Force pilots and student piolots.Chinese Journal of Otology.201 l,9(1):4-7.
11 Nagai N1.Ogavva Y,Hagiwara A,et al.Ocular vestibular evoked myogenic potentials induced by bone-conducted vibration in patients with unilateral inner ear disease.Acta Otolaryngol.2014,134:151-158.