突聋患者内耳MRI钆造影与cVEMP的相关性研究  

Gadolinium-Enhanced Inner-Ear MRI Imaging and cVEMP in IdiopathicSudden Sensorineural Hearing Loss Patients

作　　者：肖恒[1] 姚广南 张榕[1] 蔡德伦 叶胜难[1] 陈曦[2] 

机构地区：[1]福建医科大学附属第一医院耳鼻咽喉科 [2]福建医科大学附属第一医院耳鼻咽喉科研究所

出　　处：《中华耳科学杂志》2017年第5期503-509,共7页Chinese Journal of Otology

基　　金：福建省医学创新课题(2014-CX-24)资助~~

摘　　要：目的通过对单侧突发性耳聋患者进行纯音测听、内耳钆造影MRI检查、cVEMP检查以探讨突聋患者的可能发病机制及在突聋患者中膜迷路积水与cVEMP异常的相关性。方法根据纯音测听结果对65例单侧突发性耳聋患者分为低频组、高频组、平坦组、全聋组,进行内耳钆造影MRI及cVEMP检查,比较各个组间钆造影阳性率和cVEMP阳性率;按照钆造影结果分组,分别计算钆造影阳性组、阴性组的cVEMP阳性率。结果 65例患者中,低频组14人,钆造影阳性率35.7%(5/14),cVEMP阳性率50%(7/14);高频组11人,钆造影阳性率0(0/11),cVEMP阳性率9.1%(1/11);平坦组17人,钆造影阳性率17.6%(3/17),cVEMP阳性率35.3%(6/17);全聋组23人,钆造影阳性率13.0%(3/23),cVEMP阳性率43.5%(10/23);低频组、平坦组、全聋组两两之间的钆造影阳性率无明显差异性;各个频率两两之间cVEMP阳性率未存在完全性明显差异;钆造影阳性共11例,cVEMP阳性共24例。其中钆造影阳性组中cVEMP阳性率63.64%(7/11),钆造影阴性组中cVEMP阳性率31.48%(17/54),二者差值具有统计学意义(P‐0.05)。结论内耳钆造影MRI提示突发性耳聋目前仍是病因不明的疾病,膜迷路积水是低频型突发性聋的一种可能发病机制,而平坦型、全聋型突聋的膜迷路积水可能为内耳损伤后出现的一种病理结果;cVEMP可能在不同频率的突聋类型检出率无明显独特性,在一定程度上可能可以提示突发性聋患者存在膜迷路积水情况。Objective Pure tone audiometry, gadolinium-enhanced inner-ear MRI and c VEMP examination were used to study possible pathogenesis and correlation between endolymphatic hydrops(EH) and c VEMPs in idiopathic sudden sensorineural hearing loss(ISSHL). Methods Based on pure tone audiometry, 65 patients with unilateral ISSHL were categorized as having low frequency, high frequency, flat or total hearing loss. Gadolinium-enhanced inner-ear MRI and c VEMPs were performed and patients were also grouped according to their gadolinium-enhanced inner-ear MRI results and their c VEMP results analyzed. Results The rate of abnormal gadolinium-enhanced inner-ear MRI and the rate of abnormal c VEMPs were not statistically different among various types of ISSHL. The rate of abnormalc VEMPs was higher among ears with abnormal gadolinium-enhanced MRI than among those with normal gadoliniumenhanced inner-ear MRI. Conclusions EH may be responsible for low frequency ISSHL, while flat and total ISSHL may be the result of inner ear injury. Although c VEMPs may not be a specific index in various types of ISSHL, it may be considered to reflect the possibility of labyrinthine hydrops in ISSHL.

关 键 词：突发性耳聋 内耳钆造影磁共振 膜迷路积水 cVEMP 

分 类 号：R764[医药卫生—耳鼻咽喉科]