双侧梅尼埃病患者的听前庭功能特点分析  

Characteristics of the auditory and vestibular function in patients with bilateral Ménière’s disease

作　　者：高云[1] 陈元星 李健[1] 张清华 周玲玲[1] 孙勍[1] 王辉兵[1] 王恩彤 石丽亚 单希征 孙悍军[1] Gao Yun;Chen Yuanxing;Li Jian;Zhang Qinghua;Zhou Lingling;Sun Qing;Wang Huibing;Wang Entong;Shi Liya;Shan Xizheng;Sun Hanjun(Department of Otolaryngology-Head and Neck Surgery,The Third Medical Center of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第三医学中心耳鼻咽喉头颈外科解放军总医院耳鼻咽喉头颈外科医学部国家耳鼻咽喉疾病临床医学研究中心,北京100039 [2]北京电力医院耳鼻咽喉头颈外科

出　　处：《北京医学》2020年第9期824-827,共4页Beijing Medical Journal

基　　金：解放军总医院第三医学中心院级临床创新预研课题(WZ2016002)。

摘　　要：目的分析双侧梅尼埃病(bilateral Meniere’s disease, BMD)患者的听力及前庭功能特点,指导临床治疗方案的选择。方法选取2017年7月至2019年6月解放军总医院第三医学中心收治的23例BMD患者,对其起病情况、纯音听阈、临床分期、温度试验、速度阶梯试验、颈源性前庭诱发肌源性电位(cervical vestibular evoked myogenic potential, cVEMP)等结果进行回顾性分析。结果 23例患者中,双耳同时发病组8例,双耳先后发病组15例;发病年龄15~67岁,平均43岁。病程2~60年,平均18年;双耳先后发病组先发耳较后发耳早发病平均为13.2年(最短1.5年,最长39.5年)。纯音听阈:双耳先后发病组的先发耳平均听阈75.0 dBHL,后发耳平均听阈56.8 dBHL,两者相差18.2 dBHL;双耳同时发病组的听力较差耳比听力较好耳听阈高14.0 dBHL。BMD(23例、46耳)听力分期为二期3耳(6.5%),三期28耳(60.9%),四期15耳(32.6%)。温度试验:双侧均减弱或低下9例,单侧减弱或低下8例,双侧均正常6例。速度阶梯试验:双侧对称15例,双侧不对称8例。12例患者行c-VEMP检测,3例未引出,其余9例正常。结论 BMD可导致双侧听力及前庭功能的严重受损,明显影响患者的日常生活;双侧MD终末期尚无特别理想的治疗方案,在MD早期阶段需足够重视,尽量避免向终末期发展。Objective To analyze the characteristics of auditory and vestibular function in bilateral Ménière’s disease(BMD). Methods The feature of onset, pure tone threshold, clinical stage, caloric test, velocity step test and cervical vestibular evoked myogenic potential of 23 patients with BMD were retrospectively analyzed. Results There were 8 cases of bilateral ear onset at the same time, and 15 cases of bilateral ear onset successively;the onset age was 15-67 years, with an average of 43 years. The course of Ménière’s disease(MD) was 2-60 years, with an average of 18 years. The course of the first onset ear was 1.5-39.5 years earlier than the latter one, the average was 13.2 years. In the group of bilateral ear onset successively,the average pure tone threshold of the first ear was 75 dBHL, and that of the latter one was 56.8 dBHL, with a difference of18.2 dBHL;in the group of bilateral ear onset at the same time, the pure tone threshold of the poor ear was 14.0 dBHL higher than that of the better one. Three ears(6.5%) were in BMD stageⅣ, 28 ears(60.9%) were in stage Ⅳ and 15 ears(32.6%) were in stage Ⅳ. Both sides of caloric test were weakened or decreased in nine cases, unilateral weakened or decreased in eight cases, and both sides were normal in six cases. By velocity step test, there were 15 cases in bilateral symmetry, eight cases in bilateral asymmetry. C-vemp was detected in 12 cases, three of them were negative, and nine of them were normal. Conclusions BMD can lead to severe impairment of bilateral auditory and vestibular function, which significantly affects the daily life of patients. There is no ideal treatment plan for BMD at the end stage, so adequate attention should be paid to the early stage of MD to avoid its development to the end stage.

关 键 词：梅尼埃病 听力 前庭功能 

分 类 号：R764.33[医药卫生—耳鼻咽喉科]