嗜酸粒细胞性中耳炎患者前庭功能的初步分析  

Preliminary analysis of vestibular function in patients with eosinophilic otitis media

作　　者：周月 王鹏军 王慧[1] 于栋祯[1] 陈正侬[1] 吴雅琴[1] 时海波[1] ZHOU Yue;WANG Peng-jun;WANG Hui;YU Dong-zhen;CHEN Zheng-nong;WU Ya-qin;SHI Hai-bo(Department of Otolaryngology-Head&Neck Surgery,Shanghai Sixth People's Hospital,Otolaryngology Institute,Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院耳鼻咽喉头颈外科,上海交通大学耳鼻咽喉头颈外科研究所,上海200233

出　　处：《上海交通大学学报（医学版）》2021年第7期910-914,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市教育委员会高峰高原学科建设计划(20152233);上海领军人才计划(2017062);上海交通大学医学院高水平地方高校创新团队(SSMU-ZLCX20180602)。

摘　　要：目的·探讨嗜酸粒细胞性中耳炎(eosinophilic otitis media,EOM)对患者前庭功能的影响。方法·收集8例确诊的EOM患者(EOM组)资料,另外纳入年龄、性别、病程匹配的16例慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)患者(CSOM组)、16例健康志愿者(对照组)进行比较。所有对象均进行纯音测听、声导抗、视频头脉冲试验(video head impulse test,vHIT)、前庭诱发肌源性电位(vestibular evoked myogenic potential,VEMP)、动态姿势描记图(dynamic posturography,DPG)检查,分析组间差异。结果·EOM组与对照组相比,听力损失类型的构成比差异有统计学意义(P=0.000),与CSOM组相比差异无统计学意义(P=0.892)。vHIT中EOM组水平半规管增益值与CSOM组相比差异有统计学意义(P=0.035),与对照组相比差异无统计学意义(P=0.220)。EOM组上、后半规管增益值与CSOM组、对照组相比差异均无统计学意义(P=0.807,P=0.971,P=0.683,P=0.610)。颈源性VEMP(cVEMP)检测与眼源性VEMP(oVEMP)检测中,EOM组的异常率均明显高于对照组(P=0.002,P=0.033);而与CSOM组相比差异均无统计学意义(P=0.631,P=0.352)。在cVEMP波形中,EOM组的P1、N1潜伏期较对照组显著延长(P=0.000,P=0.000),P1-N1振幅较对照组、CSOM组均显著降低(P=0.000,P=0.000)。在oVEMP波形中,EOM组的P1-N1振幅较对照组、CSOM组均显著降低(P=0.005,P=0.003)。DPG检测中,EOM组的总体平衡分(P=0.025)、视觉感觉分(P=0.017)、前庭感觉分(P=0.040)、视觉依赖分(P=0.006)均显著低于对照组;与CSOM组相比,EOM组的总体平衡分显著降低(P=0.024)。结论·与中性粒细胞介导的感染性中耳炎症相比,EOM倾向于导致更为严重的内耳神经毒性。由于前庭功能障碍具有代偿缓解的特性,EOM患者自身可能缺乏相应主诉,系统全面的前庭功能评估有助于揭示功能残障,进而开展针对性的康复治疗。Objective·To discuss the effect of eosinophilic otitis media(EOM)on vestibular function.Methods·Data of 8 EOM patients(EOM group)were collected.Additionally,16 cases of chronic suppurative otitis media(CSOM group)and 16 healthy volunteers(control group)matched with age,gender and course of disease were selected for comparison.All participants were monitored by pure-tone test,acoustic impedence,video head impulse test(vHIT),vestibular evoked muscular potential(VEMP),and dynamic posturography(DPG).And then,date of the three groups were analyzed.Results·Compared with the control group,there was a statistically significant difference in the composition ratio of the types of hearing loss in the EOM group(P=0.000),while there was no significant difference in the composition ratio between the EOM group and the CSOM group(P=0.892).In vHIT,the gain values of semicircular canals in the EOM group were significantly different from those of the CSOM group(P=0.035),without visible difference from those of the control group(P=0.220).The gain values of upper and posterior semicircular canals in the EOM group were not significantly different from those in both the CSOM group and control group(P=0.807,P=0.971,P=0.683,P=0.610).In cVEMP and oVEMP,the abnormal rate of the EOM group was significantly higher than that of the control group(P=0.002,P=0.033),while being compared with the CSOM group,there was no significant difference(P=0.631,P=0.352).In cVEMP,the incubation periods of P1 and N1 in the EOM group were significantly longer than those in the control group(P=0.000,P=0.000),and the amplitudes of P1-N1 in the EOM group were lower than those in the control group and CSOM group(P=0.000,P=0.000).In DPG,the composite score(P=0.025),visual score(P=0.017),vestibular score(P=0.040)and visual preference score(P=0.006)of the EOM group were significantly lower than those in the control group.And the composite score of the EOM group was also obviously lower than the CSOM group(P=0.024).Conclusion·EOM tends to lead to more severe inner

关 键 词：嗜酸粒细胞性中耳炎 前庭功能损害 内耳毒性 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]