前庭试验组合在听神经病患者前庭功能评估中的应用  

Application of Vestibular Test Battery in Assessment of Vestibular Function in Patients with Auditory Neuropathy

作　　者：熊芬 谢林怡[1,2] 药蓉 兰兰[2] 王秋菊 刘志成[1] XIONG Fen;XIE Linyi;YAO Rong;LAN Lan;WANG Qiuju;LIU Zhicheng(Capital Medical University,College of biotechnology,Beijing 100069,China.;College of Otolaryngology Head and Neck Surgery,Chinese PLA General Hospital,Beijing100853,China.National Clinical Research Center for Otolaryngologic Diseases;Department of Otolaryngology,The First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China.)

机构地区：[1]首都医科大学生物医学工程学院,北京100069 [2]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,北京100853 [3]山西医科大学第一医院耳鼻喉科,太原030001

出　　处：《中华耳科学杂志》2022年第2期199-204,共6页Chinese Journal of Otology

基　　金：国家自然科学基金重点项目(81830028),国家自然科学基金青年项目(81900951,81900950),国家自然科学基金面上项目(82171130);军队医学科技青年培育计划孵化项目(19QNP058,21QNPY100);军队后勤科研计生专项(19JSZ14);北京市自然科学基金青年项目(7204312);国家重点研发计划“主动健康和老龄化科技应对”重点专项(2020YFC2005200&2020YFC2005201);解放军总医院医疗大数据分析及应用研究(2019MBD-005)联合资助~。

摘　　要：目的 本研究旨在探究是否可以通过使用多种前庭检测项目的组合来确定听神经病(AN)患者前庭受累情况。方法 本研究收集了30名听神经病患者(AN研究组)和30名健康受试者(对照组)。30名AN患者均接受了颈肌前庭诱发肌源性电位(cVEMP)和眼肌前庭诱发肌源性电位(oVEMP)测试;30名中的20名患者接受了双温试验(CT)测试和视频头脉冲试验(vHIT)检查。对照组均接受了cVEMP和oVEMP测试;30名中的20名健康受试者接受了CT测试;30名中的15名健康受试者接受了vHIT检查。结果 (1)AN患者的VEMPs异常率与对照组存在显著差异,oVEMP和cVEMP异常率之间没有发现显著差异。AN患者cVEMP和oVEMP的引出率较低(33.3%和41.7%),部分AN患者VEMPs引出但存在振幅、潜伏期、不对称比的异常。(2)90%AN患者的双温试验结果正常;(3)AN患者vHIT中6个半规管的异常率均显著高于正常对照组;(4)cVEMP、vHIT异常率与听力损失程度无显著相关性。结论 多数AN患者在表现出听力下降、言语识别率低的同时存在前庭损伤,耳石器-前庭神经传导通路和各半规管均可受累,球囊-前庭下成分与椭圆囊-前庭上成分累及概率相当,半规管高频功能受累概率大于低频。前庭试验组合可以用来反映AN患者前庭受累的状态和程度。Objective This study aims to determine whether a vestibular test battery can be used to assessment the vestibular involvement in patients with auditory neuropathy(AN). Methods Thirty patients with AN(study group)and 30 normal subjects(control group) were included in this prospective study. Patients in the study group underwent cervical muscle vestibular evoked myogenic potential(cVEMP) and ocular muscle vestibular evoked myogenic potential(oVEMP) tests(n=30) and caloric test(CT)(n=20) and video head impulse test( vHIT)(n=20). Subjects in the control group also underwent cVEMP and oVEMP tests(n=30), caloric test(n=20) and video head impulse test(n=15). Results The rate of VEMP abnormalities was significantly different between the study and control groups, but not between the two VEMP modalities. AN patients were less likely to exhibit cVEMPs(33.3%) or oVEMPs(41.7%), with some also demonstrating abnormal VEMP thresholds, latencies, and/or amplitudes.(2) CT test results were normal in 90% of patients with auditory neuropathy.(3) Significant differences were seen with vHIT results between the study and control groups.(4) VEMP and vHIT results were not correlated to the degree of hearing loss. Conclusion Most AN patients show vestibular damage in addition to hearing loss and poor speech recognition. The otolith-vestibular nerve conduction pathway and semicircular canals can be involved, with high frequency function of the semicircular canal more likely to be compromised than low frequency function. The vestibular test battery can be used to assessment the level of vestibular involvement in patients with AN.

关 键 词：听神经病 前庭肌源诱发电位 前庭损伤 

分 类 号：R764[医药卫生—耳鼻咽喉科]