山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (5): 33-38.doi: 10.6040/j.issn.1673-3770.1.2020.075

• 临床研究 • 上一篇    下一篇

全聋型突发性耳聋患者的预后与前庭症状及前庭功能关系的回顾性分析

吴悔,梁敏,陈建勇,张勤,李姝娜,郑贵亮,何景春,陈向平,杨军   

  1. 吴悔, 梁敏, 陈建勇, 张勤, 李姝娜, 郑贵亮, 何景春, 陈向平, 杨军上海交通大学医学院附属新华医院 耳鼻咽喉头颈外科/上海交通大学医学院 耳科学研究所/上海市耳鼻疾病转化医学重点实验室, 上海 200092
  • 收稿日期:2020-07-31 出版日期:2020-09-20 发布日期:2020-11-17
  • 作者简介:吴悔、梁敏,共同第一作者
  • 基金资助:
    国家自然科学基金(81800903);上海交通大学医工交叉重点项目(ZH2018ZDA11);上海交通大学医学院附属新华医院院级临床研究培育基金项目(17CSK03,18JXO04)

Relationship between prognosis and vestibular symptoms/function in patients with unilateral profound sudden sensorineural hearing loss: A retrospective analysis

To analyze the relationship between vestibular symptoms and function and hearing outcomes in patients with unilateral profound sudden sensorineural hearing loss(SSNHL). MethodsA retrospective analysis of 52 patients with unilateral profound SSNHL was performed. Vestibular symptoms and the results of ocular vestibular evoked myogenic potential(oVEMP), cervical vestibular evoked myogenic potential(cVEMP), video head impulse test(vHIT), and caloric test were analyzed to observe the relationship between hearing outcomes and vestibular symptoms and function. ResultsOf 52 patients with unilateral profound SSNHL, there was a significant difference between the patients with and without vestibular symptoms, patients with vestibular dysfunction, and those with normal vestibular function. Patients with abnormal oVEMP, cVEMP, vHIT, and caloric test results showed a lower total effective rate. In contrast, patients with normal results in all four tests had a higher hearing recovery. ConclusionPatients with unilateral profound SSNHL with abnormal vestibular dysfunction and symptoms had a poor curative effect. Conversely, those with normal oVEMP, cVEMP, vHIT, and caloric test results had better chances of hearing recovery. Abnormal vestibular function suggests more extensive and severe inner ear lesions in patients with unilateral profound SSNHL.   

  1. Key words: Sudden sensorineural hearing loss;
    Vestibular function;
    Ocular vestibular evoked myogenic potential;
    Cervical vestibular evoked myogenic potential;
    Video head pulse test;
    Cold and hot test
  • Received:2020-07-31 Online:2020-09-20 Published:2020-11-17

摘要: 目的 探讨全聋型突发性耳聋患者的预后与前庭症状及前庭功能的关系。 方法 回顾性分析52例单侧全聋型突发性耳聋患者的前庭症状,以及眼肌前庭诱发肌源性电位(oVEMP)、颈肌前庭诱发肌源性电位(cVEMP)、视频头脉冲试验(vHIT)和冷热试验结果,观察这些患者的听力结果与前庭症状及前庭功能的关系。 结果 在52例单侧全聋型突发性耳聋患者中,有前庭症状、前庭功能异常的全聋型患者与无前庭症状者、功能正常者相比疗效差异有统计学意义。oVEMP、cVEMP、vHIT和冷热试验四项结果异常的全聋型患者显示出更低的治疗总有效率,oVEMP、cVEMP、vHIT和冷热试验正常的突发性耳聋患者有更高的听力恢复数值。 结论 有前庭症状、前庭功能异常的全聋型突发性耳聋患者疗效较差,oVEMP、cVEMP、vHIT和冷热试验正常的全聋型突发性耳聋患者有更好的听力恢复。前庭功能异常提示突发性聋患者的内耳病变范围较大、程度较重。

关键词: 突发性耳聋, 前庭功能, 眼肌前庭诱发肌源性电位, 颈肌前庭诱发肌源性电位, 视频头脉冲试验, 冷热试验

Abstract: Objective To analyze the relationship between vestibular symptoms and function and hearing outcomes in patients with unilateral profound sudden sensorineural hearing loss(SSNHL). Methods A retrospective analysis of 52 patients with unilateral profound SSNHL was performed. Vestibular symptoms and the results of ocular vestibular evoked myogenic potential(oVEMP), cervical vestibular evoked myogenic potential(cVEMP), video head impulse test(vHIT), and caloric test were analyzed to observe the relationship between hearing outcomes and vestibular symptoms and function. Results Of 52 patients with unilateral profound SSNHL, there was a significant difference between the patients with and without vestibular symptoms, patients with vestibular dysfunction, and those with normal vestibular function. Patients with abnormal oVEMP, cVEMP, vHIT, and caloric test results showed a lower total effective rate. In contrast, patients with normal results in all four tests had a higher hearing recovery. Conclusion Patients with unilateral profound SSNHL with abnormal vestibular dysfunction and symptoms had a poor curative effect. Conversely, those with normal oVEMP, cVEMP, vHIT, and caloric test results had better chances of hearing recovery. Abnormal vestibular function suggests more extensive and severe inner ear lesions in patients with unilateral profound SSNHL.

Key words: Sudden sensorineural hearing loss, Vestibular function, Ocular vestibular evoked myogenic potential, Cervical vestibular evoked myogenic potential, Video head pulse test, Cold and hot test

中图分类号: 

  • R764.3
[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学分会小儿学组. 儿童中耳炎诊断和治疗指南(草案)[J]. 中华耳鼻咽喉头颈外科杂志, 2008, 43(12): 884-885. doi:10.3321/j.issn:1673-0860.2008.12.002. Editorial Board of Chinese Journal of Otorhinolary Head and Neck Surgery, Pediatric Division, Chinese Otorhinolaryngology Head and Neck Surgery Society of Chinese Medical Association. Draft of guideline for the diagnosis and treatment of pediatric otitis media[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2008, 43(12): 884-885. doi:10.3321/j.issn:1673-0860.2008.12.002.
[2] Nakashima T, Yanagita N. Outcome of sudden deafness with and without Vertigo[J]. Laryngoscope, 1993, 103(10): 1145-1149. doi:10.1288/00005537-199310000-00012.
[3] Shaia FT, Sheehy JL. Sudden sensori-neural hearing impairment: a report of 1, 220 cases[J]. Laryngoscope, 1976, 86(3): 389-398. doi:10.1288/00005537-197603000-00008.
[4] Mattox DE, Simmons FB. Natural history of sudden sensorineural hearing loss[J]. Ann Otol Rhinol Laryngol, 1977, 86(4): 463-480. doi:10.1177/000348947708600406.
[5] Wilson WR, Laird N, Kavesh DA. Electronystagmographic findings in idiopathic sudden hearing loss[J]. Am J Otolaryngol, 1982, 3(4): 279-285. doi:10.1016/s0196-0709(82)80067-7.
[6] Yu H, Li H. Association of Vertigo with hearing outcomes in patients with sudden sensorineural hearing loss: a systematic review and meta-analysis[J]. JAMA Otolaryngol Head Neck Surg, 2018, 144(8): 677-683. doi:10.1001/jamaoto.2018.0648.
[7] Liu J, Zhou RH, Liu B, et al. Assessment of balance and vestibular functions in patients with idiopathic sudden sensorineural hearing loss[J]. J Huazhong Univ Sci Technolog Med Sci, 2017, 37(2): 264-270. doi:10.1007/s11596-017-1726-8.
[8] Ben-David J, Luntz M, Podoshin L, et al. Vertigo as a prognostic sign in sudden sensorineural hearing loss[J]. Int Tinnitus J, 2002, 8(2): 127-128.
[9] Oiticica J, Bittar RS, Castro CC, et al. Contribution of audiovestibular tests to the topographic diagnosis of sudden deafness[J]. Int Arch Otorhinolaryngol, 2013, 17(3): 305-314. doi:10.7162/s1809-977720130003000011.
[10] Park Seung-Wan Jung Chung-Ku Rhee Hyun-Min. Vestibular diagnosis as prognostic indicator in sudden hearing loss with Vertigo[J]. Acta Oto-Laryngol, 2001, 121(533): 80-83. doi:10.1080/oto.121.533.80.83.
[11] 张青, 许信达, 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[J]. 中华耳鼻咽喉头颈外科杂志, 2014, 49(11): 897-901. doi:10.3760/cma.j.issn.1673-0860.2014.11.005. ZHANG Qing, XU Xinda, NIU Xiaorong, et al. Effects of aging on air-conducted sound elicited ocular vestibular-evoked myogenic potential and cervical vestibular-evoked myogenic potential[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2014, 49(11): 897-901. doi:10.3760/cma.j.issn.1673-0860.2014.11.005.
[12] Ben-David J, Luntz M, Podoshin L, et al. Vertigo as a prognostic sign in sudden sensorineural hearing loss[J]. Int Tinnitus J, 2002, 8(2): 127-128.
[13] Korres S, Stamatiou GA, Gkoritsa E, et al. Prognosis of patients with idiopathic sudden hearing loss: role of vestibular assessment[J]. J Laryngol Otol, 2011, 125(3): 251-257. doi:10.1017/s0022215110002082.
[14] You TZ, Wang SJ, Young YH. Registering grades of sudden deafness to predict the hearing outcome via an inner-ear test battery[J]. Int J Audiol, 2014, 53(3): 153-158. doi:10.3109/14992027.2013.851798.
[15] Sokolov M, Gordon KA, Polonenko M, et al. Vestibular and balance function is often impaired in children with profound unilateral sensorineural hearing loss[J]. Hear Res, 2019, 372: 52-61. doi:10.1016/j.heares.2018.03.032.
[16] Arbusow V, Schulz P, Strupp M, et al. Distribution of Herpes simplex virus type 1 in human geniculate and vestibular ganglia: Implications for vestibular neuritis[J]. Ann Neurol, 1999, 46(3): 416-419. doi:10.1002/1531-8249(199909)46:3416::aid-ana20>3.0.co;2-w.
[17] Hong SM, Byun JY, Park CH, et al. Saccular damage in patients with idiopathic sudden sensorineural hearing loss without Vertigo[J]. Otolaryngol-Head Neck Surg, 2008, 139(4): 541-545. doi:10.1016/j.otohns.2008.07.003.
[18] Fujimoto C, Egami N, Kinoshita M, et al. Involvement of vestibular organs in idiopathic sudden hearing loss with vertigo: an analysis using oVEMP and cVEMP testing[J]. Clin Neurophysiol, 2015, 126(5): 1033-1038. doi:10.1016/j.clinph.2014.07.028.
[19] Hou L, Chen T, Xu K, et al. Evaluation of the injured range of vestibular superior and inferior nerves in sudden deafness patients with Vertigo using video head impulse test[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2015, 50(9): 718-723.[PubMed]
[20] van de Berg R, Rosengren S, Kingma H. Laboratory examinations for the vestibular system[J]. Curr Opin Neurol, 2018, 31(1): 111-116. doi:10.1097/wco.0000000000000526.
[21] Alhabib S, Saliba I. Video head impulse test: a review of the literature[J]. Eur Arch Otorhinolaryngol,2017,274(3):1215-1222. doi: 10.1007/s00405-016-4157-4. Epub 2016 Jun 21.
[22] Bartolomeo M, Biboulet R, Pierre G. et al. Value of the video head impulse test in assessing vestibular deficits following vestibular neuritis[J]. Eur Arch Otorhinolaryngol,2014,271(4):681-688. doi: 10.1007/s00405-013-2451-y. Epub 2013 Mar 29.
[23] 高林溪, 林颖, 邱建华. 视频头脉冲试验临床研究进展[J]. 听力学及言语疾病杂志, 2015, 23(5): 554-558. doi:10.3969/j.issn.1006-7299.2015.05.028.
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