山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (5): 51-55.doi: 10.6040/j.issn.1673-3770.1.2020.083

• 临床研究 • 上一篇    

原发性良性阵发性位置性眩晕患者VEMP异常率的临床观察

陈建勇, 孙夏雨, 沈佳丽, 汪玮, 王璐, 贺宽, 张勤, 马孝宝, 沈敏, 陈向平, 杨军   

  1. 陈建勇, 孙夏雨, 沈佳丽, 汪玮, 王璐, 贺宽, 张勤, 马孝宝, 沈敏, 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:2020-08-20 发布日期:2020-11-17
  • 作者简介:陈建勇、孙夏雨,共同第一作者
  • 基金资助:
    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)

Abnormality rate of vestibular evoked myogenic potentials in patients with primary and recurrent benign paroxysmal positional vertigo: a clinical observation

This study aimed to compare the abnormality rate of vestibular evoked myogenic potentials(VEMPs)in patients with primary and recurrent benign paroxysmal positional vertigo(BPPV)and test the hypothesis that otolith dysfunction causes the recurrence of BPPV. MethodsCervical VEMP(cVEMP)and ocular VEMP(oVEMP)tests using air-conducted 500 Hz tone-burst stimuli were performed on 57 patients with unilateral primary BPPV(n=36)and recurrent BPPV(n=21)between June 2019 and May 2020. Abnormalities in cVEMP and oVEMP were compared between the primary and recurrent BPPV groups. Results(1) The differences in sex, the involved side, and canal between the primary and recurrent BPPV groups were not significant; however, the difference was statistically significant in terms of age; (2) Of the 57 BPPV patients, cVEMP or oVEMP was not elicited in 21 cases(36.84%)and 35 cases(61.40%), respectively. The abnormality rate of oVEMP was much higher(P<0.05); (3)Abnormal cVEMP was observed in 16 of 36(44.45%)and 5 of 21(23.81%)cases in the primary and recurrent BPPV groups, respectively. Abnormal oVMEP was observed in 19 of 36(52.79%)and 16 in 21(76.19%)patients in the primary and recurrent BPPV groups, respectively. Differences in the abnormality rates of cVMEP and oVMEP were not found between the primary and recurrent BPPV groups(P>0.05); (4) When the recurrent BPPV group was further divided into 2-times groups and ≥3-times group according to the recurrent frequency, there were also no statistical differences in the VEMP abnormality rate in these three groups(P>0.05). ConclusionThe results showed no significant difference in the abnormality rate of cVEMP and oVEMP between the primary BPPV and recurrent BPPV groups, indicating that the possible recurrent mechanism of primary BPPV still needs to be further studied.   

  1. Key words: Benign paroxysmal positional vertigo;
    Cervical vestibular evoked myogenic potential;
    Ocular VEMP;
    Primary;
    Recurrent
  • Received:2020-08-20 Published:2020-11-17

摘要: 目的 比较原发性初发和复发良性阵发性位置性眩晕(BPPV)患者的前庭诱发肌源性电位(VEMPs)特点,探索原发性BPPV屡次复发的可能发病机制。 方法 收集首次就诊即确诊为单侧原发性BPPV的患者57例,其中初发患者36例,复发患者21例。所有患者均进行气导声刺激条件下的颈肌VEMP(cVEMP)和眼肌VEMP(oVEMP)检查,对比分析初发组和复发组cVEMP和oVEMP结果的差异。 结果 (1)初发和复发BPPV组在性别、发病侧别及受累半规管均无统计学差异(P>0.05),年龄存在统计学差异(P<0.05);(2)57例BPPV患者中21例(36.84%)cVEMP异常,35例(61.40%)oVEMP异常,oVEMP异常率更高(P<0.05);分别对初发组中和复发组中的cVEMP和oVEMP异常率进行比较,结果显示两组oVEMP异常率更高,差异具有统计学意义(P<0.05);(3)初发BPPV组cVEMP异常有16例(44.45%),复发BPPV组异常有5例(23.81%);初发BPPV组oVEM异常有19例(52.79%),复发BPPV组中oVEMP异常有16例(76.19%);两组cVEMP和oVEMP异常率均无统计学差异(P>0.05);(4)复发2次组和复发3次以上组,与初发组进行VEMPs异常率比较显示三组间cVEMP及oVEMP异常率均无统计学差异(P>0.05)。 结论 原发性初发组和复发组BPPV患者的cVEMP和oVEMP异常率差异均无统计学意义,提示耳石器功能异常可能不是原发性BPPV患者反复复发的发病机制。

关键词: 良性阵发性位置性眩晕, 颈肌前庭诱发肌源性电位, 眼肌前庭诱发肌源性电位, 初发性, 复发性

Abstract: Objective This study aimed to compare the abnormality rate of vestibular evoked myogenic potentials(VEMPs)in patients with primary and recurrent benign paroxysmal positional vertigo(BPPV)and test the hypothesis that otolith dysfunction causes the recurrence of BPPV. Methods Cervical VEMP(cVEMP)and ocular VEMP(oVEMP)tests using air-conducted 500 Hz tone-burst stimuli were performed on 57 patients with unilateral primary BPPV(n=36)and recurrent BPPV(n=21)between June 2019 and May 2020. Abnormalities in cVEMP and oVEMP were compared between the primary and recurrent BPPV groups. Results (1) The differences in sex, the involved side, and canal between the primary and recurrent BPPV groups were not significant; however, the difference was statistically significant in terms of age; (2) Of the 57 BPPV patients, cVEMP or oVEMP was not elicited in 21 cases(36.84%)and 35 cases(61.40%), respectively. The abnormality rate of oVEMP was much higher(P<0.05); (3)Abnormal cVEMP was observed in 16 of 36(44.45%)and 5 of 21(23.81%)cases in the primary and recurrent BPPV groups, respectively. Abnormal oVMEP was observed in 19 of 36(52.79%)and 16 in 21(76.19%)patients in the primary and recurrent BPPV groups, respectively. Differences in the abnormality rates of cVMEP and oVMEP were not found between the primary and recurrent BPPV groups(P>0.05); (4) When the recurrent BPPV group was further divided into 2-times groups and ≥3-times group according to the recurrent frequency, there were also no statistical differences in the VEMP abnormality rate in these three groups(P>0.05). Conclusion The results showed no significant difference in the abnormality rate of cVEMP and oVEMP between the primary BPPV and recurrent BPPV groups, indicating that the possible recurrent mechanism of primary BPPV still needs to be further studied.

Key words: Benign paroxysmal positional vertigo, Cervical vestibular evoked myogenic potential, Ocular VEMP, Primary, Recurrent

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. 良性阵发性位置性眩晕诊断和治疗指南[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(3): 173-177.
[2] 邓巧媚, 张玥琦, 王巍, 等. 良性阵发性位置性眩晕与合并疾病的关联性分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 22-25.
[3] Steenerson RL, Cronin GW, Marbach PM. Effectiveness of treatment techniques in 923 cases of benign paroxysmal positional vertigo[J]. Laryngoscope, 2005, 115(2): 226-231.
[4] Sakaida M, Takeuchi K, Ishinaga H, et al. Long-term outcome of benign paroxysmal positional vertigo[J]. Neurology, 2003, 60(9): 1532-1534.
[5] Brandt T, Huppert D, Hecht J, et al. Benign paroxysmal positioning vertigo: a long-term follow-up(6-17 years)of 125 patients[J]. Acta Otolaryngol, 2006, 126(2):160-163.
[6] Papathanasiou ES, Straumann D. Why and when to refer patients for vestibular evoked myogenic potentials: A critical review[J]. Clin Neurophysiol, 2019, 130(9): 1539-1556.
[7] Choi SJ, Lee JB, Lim HJ, et al. Clinical Features of Recurrent or Persistent Benign Paroxysmal Positional Vertigo[J]. Otolaryngology-Head and Neck Surgery, 2012, 147(5): 919-924.
[8] Fife TD, Colebatch JG, Kerber KA, et al. Practice guideline: Cervical and ocular vestibular evoked myogenic potential testing: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology[J]. Neurology, 2017, 89(22): 2288-2296.
[9] Lee JD, Park MK, Lee BD, et al. Abnormality of cervical vestibular-evoked myogenic potentials and ocular vestibular-evoked myogenic potentials in patients with recurrent benign paroxysmal postitional vertigo[J]. Acta Otolaryngol, 2013, 133(2):150-153.
[10] Young YH. Vestibular evoked myogenic potentials: optimal stimulation and clinical application[J]. J Biomed Sci, 2006, 13(6):745-751.
[11] 陈太生, 王巍, 徐开旭, 等. 良性阵发性位置性眩晕及其诊断治疗的思考[J]. 山东大学耳鼻喉眼学报, 2019, 33(5), 1-5.
[12] Colebatch JG, Halmagyi GM, Skuse NF. Myogenic potentials generated by a click-evoked vestibulocollic reflex[J]. J Neurol Neurosurg Psychiatry, 1994, 57(2):190-197.
[13] Curthoys IS, Iwasaki S, Chihara Y, et al. The ocular vestibular-evoked myogenic potential to air-conducted sound; probable superior vestibular nerve origin[J]. Clin Neurophysiol, 2011, 122(3): 611-616.
[14] Xu H, Liang FY, Chen L, et al. Evaluation of the utricular and saccular function using oVEMPs and cVEMPs in BPPV patients[J]. J Otolaryngol Head Neck Surg, 2016, 45:12.
[15] Nakahara H, Yoshimura E, Tsuda Y, et al. Damaged utricular function clarified by oVEMP in patients with benign paroxysmal positional vertigo[J]. Acta Oto Laryngologica, 2013, 133(2):144-149.
[16] Gacek RR. Pathology of benign paroxysmal positional vertigo revisited[J]. Ann Otol Rhinol Laryngol, 2003,112: 574-582.
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