山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (5): 20-26.doi: 10.6040/j.issn.1673-3770.1.2020.073

• 临床研究 • 上一篇    下一篇

外耳道耳蜗电图对梅尼埃病患者的诊断价值

何白慧,张帆,孙夏雨,陈建勇,王璐,李姝娜,陈向平,杨军   

  1. 何白慧, 张帆, 孙夏雨, 陈建勇, 王璐, 李姝娜, 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:2020-08-03 发布日期:2020-11-17
  • 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)

Diagnostic value of electrocochleography using external auditory canal electrode in patients with Menieres disease

  • Received:2020-08-03 Published:2020-11-17

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摘要： 目的 探讨外耳道耳蜗电图对于梅尼埃病患者的诊断价值。 方法 对确诊梅尼埃病的58例患者(60耳),采用外耳道铜箔片电极完成耳蜗电图检查。采集患者的病例信息、耳蜗电图检查结果、纯音测听及内耳膜迷路MRI钆造影结果,同时招募40例正常志愿者做外耳道耳蜗电图检查对照。评估耳蜗电图检出率、总和电位(SP)和听神经动作电位(AP)的振幅比(SP/AP)、两者面积比(Asp/Aap)、潜伏期及各波时长,其中Asp/Aap采用改进后的计算方式。采用t检验及Mann-Whitney U检验分析比较梅尼埃病患耳与单侧罹患者对侧耳及正常对照耳之间各参数指标的差异。分析Asp/Aap与患者病程、发病频率、听力分期及MRI显示的积水程度的相关性。 结果 60耳中46耳引出耳蜗电图(76.67%),单侧罹患者对侧耳及正常对照均引出。使用受试者工作特征曲线(ROC)得出外耳道耳蜗电图SP/AP及Asp/Aap的最佳截点分别为0.38及2.42,SP/AP曲线下面积(AUC)为0.920,而Asp/Aap的AUC为0.985,说明使用面积比的诊断价值更高。患耳SP/AP、Asp/Aap及SP时长较单侧罹患者对侧耳及正常对照耳显著升高,患耳SP/AP与疾病病程及分期相关,SP/AP、Asp/Aap均与MRI显示的耳蜗积水程度相关,而前庭积水程度仅与Asp/Aap相关。 结论 外耳道电极耳蜗电图的振幅比及面积比均在一定程度上反映病程及内耳积水程度。外耳道耳蜗电图对梅尼埃病的临床诊断有一定辅助意义。

关键词: 外耳道耳蜗电图, 振幅比, 面积比, 梅尼埃病, 内耳积水

Abstract: Objectives This study was designed to evaluate the diagnostic value of extra-tympanic electrocochleography(ET-ECochG)in definite Ménières disease(MD)patients. Methods Fifty-eight definite MD patients(60 ears)underwent ET-ECochG using bronze foil electrodes. The medical history, as well as pure tone audiometry, ET-ECochG, and 3D FLAIR MRI data of each patient were collected. Meanwhile, forty healthy volunteers were enrolled as controls. The amplitudes, latencies, and durations of SP and AP, the SP/AP amplitude ratio(SP/AP), and the area ratio of SP/AP(Asp/Aap)were collected. An adjusted calculation method for Asp/Aap was proposed. The differences among the ET-ECochG results of the definite MD ears, contralateral asymptomatic ears, and normal ears were analyzed using the t-test and the Mann-Whitney U test. The associations of Asp/Aap of ET-ECochG with the clinical history, pure tone audiometry, and endolymphatic hydrops evaluated via MRI were analyzed. Results ET-ECochG was identified in 46 of 60 ears(76.67%). Using the receiver operating characteristic(ROC)curve, the optimal cutoff points of SP/AP and Asp/Aap were 0.38 and 2.42, respectively. The area under the ROC curve(AUC)of Asp/Aap(0.985)was higher than the AUC of SP/AP(0.920). The ET-ECochG results of the definite MD ears, including SP/AP, Asp/Aap, and SP duration, were significantly higher than those of the contralateral asymptomatic ears and normal ears(p<0.05). The duration and disease stages of MD were significantly associated with SP/AP. The degree of endolymphatic hydrops of the cochlea was correlated with SP/AP and Asp/Aap, whereas the degree of vestibular hydrops only correlated with Asp/Aap. Conclusion SP/AP and Asp/Aap may be indicative of the degree of endolymphatic hydrops. Thus, ET-ECochG is useful for the clinical diagnosis of MD.

Key words: Extra-tympanic electrocochleography, Amplitude ratio, Area ratio, Menieres disease, Endolymphatic hydrops

中图分类号: 

  • R764.43
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