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

PDF (PC)

268

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
[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. 梅尼埃病诊断和治疗指南(2017)[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(3): 167-172. doi:10.3760/cma.j.issn.1673-0860.2017.03.002. Editorial Board of Chinese Journal of Otorhinolary, Society of Otorhinolaryngology Head and Neck Surge. Guideline of diagnosis and treatment of Meniere disease(2017)[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017, 52(3): 167-172. doi:10.3760/cma.j.issn.1673-0860.2017.03.002.
[2] Gibson WP. The clinical uses of electrocochleography[J]. Front Neurosci, 2017, 11: 274. doi:10.3389/fnins.2017.00274.
[3] Al-momani MO, Ferraro JA, Gajewski BJ, et al. Improved sensitivity of electrocochleography in the diagnosis of Menieres disease[J]. Int J Audiol, 2009, 48(11): 811-819. doi:10.3109/14992020903019338.
[4] 王藁浴, 谢艳, 周慧芳, 等. 耳蜗电图面积比对梅尼埃病不同时期的诊断价值[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(14): 1142-1145. doi:10.13201/j.issn.1001-1781.2016.14.014. WANG Gaoyu, XIE Yan, ZHOU Huifang, et al. The value of area curve ratio electrocochleography in diagnosis of Menieres disease during different periods[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2016, 30(14): 1142-1145. doi:10.13201/j.issn.1001-1781.2016.14.014.
[5] 雷艳, 康厚墉, 胡国华, 等. 耳蜗电图SP/AP面积比在梅尼埃病诊断中的应用研究[J]. 重庆医科大学学报, 2016, 41(6): 632-636. doi:10.13406/j.cnki.cyxb.000981. LEI Yan, KANG Houyong, HU Guohua, et al. Application of SP/AP area ratio of electrocochleography in the diagnosis of Menieres disease[J]. Journal of Chongqing Medical University, 2016, 41(6): 632-636. doi:10.13406/j.cnki.cyxb.000981.
[6] Eggermont JJ. Ups and Downs in 75 years of electrocochleography[J]. Front Syst Neurosci, 2017, 11: 2. doi:10.3389/fnsys.2017.00002.
[7] Lake AB, Stuart A. The effect of test, electrode, and rate on electrocochleography measures[J]. J Am Acad Audiol, 2019, 30(1): 41-53. doi:10.3766/jaaa.17081.
[8] Ayub A, Qi L, Nunez DA. A systematic review and meta-analysis of extratympanic electrocochleography in Ménières disease diagnosis[J]. Int J Audiol, 2019, 58(9): 533-540. doi:10.1080/14992027.2019.1606947.
[9] Bernaerts A, Vanspauwen R, Blaivie C, et al. The value of four stage vestibular Hydrops grading and asymmetric perilymphatic enhancement in the diagnosis of Menières disease on MRI[J]. Neuroradiology, 2019, 61(4): 421-429. doi:10.1007/s00234-019-02155-7.
[10] Oh KH, Kim KW, Chang J, et al. Can we use electrocochleography as a clinical tool in the diagnosis of Menieres disease during the early symptomatic period?[J]. Acta Otolaryngol, 2014, 134(8): 771-775. doi:10.3109/00016489.2014.907500.
[11] Mammarella F, Zelli M, Varakliotis T, et al. Is electrocochleography still helpful in early diagnosis of meniere disease?[J]. J Audiol Otol, 2017, 21(2): 72-76. doi:10.7874/jao.2017.21.2.72.
[12] Lamounier P, de Souza TSA, Gobbo DA, et al. Evaluation of vestibular evoked myogenic potentials(VEMP)and electrocochleography for the diagnosis of Ménières disease[J]. Braz J Otorhinolaryngol, 2017, 83(4): 394-403. doi:10.1016/j.bjorl.2016.04.021.
[13] Obeidat FS, Lewis Bell S. Comparing the sensitivity and specificity of cervical vestibular-evoked myogenic potentials and electrocochleography in the diagnosis of Menieres disease[J]. Int J Audiol, 2019, 58(11): 738-746. doi: 10.1080/14992027.2019.1627008.
[14] 许珉, 陈耔辰, 魏馨雨, 等. 前庭诱发肌源性电位、冷热试验和耳蜗电图在梅尼埃病诊断中的评估价值[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(8): 704-708. doi: 10.13201/j.issn.1001-1781.2019.08.006. XU Min, Chen Zichen, WEI Xinyu, et al. Evaluation of vestibular evoked myogenic potential, caloric test and cochlear electrogram in the diagnosis of Menieres disease[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2019, 33(8):704-708. doi: 10.13201/j.issn.1001-1781.2019.08.006.
[15] Zakaria MN, Nik Othman NA, Musa Z. Electrocochleographic recording in Asian adults: Preliminary normative data and demographic analyses[J]. J Otol, 2017, 12(1): 29-33. doi:10.1016/j.joto.2017.02.002.
[16] Grasel SS, de Oliveira Beck RM, Loureiro RSC, et al. Normative data for TM electrocochleography measures[J]. J Otol, 2017, 12(2): 68-73. doi:10.1016/j.joto.2017.04.005.
[17] Bramhall NF, Konrad-Martin D, McMillan GP, et al. Auditory brainstem response altered in humans with noise exposure despite normal outer hair cell function[J]. Ear Hear, 2017, 38(1): e1-e12. doi:10.1097/aud.0000000000000370.
[18] Gerenton G, Giraudet F, Djennaoui I, et al. Abnormal fast fluctuations of electrocochleography and otoacoustic emissions in Menières disease[J]. Hear Res, 2015, 327: 199-208. doi:10.1016/j.heares.2015.07.016.
[19] Redondo-Martínez J, Morant-Ventura A, Robledo-Aguayo D, et al. Extra-tympanic electrocochleography in a normal population. A descriptive study[J]. Acta Otorrinolaringologica Engl Ed, 2016, 67(5): 254-260. doi:10.1016/j.otoeng.2015.10.001.
[20] Hornibrook J. Tone burst electrocochleography for the diagnosis of clinically certain Menieres disease[J]. Front Neurosci, 2017, 11: 301. doi:10.3389/fnins.2017.00301.
[21] 王蕊, 单希征, 王恩彤, 等. 梅尼埃病耳蜗电图特征分析[J]. 北京医学, 2017, 39(8): 796-798. doi:10.15932/j.0253-9713.2017.08.013. WANG Rui, SHAN Xizheng, WANG Entong, et al. Characteristics of electrocochleography in Menieres disease[J]. Beijing Medical Journal, 2017, 39(8): 796-798. doi:10.15932/j.0253-9713.2017.08.013.
[22] Cebulla M, Stürzebecher E, Elberling C, et al. New clicklike stimuli for hearing testing[J]. J Am Acad Audiol, 2007, 18(9): 725-738. doi:10.3766/jaaa.18.9.2.
[23] Wu H. Endolymphatic Hydrops detected by 3-dimensional fluid-attenuated inversion recovery MRI following intratympanic injection of gadolinium in the asymptomatic contralateral ears of patients with unilateral ménières disease[J]. Med Sci Monit, 2015, 21: 701-707. doi:10.12659/msm.892383.
[24] 黄巧,尹时华. 内耳上皮钠通道、水通道蛋白与内淋巴代谢相关性的研究进展[J]. 山东大学耳鼻喉眼学报,2019, 33(4): 145-148. doi:10.6040/j.issn.1673-3770.0.2018.301. Huang Qiao YS. Correlation between endolymphatic hydrops and inner ear epithelial sodium channels and aquaporins[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 145-148. doi:10.6040/j.issn.1673-3770.0.2018.301.
[25] Li W, Lei Y, Zhu J, et al. Signs of electrocochleography on endolymphatic sac decompression for patients with Menieres Disease: Our experience in 12 patients[J]. Clin Otolaryngol, 2018, 43(3): 920-923. doi: 10.1111/coa.13047.
[1] 许嘉, 李欣, 陈雯婧, 高娟娟, 卢星星, 伊海金. 联合应用内淋巴囊减压和局部激素治疗难治性梅尼埃病的短期与长期疗效分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 17-21.
[2] 黄岚,高伟陈钢钢. 内耳疾病继发BPPV的发病机制和临床特征的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 108-113.
[3] 张瑶瑶,王海涛. 内耳钆造影磁共振成像技术在梅尼埃病诊疗中的应用[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 101-107.
[4] 刘宇鹏,梁敏,何景春,郑贵亮,李姝娜,张青,杨军. 梅尼埃病前庭功能分级的探讨[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 14-19.
[5] 刘宇鹏, 吴文瑾, 何景春, 郑贵亮, 张青, 杨军. 迷路后径路前庭神经切断术治疗难治性梅尼埃病75例[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 46-50.
[6] 韩朝, 丁娟. 中耳肌肉生理及病理[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 6-10.
[7] 王登元,陈智斌,王杪琳. 伴发梅尼埃病的良性阵发性位置性眩晕的临床特点[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 61-65.
[8] 侯小兵,任同力,张毅博. 69例梅尼埃病伴耳鸣的发病特点及影响因素[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 37-40.
[9] 刘旭晖,黄魏宁,孟曦曦,刘芳,陈敏,傅元,张晨,张媛媛. 梅尼埃病患者内耳内淋巴间隙的比值与正常受试者的比较[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 39-42.
[10] 张运波,习国平,靳红芳,王彩君. 非手术序列化治疗单侧梅尼埃病48例[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 73-76.
[11] 苏怡, 张革化, 曾祥丽. 早期梅尼埃病患者前庭诱发肌源性电位的特征[J]. 山东大学耳鼻喉眼学报, 2014, 28(4): 26-29.
[12] 菅慧蓉，于刚，陈刚，林乃芬，王海波. 绝经后梅尼埃病女性雌激素水平与听-前庭功能关系的研究[J]. 山东大学耳鼻喉眼学报, 2012, 26(2): 39-41.
[13] 于海洋， 孙丰林， 张增，王卫国. 鼻内镜下经咽鼓管鼓室内置管注药治疗梅尼埃病[J]. 山东大学耳鼻喉眼学报, 2011, 25(6): 64-.
[14] 吴佳欐1，陈文文1，罗禹2，童军1，邓亚新1，单良1，方旭华1. 突发聋和梅尼埃病鼓室灌注疗效与内耳MRI显影相关性[J]. 山东大学耳鼻喉眼学报, 2011, 25(4): 38-40.
[15] 赵晓燕,王建明,黄 安 . 前庭诱发肌源性电位对眩晕患者的诊断价值[J]. 山东大学耳鼻喉眼学报, 2008, 22(1): 43-45 .
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 杨长亮,黄治物,姚行齐,诸勇,孙艺 . 正常气骨导听性脑干反应及其应用[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 9 -13 .
[2] 曹忠良 . 颌面复合伤155例临床分析[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 89 -89 .
[3] 毕景云 . 鼻中隔矫正术后血肿的处理[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 90 -91 .
[4] 刘大昱,潘新良,雷大鹏,许风雷,张立强,栾信庸 . 梨状窝内侧壁癌的手术治疗[J]. 山东大学耳鼻喉眼学报, 2007, 21(1): 8 -11 .
[5] 楼正才 . 掌拳击伤鼓膜损伤机制及临床特点分析[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 188 -188 .
[6] 刘 艳,刘新义,王金平,李大健 . 后鼓室解剖结构测量观察及临床意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 218 -221 .
[7] 赵 敏,王守森,甄泽年,陈贤明,王茂鑫 . 鼻内镜联合显微镜行蝶窦及经蝶鞍区微创手术[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 244 -245 .
[8] 伦 杰,吕心红 . 鼻部脂溢性角化病1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 252 -252 .
[9] 王红霞,王鹏程 . NSE、S100及GFAP在视网膜母细胞瘤中的表达及意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 263 -264 .
[10] 黄 方,黄海琼,黄建强,何荷蕃 . 支气管内镜视频监视系统在小儿气管-支气管异物诊治中的应用[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 276 -277 .
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发