Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (5): 27-32.doi: 10.6040/j.issn.1673-3770.1.2020.063

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Clinical value of vestibular evoked myogenic potential to predict prognosis of unilateral idiopathic sudden sensorineural hearing loss

  

  • Received:2020-07-03 Published:2020-11-17

Abstract: Objective To analyze the clinical outcomes of patients with unilateral idiopathic sudden sensorineural hearing loss(SSNHL)and explore the relationship between vestibular function and prognosis in patients with SSNHL. Methods A retrospective analysis of 59 patients(59 ears)with SSNHL was performed. A total of 183 vestibular function tests were performed in all patients to assess the influence of vestibular functions on the clinical outcome of SSNHL. Results Treatments were less effective in patients with abnormalities in ocular vestibular evoked myogenic potential(oVEMP)or cervical vestibular evoked myogenic potential(cVEMP). Those with normal oVEMP and cVEMP had relatively better hearing recovery. The outcomes of the caloric test or video head impulse test showed no association with the efficacy of treatment or hearing recovery in patients with SSNHL. Treatment was less effective in patients with abnormalities in both oVEMP and cVEMP, who also had worse hearing recovery than those who had an abnormal finding in only one of the two tests. Conclusions Patients with abnormal oVEMP or cVEMP results had poor clinical outcomes, while those with normal oVEMP and cVEMP demonstrated better hearing recovery with treatment. Thus, oVEMP and cVEMP could be effective indices to predict the prognosis of patients with SSNHL. An abnormal vestibular function is a definite indicator of a wider and more severe pathological change in the inner ear of patients with SSNHL.

Key words: Idiopathic sudden sensorineural hearing loss, Vestibular function, Vestibular evoked myogenic potential, Caloric test, Video head impulse test

CLC Number: 

  • R764.43
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[1] LI Jiawei, LIU Xiaoyang, YANG Xingyu, SUN Xiaoming, LI Xidan. Effect of repetitive transcranial magnetic stimulation on chronic vestibular syndrome [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(1): 7-10.
[2] . Diagnosis and management of peripheral vestibular diseases [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 1-6.
[3] . Effects of aging on galvanic vestibular stimulation elicited vestibular evoked myogenic potential [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 7-13.
[4] . A new grade of vestibular function abnormality in Menieres disease: a pilot study [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 14-19.
[5] 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 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 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.. Relationship between prognosis and vestibular symptoms/function in patients with unilateral profound sudden sensorineural hearing loss: A retrospective analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 33-38.
[6] This study was aimed at determining vestibular involvement and the location and frequency of vestibular dysfunction in patients with auditory neuropathy. MethodsTwenty patients with non-syndromic auditory neuropathy were enrolled. Using vestibular test battery, we calculated the ocular vestibular-evoked myogenic potential(oVEMP), cervical vestibular-evoked myogenic potential(cVEMP), video head impulse test(vHIT), suppression head impulse paradigm(SHIMP), and caloric test results. ResultsThe oVEMP and cVEMP were calculated for all patients, and the abnormality rates were % and %, respectively, showing no significant difference. The vHIT in the lateral, anterior, and posterior semicircular canals, and SHIMP in the lateral canals were calculated for patients( ears), and the abnormality rates were %, %, %, and %, respectively, showing no significant difference among the four tests. Nineteen patients exhibited a % abnormality rate for the caloric test. Of the patients with the SHIMP and vHIT results, % showed abnormal caloric test results, which was much higher than the abnormality rate of SHIMP and vHIT. ConclusionPatients with auditory neuropathy showed vestibular involvement, and the superior and inferior vestibular components, including the vestibular peripheral receptors and nerves, had an equal probability of dysfunction. All the otolith organs and semicircular canals could be involved. The possibility of dysfunction was equal for different portions of the semicircular canal, while the functional involvement was more likely to be observed in low-frequency tests.. Location and frequency characteristics of vestibular dysfunction in patients with nonsyndromic auditory neuropathy [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 39-45.
[7] 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.. Abnormality rate of vestibular evoked myogenic potentials in patients with primary and recurrent benign paroxysmal positional vertigo: a clinical observation [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 51-55.
[8] To explore the relationship between dizziness-vertigo and nystagmus intensity, according to the nystagmus accompanied by dizziness and/or vertigo during caloric test. MethodsThe relationship between dizziness and vertigo sensations and nystagmus intensity was analyzed in 399 patients with peripheral vestibular disorders,who underwent routine caloric test. The nystagmus intensity is as an index, accompanied by dizziness and/or vertigo sensations induced during caloric test. ResultsWarm and cold stimulation induced dizziness and vertigo and associated nystagmus overall analysis, the intensity of nystagmus was always greater than that of dizziness when vertigo occurred. The nystagmus thresholds for dizziness and vertigo induced by warm and cold air stimulation in the left ears were 4.2°/s and 5.9°/s for cold, 4.2°/s and 8°/s for warm, in the right ears were 4.6°/s and 6.2°/s for cold, 5.3°/s and 6.5°/s for warm, respectively. Three hundred ninety nine patients were subjected to alternating warm and cold stimulation in both ears for a total of 1596 times, which induced dizziness 513 times(32.14%), of which 312 times only dizziness and 201 times vertigo ten seconds after dizziness. Vertigo was induced 906 times(56.77%), of which 705 occurred directly without transitioning from dizziness to vertigo, and another 201 times vertigo occurred after ten seconds of dizziness; 378(23.68%)times did not induce dizziness and vertigo. ConclusionsVertigo corresponds to a higher nystagmus intensity threshold than dizziness, with patients showing dizziness when the nystagmus is weak and vertigo when it is stronger. Warm and cold air stimulation induced nystagmus intensity from weak to strong, and from dizziness to vertigo sensations induced at the same time, suggesting that the symptoms of dizziness and vertigo are related to the asymmetric between the two vestibular tension.. Study of the relationship of dizziness and vertigo sensations with the nystagmus intensity [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 56-60.
[9] To study the characteristics of air-conducted ocular vestibular evoked myogenic potential(AC-oVEMP)and cervical vestibular evoked myogenic potential(AC-cVEMP)in normal Chinese children. MethodsFifty-two 4-10-year-old children with normal hearing(male 30, female11, 104 female)were recruited. Using 500-Hz air-conducted pure tone burst as a stimulus, oVEMP and cVEMP were assessed. The response rates and waveform parameters of the left and right ears were recorded and analyzed statistically using SPSS software. ResultsThe respective findings for oVEMP and cVEMP were as follows: response rates: 92% and 96%; P1 latencies:(17.07±0.89)ms and(15.55±1.58)ms; N1 latencies:(12.39±0.91)ms and(23.10±2.29)ms; N1P1 latencies:(4.68±0.88)ms and(7.83±1.56)ms; amplitudes:(7.24±4.79)μV and(197.40±118.37)μV; interaural asymmetry ratios(AR,%):(19.03±12.50)% and(22.16±18.64)%. There were no significant differences between the latencies, N1P1 latencies, or amplitudes of the left and right ears(P>0.05). ConclusionoVEMP and cVEMP can be elicited by the stimuli of air-conducted pure tone bursts in the majority of normal children. They can be used to evaluate vestibular function, as they are feasible and compliance in children is high. The results provide the normal reference range of VEMP for children in China.. Characteristics of air-conducted vestibular-evoked myogenic potential in normal children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 67-71.
[10] To record the bone-conducted vestibular-evoked myogenic potential(BC-VEMP)in order to provide a reference for the clinical evaluation of vestibular function in normal-hearing children. MethodsThirty-one normal-hearing children(62 ears)aged 4-12 years were selected to undergo BC-VEMP determination. These children were divided into two groups according to age. Those aged 4-5 years(11 children, 22 ears)belonged to one group while those aged 6-12 years(20 children, 40 ears)belonged to the other. A 60 dB nHL was used as the initial stimulus intensity by which the N1 latency, P1 latency, n1-p1 interval, n1-p1 amplitude, amplitude asymmetry ratio, and threshold of cervical VEMP(CVMP)and ocular VEMP(ocular VEMP)were recorded. The SPSS software was used for statistical analysis. ResultsThere was no significant difference in P1, N1 latency, P1-N1 wave interval, P1-N1 amplitude, threshold, and amplitude asymmetry ratio of BC-oVEMP between the 4-5-year-old and the 6-12-year-old groups(P>0.05). There was no significant difference in N1, P1 latency, n1-p1 wave interval, n1-p1 amplitude, threshold, and amplitude asymmetry ratio of BC-VEMP between the two groups(P>0.05). ConclusionBC-VEMP is a feasible auxiliary examination of vestibular function. The establishment of normal values of BC-VEMP in different age groups can provide a reference for clinical evaluation of vestibular function in children.. The establishment of a normal value of bone-conducted vestibular-evoked myogenic potential in normal-hearing children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 72-77.
[11] Newborns and infants with hearing loss often suffer from vestibular dysfunction, which may aggravate with the gradual deterioration of hearing, resulting in delayed motor development or motor dysplasia. The motor development of newborns and infants depends on the function of the vestibular organs; thus, early vestibular function evaluation has positive prognostic significance. However, newborns and infants lack the language skills to fully express their symptoms. Furthermore, a series of complex vestibular function tests may cause them discomfort, such as vertigo and nausea, and the equipment and environment often scare them, which make vestibular assessment very challenging. Additionally, the structure and function of the vestibular, visual, and proprioceptive systems gradually mature with growth and development. Therefore, the clinical data of vestibular quantitative tests in different age groups cannot be compared with the standard reference range in adults. Hence, not all types of vestibular tests are necessary or appropriate in newborns and infants and should be adjusted according to the stage of development. In this study, we performed a literature review with focus on the common vestibular function tests according to the age and developmental stage of newborns and infants.. Update on the development and evaluation of vestibular function in newborns and Infants [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 82-88.
[12] LIU Bing, LI Bei, ZHANG Li, CHEN Min, ZHANG Jie. Clinical Analysis of Benign Paroxysmal Vertigo in preschool and school-age children [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(5): 58-60.
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[14] YIN Xueling. Changes of vestibular function in patients with obstructive sleep apnea-hypopnea syndrome [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2015, 29(3): 9-12.
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