A new grade of vestibular function abnormality in Menieres disease: a pilot study
Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):
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Objective To establish a new grade of vestibular function abnormality in patients with Menieres disease(MD)and to preliminarily investigate its clinical significance and correlation with the hearing stage. Methods Clinical data of patients with unilateral intractable MD hospitalized from January 2015 to December 2019 were retrospectively reviewed. All patients underwent pure-tone audiometry, cervical vestibular-evoked myogenic potential(cVEMP)testing, ocular VEMP(oVEMP)testing, the video head impulse test(vHIT), and the caloric test. Abnormal semicircular canal function was defined as an abnormal vHIT or caloric test result. Abnormal saccule function was defined as an abnormal cVEMP. Abnormal utricle function was defined as an abnormal oVEMP. Vestibular function grade Ⅰ was defined when the utricle, saccule, and semicircular canal were normal. Vestibular function grade Ⅱ was defined when the utricle, saccule, or semicircular canal was abnormal. Vestibular function grade Ⅲ was defined when two structures among the utricle, saccule, and semicircular canal were abnormal. Finally, vestibular function grade Ⅳ was defined when the utricle, saccule, and semicircular canal were all abnormal. Results We enrolled 95 cases of MD, including 13, 13, 52, and 17 cases in stages Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. The pure-tone average(PTA)hearing at 500 Hz, 1 kHz, and 2 kHz was 51.86±21.70 dB HL in the ears with MD. The abnormal rates of cVEMP, oVEMP, vHIT, and caloric test results were 63.2%, 74.7%, 33.7%, and 52.6%, respectively. According to the grade of vestibular function abnormality, 9, 28, 39, and 19 cases were in grades Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. The vestibular function stage significantly correlated with the PTA(P<0.01, r=0.35), MD stage(P< 0.01, r=0.35), and disease duration(P=0.02, r=0.24). The vestibular function stage did not significantly correlate with patient age(P=0.084). Conclusion The rates of abnormal otolith and semicircular canal functions increase with the development of MD. Therefore, patients with MD can be accurately assessed with precise testing of the utricle, saccule, and semicircular canals. The status of the development of MD is reflected in the hearing and vestibular function stages. The combined assessment of hearing and vestibular functions can provide a useful reference for the treatment and prognosis of patients with MD.