梅尼埃病前庭功能分级的探讨

doi:10.6040/j.issn.1673-3770.1.2020.062

摘要/Abstract

摘要： 目的建立一种新的梅尼埃病患者前庭功能分级方法,初步探索其临床意义及与梅尼埃病听力分期的相关性。方法收集112例单侧梅尼埃病患者资料,所有患者均完成包括纯音测听、cVEMP、oVEMP、vHIT以及冷热试验检查。冷热试验和vHIT的结果中任一项异常均视为半规管功能异常。cVEMP结果异常视为球囊功能异常,oVEMP结果异常视为椭圆囊功能异常。球囊、椭圆囊、半规管功能均正常的患者为前庭功能I级,球囊、椭圆囊、半规管功能其中1项异常者为前庭功能Ⅱ级,2项异常者为前庭功能Ⅲ级,3项均异常者为前庭功能Ⅳ级。结果根据听力分期,符合入组标准的95例梅尼埃病患者中Ⅰ期13例、Ⅱ期13例、Ⅲ期52例、Ⅳ期17例。患耳平均听阈为(51.86±21.70)dB HL。前庭功能检测结果cVEMP异常率63.2%,oVEMP24异常率74.7%,vHIT异常率33.7%,冷热试验异常率52.6%。前庭功能分级Ⅰ级9例、Ⅱ级28例、Ⅲ级39例、Ⅳ级19例。前庭功能分级与患者的听力差异有统计学意义(P<0.01, r=0.35)。前庭功能分级与患者梅尼埃病分期差异有统计学意义(P<0.01, r=0.35)。前庭功能分级与患者的病程差异有统计学意义(P=0.02, r=0.24)。前庭功能分级与患者的年龄差异无统计学意义(P=0.084)。结论梅尼埃病患者随着病程的进展,耳石器功能和半规管功能检测异常率会逐渐增加。通过对球囊、椭圆囊、半规管低频和高频功能的精细化检测,能够对梅尼埃病患者前庭功能进行精准评估。听力分期与前庭功能分级的同步评估能够反映患者疾病的进展状态,同时能够对患者治疗方案的选择和术后康复的预判起到参考作用。

关键词: 梅尼埃病, 眩晕, 临床分期, 耳石器, 半规管, 前庭功能, 分级

Abstract: Objective To establish a new grade of vestibular function abnormality in patients with Menieres 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.

Key words: Meniere's disease, Vertigo, Clinical stage, Otolith, Semicircular canal, Vestibular function, Grading

中图分类号:

R764.33

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.

参考文献

[1] Oberman BS, Patel VA, Cureoglu S, et al. The aetiopathologies of Ménières disease: a contemporary review[J]. Acta Otorhinolaryngol Ital, 2017, 37(4):250-263. doi: 10.14639/0392-100X-793.
[2] Committee on Hearing and Equilibrium. Committee on hearing and equilibrium guidelines for the diagnosis and evaluation of therapy in Menieres disease[J]. Otolaryngol Head Neck Surg, 1995, 113(3):181-185. doi:10.1016/s0194-5998(95)70102-8.
[3] 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.
[4] Sandhu JS, Low R, Rea PA, et al. Altered frequency dynamics of cervical and ocular vestibular evoked myogenic potentials in patients with ménières disease[J]. Otol Neurotol, 2012, 33(3):444-449. doi:10.1097/mao.0b013e3182488046.
[5] Sobhy OA, Elmoazen DM, Abd-Elbaky FA. Towards a new staging of Ménières disease: a vestibular approach[J]. Acta Otorhinolaryngol Ital, 2019, 39(6):419-428. doi:10.14639/0392-100x-2461.
[6] Okumura T, Imai T, Takimoto Y, et al. Assessment of endolymphatic Hydrops and otolith function in patients with Ménières disease[J]. Eur Arch Otorhinolaryngol, 2017, 274(3):1413-1421. doi:10.1007/s00405-016-4418-2.
[7] Fukushima M, Oya R, Nozaki K, et al. Vertical head impulse and caloric are complementary but react opposite to Menieres disease Hydrops[J]. Laryngoscope, 2019, 129(7):1660-1666. doi:10.1002/lary.27580.
[8] 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.
[9] Schuknecht HF, Gulya AJ. Endolymphatic hydrops: an overview and classification[J]. Ann Otol Rhinol Laryngol, 1983, 92(5_suppl):1-20. doi:10.1177/00034894830920s501.
[10] Agrawal Y, Minor LB. Physiologic effects on the vestibular system in Menieres disease[J]. Otolaryngol Clin North Am, 2010, 43(5):985-993. doi:10.1016/j.otc.2010.05.002.
[11] Colebatch JG, Halmagyi GM. Vestibular evoked potentials in human neck muscles before and after unilateral vestibular deafferentation[J]. Neurology, 1992, 42(8):1635-1636. doi:10.1212/wnl.42.8.1635.
[12] Gilchrist DP, Curthoys IS, Burgess AM, et al. Semicircular canal occlusion causes permanent VOR changes[J]. NeuroReport, 2000, 11(11):2527-2531. doi:10.1097/00001756-200008030-00036.
[13] 李斐, 庄建华, 陈瑛, 等. 梅尼埃病不同听力分期中颈肌前庭诱发肌源性电位的差异[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(1):9-12. doi:10.13201/j.issn.1001-1781.2016.01.003. LI Fei, ZHUANG Jianhua, CHEN Ying, et al. Difference of cervical vestibular evoked myogenic potentials in different audition stage of Ménière disease[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2016, 30(1):9-12. doi:10.13201/j.issn.1001-1781.2016.01.003.
[14] 牛晓蓉, 韩鹏, 陈耔辰, 等. 前庭耳石器通路功能评价在梅尼埃病分期中的初步研究[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(3):195-199. doi:10.3760/cma.j.issn.1673-0860.2017.03.006. NIU Xiaorong, HAN Peng, CHEN Zichen, et al. Pilot study on the functional evaluation of vestibular otolith-organ pathway in the stage of patients with Meniere disease[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017, 52(3):195-199. doi:10.3760/cma.j.issn.1673-0860.2017.03.006.
[15] 范文君, 罗彬, 管锐瑞, 等. 不同分期梅尼埃病患者眼肌前庭诱发肌源性电位及冷热试验检测分析[J]. 听力学及言语疾病杂志, 2017, 25(5):488-491. doi:10.3969/j.issn.1006-7299.2017.05.012. FAN Wenjun, LUO Bin, GUAN Ruirui, et al. Application of ocular vestibular evoked myogenic potential and caloric test to different stages of meniere disease[J]. Journal of Audiology and Speech Pathology, 2017, 25(5):488-491. doi:10.3969/j.issn.1006-7299.2017.05.012.
[16] Gürkov R, Flatz W, Louza J, et al. In vivo visualized endolymphatic Hydrops and inner ear functions in patients with electrocochleographically confirmed ménières disease[J]. Otol Neurotol, 2012: 1. doi:10.1097/mao.0b013e31825d9a95.
[17] Liu YP, Jia H, Shi J, et al. 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.

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