非综合征型听神经病患者前庭上下成分功能障碍定位研究与频率特征

目的探讨听神经病伴发前庭功能障碍的可能性,并分析其部位和频率特征。方法以眼肌前庭诱发肌源性电位(oVEMP)、颈肌前庭诱发肌源性电位(cVEMP)、视频头脉冲试验(vHIT)、头脉冲抑制试验(SHIMP)和冷热试验对20例(40耳)非综合征型听神经病患者进行前庭功能评估,对统计学处理结果进行客观分析。结果20例患者(40耳)接受oVEMP和cVEMP测试,oVEMP异常率为85%,cVEMP异常率为95%,差异无统计学意义。11例(22耳)接受vHIT和SHIMP测试,外、上、后半规管vHIT和SHIMP的异常率分别为14%、18%、9%和9%,组间差异无统计学意义。19例患者行冷热试验,异常率为74%。11例接受vHIT和SHIMP测试的患者,冷热试验异常率为82%,显著高于vHIT和SHIMP异常率,差异有统计学意义。结论听神经病患者存在前庭功能障碍,前庭上下成分(包括感受器和前庭上下神经)受累概率相当,耳石器和半规管均可受累,各半规管受累概率相当,半规管功能损伤主要累及低频。

Location and frequency characteristics of vestibular dysfunction in patients with nonsyndromic auditory neuropathy

Objectives This study was aimed at determining vestibular involvement and the location and frequency of vestibular dysfunction in patients with auditory neuropathy. Methods Twenty 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. Results The oVEMP and cVEMP were calculated for all patients, and the abnormality rates were 85% and 95%, respectively, showing no significant difference. The vHIT in the lateral, anterior, and posterior semicircular canals, and SHIMP in the lateral canals were calculated for 11 patients(22 ears), and the abnormality rates were 14%, 18%, 9%, and 9%, respectively, showing no significant difference among the four tests. Nineteen patients exhibited a 74% abnormality rate for the caloric test. Of the 11 patients with the SHIMP and vHIT results, 82% showed abnormal caloric test results, which was much higher than the abnormality rate of SHIMP and vHIT. Conclusion Patients 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.