耳蜗电图-SP/AP值在诊断梅尼埃病的研究(摘要)

关于梅尼埃病耳蜗电图-SP／AP比值的阳性标准,目前国内外学者有的用0．43、0．40、0．37、0．30、0．25各种阳性标准,众说纷法,莫衷一是。我们对57例梅尼埃病患者及20耳听力正常青年人的耳蜗电图进行了研究。结果显示：20耳正常青年人的耳蜗电图-SP／AP比值为0．27±0．08（x±2SD为0．43）其中有2例可达0．38;57例梅尼埃病患者中,有45例（78．9％）－SP／AP≥0．4,有38例（667％）-SP／AP≥0．43;听力损失在中、重度以上27例,其中24例（88．9％）≥0．40。根据结果,我们认为,用于一般临床诊断,可以应用-SP／AP≥0．40…     

眩晕患者的耳蜗电图与甘油试验的关系(附112例报告)

目的：进一步了解耳蜗电图对梅尼埃病的诊断价值。方法：对１１２例眩晕患者进行了耳蜗电图、甘油试验及有关听力学检查和冷热水试验。将梅尼埃病和突发性聋、颈性眩晕和其他眩晕病、健康人正常耳的检查结果进行比较。结果：梅尼埃病的耳蜗电图－ＳＰ／ＡＰ异常率为５４．６９％,甘油试验阳性率为５３．１２％,两者相比差异无显著性意义（Ｐ〉０．０５）。结论：以耳蜗电图－ＳＰ／ＡＰ〉０．４ｍｓ配合甘油试验和其他检查,梅尼埃     

梅尼埃病耳蜗及前庭功能损害程度的相关性研究

目的探讨梅尼埃病耳蜗与前庭功能损害程度的相关性及不同程度病变的临床特征。方法对符合诊断标准的44例梅尼埃病患者进行纯音测听、畸变产物耳声发射、Metz重振试验、听性脑干反应(ABR)、耳蜗电图(ECochG)、甘油试验等听力学检查及双温试验、Fukuda踏步试验等前庭功能检查。将测试结果用耳蜗与前庭功能损害的综合评价函数进行评价,同时根据0.5、1、2kHz平均听阈,将病例分成I组6例(平均听阈<25dBHL)、Ⅱ组13例(平均听阈25～40dBHL)、Ⅲ组25例(平均听阈41～70dBHL)。结果Ⅰ、Ⅱ、Ⅲ组-SP/AP阳性率和CP异常率呈上升趋势,各组间差异有统计学意义(P<0.05)。半规管功能异常者(25例)中纯音听阈值、-SP/AP值和耳蜗电图阳性率明显高于半规管功能正常者(19例)(P<0.05)。ECochG阳性者(28例)Metz重振试验、甘油试验阳性率显著高于ECochG阴性者(16例)(P<0.05)。耳蜗功能损害的综合评价函数为f1=0.212Ⅹ11+0.259Ⅹ12+0.429Ⅹ13+0.367Ⅹ14,前庭功能损害的综合评价函数为f2=0.275Ⅹ21+0.375Ⅹ22+0.398Ⅹ23+0.119Ⅹ24,综合评价函数f1与f2呈正相关性(r=0.395,P<0.05)。结论梅尼埃病耳蜗功能与前庭功能损害程度呈较弱正相关性,运用主成分分析法构建的综合评价模型可以较全面综合原始变量信息,合理反映耳蜗和前庭功能损伤程度,为疾病诊断、治疗选择和疗效评价提供依据。     

迟发性膜迷路积水的诊断

目的：探讨迟发性膜迷路积水（DEH）的诊断手段及意义。方法：15例DEH患者,分别行纯音听阈及耳蜗电图检查、前庭双温试验和前庭诱发的肌源性电位检查（VEMP）,用以诊断及判断DEH的侧别和病变累及范围。结果：15例患者均为中～重度以上感音神经性聋。积水与听力下降同侧10例,对侧4例,双侧1例。水平半规管和球囊均有积水5例,水平半规管积水6例,球囊积水2例。VEMP异常者7例,其中1例患侧p13-n23振幅消失,2例p13潜伏期延长,4例患侧p13-n23低振幅。结论：DEH的诊断除了纯音测听外,耳蜗电图检查、前庭双温试验和VEMP检查是重要的实验室检查,应列为诊断常规。     

老年梅尼埃病(附13例报告)

目的:研究老年梅尼埃病的发病情况及其临床特征.方法:观察586例梅尼埃病患者中老年梅尼埃病的发病情况.分析患者的纯音听力、耳蜗电图、前庭双温试验及前庭诱发的肌源性电位检查结果.结果:≥60岁发生梅尼埃病的患者为13例(2.22%),在患者的首发症状中,耳蜗症状首发者占69.2%(9/13),耳聋伴眩晕者占15.4%(2/13),旋转性眩晕为首发者占7.7%(1/13),倾倒感占7.7%(1/13).首发症状按出现例数排列依次为:耳鸣、耳鸣加耳聋、耳聋加眩晕、单纯眩晕或倾倒.老年梅尼埃病患者的听力图呈现多样性,发病时可呈现为覆盆型、平坦型和高频下降为主型,其中高频下降者在病程长短的患者中均可见到.前庭功能检查结果呈现多样性.结论:老年梅尼埃病患者的听力图中,高频听力损失常较低频更为明显.-SP/AP≥0.4的阳性率较高.前庭功能检查结果同样表现为多样性,其结果正常或异常与病程无关,但首发为倾倒感的患者,前庭诱发的肌源性电位异常.     

甘油试验眼震电图改变对梅尼埃病诊断的意义

为研究以前庭功能为指征的甘油试验诊断梅尼埃病的方法，选择健康人２０例４０耳，于服甘油（１．５ｇ／ｋｇ）前及１、２、３小时后，用眼震电图（ＥＮＧ）记录冷热试验眼震慢相速度（ＳＰＶ），经统计９５％最大ＳＰＶ反应指数正常值上限为＋１５％（４４℃水）及＋１０％（３０℃水）。以甘油试验最大ＳＰＶ反应指数较前升高＞＋１５％或＞＋１０％作为阳性标准。梅尼埃病患者４４例（４８耳），其中典型梅尼埃病２７例（３０耳），甘油试验眼震电图阳性率为８２．５％，前庭型梅尼埃病１７例（１８耳）阳性率７７．８％，发作期阳性率明显高于缓解期。显示该试验是梅尼埃病客观诊断方法之一，尤其适用于前庭型梅尼埃病的诊断。     

梅尼埃病耳蜗电图的长期跟踪观察

梅尼埃病的耳蜗电图呈典型的明显-SP改变,但其产生机理尚不清楚。作者对一些梅尼埃病患者进行了长期随访,观察了其耳蜗电图的波动变化。受试者为24例耳蜗电图具有明显-SP改变或-SP/AP比值异常增大的梅尼埃病患者,其中12人接受内淋巴囊瓣膜移植手术,另12人采用非手术治疗。在首次耳蜗电图记录后的1～9年间,每个受试者又分别接受3～9次不等的耳蜗电图检测。结果显示,12名手术病人中,仅1人的-SP/AP比值日后发生了明显改变,自第4年,其-SP/AP比值一直保持在正常水平,其术后7个月和4.5年的听力图显示,250Hz和500Hz的纯音听力得到改善,而2kHz以上的纯声听力则进一步减退,余11人     

梅尼埃病患者前庭内淋巴积水程度与其症状和听觉及前庭功能的相关性分析

目的探讨梅尼埃病患者前庭内淋巴积水程度与其症状、听觉及前庭功能的相关性。方法以34例单侧梅尼埃病患者为研究对象,分别行双侧鼓室内注入稀释8倍的钆喷酸葡胺注射液,24小时后在3T场强下行内耳3DFLAIR序列磁共振成像(three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging,3DFLAIR MRI),评估内淋巴积水程度,并与患者年龄、病程、疾病分级、眩晕发作频率、前庭诱发肌源性电位(VEMP)结果、耳蜗电图结果、冷热试验结果、纯音听阈进行相关性分析。结果 34例患者鼓室注入钆剂后,除5例出现短暂眩晕外,其余患者均未诉不适,未见鼓膜穿孔、感染等并发症。3DFLAIR MRI显示34例患耳前庭外淋巴间隙均清晰显影,可清晰对比显示前庭内淋巴积水征象,其中轻度积水8例,中度积水11例,重度积水15例。34例患者平均听阈为9~90dB HL,平均为43.56dB HL;冷热试验异常21例,正常13例,诊断率为61.76%;VEMP正常17例,异常7例,未引出10例,诊断率为50%;耳蜗电图异常22例,正常12例,诊断率为64.71%。患者前庭内淋巴积水程度与病程、眩晕发作频率、耳蜗电图结果、冷热试验结果无显著相关性(P>0.05),与患者年龄、纯音听阈、疾病分级、VEMP结果有显著相关性(P<0.01),对应的相关系数分别为0.494、0.568、0.590、0.495。结论梅尼埃病患者前庭内淋巴积水程度与其年龄、疾病分级,纯音听阈及VEMP结果显著相关,与病程、眩晕发作频率、耳蜗电图、冷热试验结果无明显相关性。     

经鼓室钆注射内耳成像磁共振检查在梅尼埃病中的应用

目的 对梅尼埃病(Meniere's disease)患者采用经鼓膜穿刺鼓室内注入对比剂钆、内耳三维快速液体衰减反转恢复磁共振(three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging,3D-FLAIR MRI)扫描,将影像学显示的膜迷路积水情况与临床听力及前庭功能检查结果进行比较,探讨经鼓室钆注射内耳成像磁共振在梅尼埃病诊断中的应用价值.方法 32例经临床确诊的单侧梅尼埃病患者,双侧耳均经鼓膜穿刺鼓室内注入对比剂钆喷酸葡胺稀释液,24 h后行3D-FLAIR MRI和三维平衡快速梯度回波磁共振扫描,观察双侧耳蜗、前庭和半规管外淋巴间隙的增强显影,对耳蜗底转鼓阶和前庭阶分别进行评分,并对前庭外淋巴间隙显影范围进行测量.患者常规行纯音测听、冷热试验、前庭诱发肌源性电位(vestibular evoked myogenic potential,VEMP)和耳蜗电图检查.将患侧耳蜗底转前庭阶评分及前庭外淋巴间隙显影范围分别按纯音测听、冷热试验、VEMP、耳蜗电图的检查结果分组进行比较,采用SPSS17.0统计软件进行数据分析.结果 全部患者内耳3D-FLAIR MRI均显示对比剂钆广泛分布于耳蜗、前庭和半规管的外淋巴间隙,可清晰对比显示内淋巴间隙.患侧耳蜗底转前庭阶评分值与健侧比较,差异具有统计学意义(Z=4.309,P＜0.05);患侧与健侧前庭外淋巴间隙显影范围(-x±s)分别为(6.04±2.89)mm2和(8.28±3.04) mm2,二者比较差异具有统计学意义(t =3.322,P ＜0.05).VEMP异常组患者与VEMP正常组比较,患侧前庭显影范围明显缩小,差异具有统计学意义(F=11.96,P＜0.05).耳蜗电图异常组患者与正常组比较,耳蜗底转前庭阶评分明显偏低,差异具有统计学意义(Z=3.17,P＜0.05).患侧耳蜗前庭阶评分及前庭显影范围与患者听力水平及冷热试验结果无明显相关.结论 经鼓室钆注射内耳3 D-FLAIRMRI可以区分内、外淋巴间隙的边界,显示膜迷路积水情况,可为梅尼埃病的诊断提供影像学参考.VEMP和耳蜗电图检查结果可能与前庭和耳蜗积水程度有一定相关性.     

梅尼埃病首发症状的临床分析

目的了解梅尼埃病患者的性别、首发的年龄、症状,并根据首发症状进行临床分类。方法回顾分析准确提供首发症状的145例梅尼埃病患者,按照耳聋和（或）耳鸣（耳蜗症状）、半规管（旋转性眩晕）和耳石器症状（倾到或平衡障碍）进行分类。结果首发症状依次为耳鸣45例、耳蜗加眩晕症状30例、眩晕28例、耳鸣加耳聋27例、听力下降9例、耳石器症状6例。累及耳蜗及前庭系统30例;累及耳蜗81例：累及半规管28例：累及耳石器6例。小于20岁和大于60岁年龄组患者数最少。男性高发年龄较女性高发年龄早10年,男性和女性在30-49岁年龄段发病例数最多。三种类型梅尼埃病临床首发症状与典型症状出现的间隔差异均较大。结论梅尼埃病耳蜗受累明显高于前庭,首发症状耳鸣最常见,其次是听力下降,再次为眩晕,倾倒的出现率最低。对不典型病例的早期诊断酌情选择纯音测听、耳蜗电图、前庭双温试验和前庭诱发的肌源性电位等检查。     

Reliability of the vestibular evoked myogenic potential test in assessing intratympanic gentamicin therapy in Meniere's disease

CONCLUSIONS: The results of this preliminary study demonstrate that with regard to determining the efficacy of intratympanic (IT) gentamicin treatment in patients with Meniere's disease, the reliability of testing for vestibular evoked myogenic potentials (VEMPs) is comparable to that of caloric tests. Compared with caloric tests, VEMP measurements are more comfortable and take less time. The results of VEMP and caloric testing do not correlate with the results of hearing tests. OBJECTIVE: To test the reliability of VEMP testing to monitor the results of IT gentamicin therapy in patients with Meniere's disease. SUBJECTS AND METHODS: Twelve patients with unilateral Meniere's disease were evaluated with pure tone audiometry (PTA), bithermal caloric tests, and VEMP tests. Patients with measurable caloric and VEMP results before IT gentamicin treatment were included in the study. IT gentamicin (0.5 ml) at a concentration of 40 mg/ml was administered to the patients. Reinjection was performed 10 days later depending on patients' complaints. Patients were re-evaluated with short- and long-term VEMP, hearing, and caloric test results. RESULTS: Caloric responses and VEMPs changed following gentamicin therapy in 9 patients and 12 patients, respectively. Long-term results of caloric and VEMP tests in patients receiving IT gentamicin treatment changed in 7 patients and 10 patients, respectively.     

摇头眼震与前庭冷热试验的互补作用

目的：探讨摇头眼震（HSN）检查与前庭冷热试验前庭系统疾病定侧诊断方面的互补作用。方法：60例眩晕疾病患者均行前庭冷热试验、HSN及相关听力学检查。结果：半规管轻瘫（CP）正常，引出HSN者19例：①HSN的方向与CP方向相反者11例，HSN指向健侧；②HSN的方向与CP方向相同者8例，HSN指向患侧。CP正常，未引出HSN者10例。CP异常，未引出HSN者8例。CP异常，引出HSN者23例：①HSN的方向与CP方向相反者19例；②HSN的方向与CP方向相同者4例，HSN指向患侧。结论：HSN与前庭冷热试验可互为补充，两者联合应用有助于全面了解水平半规管的功能。     

前庭诱发的肌源性电位临床应用

前庭诱发的肌源性电位（Vestibular evoked myogenic potentials，VEMP）可用于评价球囊功能及其对称性。本文总结VEMP在神经耳科学中的应用情况。首先建立VEMP的临床适用的检查方法，这些方法包括：刺激声的选择、刺激强度及给声方式，建立VEMP在振幅、阈值、潜伏期和耳间潜伏期的正常值。临床上常用于：梅尼埃病和迟发性膜迷路积水、前庭神经炎、听神经瘤、前半规管裂综合征和听神经病的诊断定位。VEMP的振幅变化较大．潜伏期的变化较大，而阈值较稳定。梅尼埃病和迟发性膜迷路积水、前庭神经炎、听神经瘤可以出现振幅的异常或引不出；梅尼埃病、迟发性膜迷路积水和听神经瘤可见振幅和潜伏期异常。听神经瘤还可见耳间潜伏期延长。听神经病主要表现为振幅的异常，振幅减低或引不出。VEMP是一种稳定的肌源性电位，双侧声刺激较为适宜。VEMP的阈值检查主要用于压力或声音敏感性眩晕；耳间潜伏期的异常主要见于桥一小脑角占位病变：振幅和潜伏期的异常一般没有特异性．可见于累及前庭下神经的病变。     

梅尼埃病的球囊功能

目的 :通过记录、分析梅尼埃病患者的前庭诱发的肌源性电位 (VEMP) ,了解球囊的功能。方法 :15例确诊为梅尼埃病的患者行VEMP检查 ,分析梅尼埃病VEMP的不同表现形式 ,并将该结果与冷热试验结果比较。结果 :正常双侧短声刺激p13波和n2 3波出现率为 10 0 % ,梅尼埃病受试者VEMP 30 %不能正常引出 ,有 3种表现形式 :VEMP双侧无反应、患侧反应振幅正常和VEMP患侧反应低振幅。结论 :梅尼埃病患者膜迷路积液可影响球囊功能 ,VEMP检查有助于梅尼埃病的诊断     

伴眩晕的突发性聋患者椭圆囊-球囊功能分析

目的通过观察突聋伴眩晕患者主观垂直视觉(subjective visual vertical,SVV)偏斜和前庭诱发肌源性电位(vestibular evoked myogenic potentials,VEMP),了解椭圆囊-球囊功能与症状的关系。方法16例突聋伴眩晕的患者和10例突聋无眩晕的患者分别行SVV及VEMP检查。其中,6例突聋伴眩晕患者行前庭双温试验检查。结果伴晕眩的突聋患者中,VEMP异常者8例,正常8例;SVV异常6例,正常10例,且所有SVV异常者,VEMP均异常。不同程度听力损失之间VEMP正常与异常率无显著性差异(P>0.05),纯音听阈与SVV的关系在统计学上也无相关性(P>0.05)。结论突聋伴眩晕患者可伴有球囊和/或椭圆囊功能障碍,前庭上神经和前庭下神经损伤无特定的规律。全面的前庭功能评价有助于进一步了解伴眩晕的突聋患者的前庭功能状态。     

梅尼埃病与偏头痛性眩晕的听-前庭功能比较

目的探讨梅尼埃病与偏头痛性眩晕的听功能及前庭功能状态的不同特点,进行比较分析,为二者的鉴别诊断提供帮助。方法回顾性分析2007年5月至2008年9月山东省立医院眩晕门诊52例梅尼埃病患者与36例偏头痛性眩晕患者的临床资料,全部患者均在急性期或亚急性期行纯音测听、视频眼震电图、冷热试验、前庭诱发的肌源性电位检查,部分梅尼埃病及全部偏头痛性眩晕患者行高刺激率听性脑干反应检查,对二者的听力与前庭功能检查结果进行比较分析。结果梅尼埃病患者共52例,男24例,女28例,年龄14-70岁,平均45.8岁。纯音测听异常52例,均为单侧感音神经性聋。视频眼震电图检查示中枢性异常眼动10例。冷热试验异常37例,均为单侧半规管反应低下。前庭诱发的肌源性电位检查异常31例。行高刺激率听性脑干反应检查共32例,5例异常。偏头痛性眩晕患者共36例,男8例,女28例,年龄16-62岁,平均43.6岁。纯音测听异常9例,均为单侧轻至中度感音神经性聋。视频眼震电图检查示中枢性异常眼动17例。冷热试验异常8例,均为单侧半规管反应低下。前庭诱发的肌源性电位检查异常18例,高刺激率听性脑干反应检查异常22例。经统计学分析,二者纯音测听、中枢性眼动检查、冷热试验及高刺激率听性脑干反应的检查结果差异有显著性。结论与梅尼埃病相比,偏头痛性眩晕患者纯音测听及冷热试验异常较少见,中枢性服动检查及高刺激率听性脑干反应异常率较高。在结合患者病史及临床表现的基础上.以上检查可为二者的鉴别提供辅助参考。     

Vestibular evoked myogenic potentials in brainstem stroke

OBJECTIVES/HYPOTHESIS: Despite its widespread application in the posterior fossa tumor, the study of vestibular evoked myogenic potential (VEMP) in cases of posterior fossa stroke remains scarce. The purpose of the study was to establish the role of VEMP in patients with brainstem stroke. STUDY DESIGN: Retrospective study. METHODS: Patients with acute vertigo were admitted and underwent a battery of auditory vestibular tests including caloric and VEMP tests; then they were surveyed by magnetic resonance imaging scan. Seven patients (two men and five women) were demonstrated as having brainstem stroke, including infarction in five patients and hemorrhage in two. RESULTS: Clinical manifestations consisted of dizziness/vertigo in all patients, spontaneous nystagmus in five (71%), and ataxia in three. No patients had experienced conscious change or conventional neurological deficits (eg, long tract signs). Electronystagmography revealed abnormal findings on eye tracking test in 100% of patients, on optokinetic nystagmus test in 71% of the patients, and on caloric testing in 10 ears (71%), including absent ice-water caloric test response in 7 ears and canal paresis in 3 ears. Vestibular evoked myogenic potential testing displayed normal response in 3 ears and abnormal response in 11 ears (79%), including absent vestibular evoked myogenic potentials in 8 ears and delayed vestibular evoked myogenic potentials in 3 ears. When results of both caloric testing and VEMP test were combined, the abnormal rate increased to 93% (13 of 14 patients). CONCLUSIONS: Caloric testing assesses the vestibulo-ocular reflex, which passes upward through the upper brainstem, whereas VEMP testing evaluates the sacculocollic reflex, which travels downward through the lower brainstem. Hence, in evaluating the extension of brainstem stroke, both caloric and VEMP testing should be performed.     

Benign paroxysmal vertigo of childhood: diagnostic value of vestibular test and high stimulus rate auditory brainstem response test

Objective

To investigate the diagnostic value of vestibular test and high stimulus rate auditory brainstem response (ABR) test and the possible mechanism responsible for benign paroxysmal vertigo of childhood (BPVC).

Methods

Data of 56 patients with BPVC in vertigo clinic of our hospital from May 2007 to September 2008 were retrospectively analyzed in this study. Patients with BPVC were tested with pure tone audiometry, high stimulus rate auditory brainstem response test (ABR), transcranial Doppler sonography (TCD), bithermal caloric test, and VEMP. The results of the hearing and vestibular function test were compared and analyzed.

Results

There were 56 patients with BPVC, including 32 men, 24 women, aged 3-12 years old, with an average of 6.5 years. Among 56 cases of BPVC patients, the results of pure tone audiometry were all normal. High stimulus rate ABR was abnormal in 66.1% (37/56) of cases. TCD showed 57.1% abnormality in 56 cases, including faster flow rate in 28 cases and slower flow rate in 4 cases. High stimulus rate ABR and TCD were both abnormal in 48.2% (27/56) of cases. Bithermal caloric test was abnormal in 14.3% (8/56) of cases. VEMP showed 32.1% abnormality, including amplitude abnormality in 16 cases and latency abnormality in 2 cases. The abnormal rate of VEMP was much higher than that of caloric test.

Conclusion

Vascular mechanisms might be involved in the pathogenesis of BPVC and there is strong evidence for close relationship between BPVC and migraine. High stimulus rate ABR is helpful in the diagnosis of BPVC. The inferior vestibular pathway is much more impaired than the superior vestibular pathway in BPVC.