Comparison between electrocochleography and glycerol test in the diagnosis of Meniere's disease

Electrocochleography (ECoG) and glycerol test were performed in 51 Meniere ears. The positive rate of both tests was compared. The positive rate of ECoG and glycerol test was 63% and 51%, respectively. The ears with positive result of both tests and of either test were 15 of 51 ears (29%) and 43 of 51 ears (84%), respectively. The positive rate of ECoG was higher in ears with a moderate to severe hearing loss at high frequencies, while the positive rate of glycerol test was higher in ears with a moderate to severe hearing loss at low frequencies. The present study has demonstrated that ECoG is different in selectivity of detection of the endolymphatic hydrops from glycerol test and that the combination of both tests increases the detection rate of the endolymphatic hydrops in Meniere's disease.     

静脉甘油试验和鼓室钆造影在梅尼埃病诊断中的价值

目的观察静脉甘油试验和鼓室钆造影在梅尼埃病诊断中的价值。方法对2015年5月至2016年7月,在空军总医院航空航天眩晕诊疗研究中心诊治的89例梅尼埃病患者(其中6例为双侧发病,共95耳)进行静脉甘油试验(静脉点滴甘油果糖250ml,分别于点滴前,结束后1、2、3h进行纯音测听,甘油应用前后低中频区任意频率听阈下降≥15d B,或相邻两频率听阈下降≥10d B,或不连续的3个频率或以上下降≥10d B为阳性)。其中55例(4例为双侧发病,共59耳)24h后进行鼓室钆造影[鼓室内注入钆喷酸葡胺稀释液,并再过24h后进行内耳3D-FLAIR MRI扫描,进行三维重建,在水平半规管层面测量前庭中内淋巴间隙面积与同侧耳前庭总面积,求二者比值R,R=低信号区÷(低信号区+高信号区)×100%,>33.3%为阳性]。结果 95耳静脉甘油试验,阳性率65.3%(62/95),且试验中患者无头痛、头晕、恶心、呕吐、口渴、乏力、腹痛等不适反应。进行两项检查的59耳,甘油试验阳性率67.8%(40/59),鼓室钆造影剂阳性率96.6%(57/59),差异有统计学意义(χ2=16.741,P<0.01)。结论甘油试验和鼓室钆造影在梅尼埃病诊断中均有一定的参考价值,其中静脉甘油试验方法简单,患者无口服甘油引起的副作用,仪器和技术条件要求不高,适用于各级医院;鼓室钆造影阳性率更高,但检测设备和和技术要求高,适用于有条件的医疗单位进行精确诊断和研究。     

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.     

内耳钆造影磁共振成像技术在梅尼埃病诊疗中的应用

随着内耳钆造影磁共振成像技术的出现,为多种内耳疾病的诊断提供了新方法,也为梅尼埃病的诊断提供新契机,甚至有望成为其诊断的金标准。论文围绕国内外鼓室钆造影技术的发展现状,归纳了钆造影的磁共振成像技术特点、给药方式、评估方法及与传统检查方式进行了对比,总结了内耳钆造影磁共振成像技术在梅尼埃病诊疗中的研究现状。     

Visualization of endolymphatic hydrops in patients with Meniere's disease

OBJECTIVE: Recently, there have been many reports of intratympanic gentamicin therapy for the treatment of intractable Meniere's disease. Intratympanic administration of steroids has also been used to treat sudden sensorineural hearing loss. We attempted to visualize how the intratympanically administered drug enters the inner ear. METHODS: Gadolinium hydrate diluted eightfold with saline was injected intratympanically through the tympanic membrane using a 23 G needle in nine patients with inner ear diseases. With a 3 Tesla magnetic resonance imaging (MRI) unit, three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) imaging was performed. RESULTS: 3D-FLAIR MRI clearly revealed that the gadolinium entered the perilymphatic space and delineated the perilymphatic and endolymphatic spaces of the inner ear. In patients with endolymphatic hydrops, the perilymphatic space surrounding the endolymph was small or had disappeared. Gadolinium appeared first in the scala tympani of the basal turn of the cochlea and the perilymphatic space of the vestibule. One day after the intratympanic injection of gadolinium, the gadolinium was observed in almost all parts of the perilymph. Six days after the intratympanic injection, the gadolinium had almost disappeared from the inner ear. CONCLUSION: We reported the first visualization of endolymphatic hydrops in patients with Meniere's disease. The relationship between the image of the endolymphatic space and functional tests, such as electrocochleography and vestibular-evoked myogenic potential, must be examined in the near future. It is important for the development of intratympanic drug therapies for inner-ear diseases to investigate how the drugs enter and leave the inner ear.     

Changes in otoacoustic emission during the glycerol test in the ears of patients with Meniere's disease

Monitoring of cochlear function is one proposed clinical application of otoacoustic emission (OAE). To determine the clinical utility of OAE in monitoring, we studied changes in OAE during the glycerol test used to diagnose endolymphatic hydrops. Transiently evoked OAE (TEOAE) and distortion product OAE (DPOAE) were measured before and 3 hours after oral administration of glycerol in 22 ears of patients with Meniere's disease. The positive result in the glycerol test was observed in 11 of 22 ears. TEOAE was recorded using a nonlinear click stimulus, and total echo power (TEP) of the whole response and filtered echo power (FEP) of its mid-frequency (1000-2000 Hz) component were used as TEOAE parameters. The growth functions of DPOAE were recorded at 3 F2 frequencies--1000, 1500, and 2000 Hz. Changes in the growth function were determined based on changes in 2 parameters--maximum level and detection threshold of DPOAE. When changes in these 4 parameters exceeded 2 standard deviations above mean test-retest variability determined from OAE data for 17 normal ears, they were considered significant. Significant changes indicating improved cochlear function in 4 OAE parameters or the appearance of OAE during the glycerol test were judged positive for OAE. Regardless of glycerol test results, positive findings were observed in both OAEs whenever a pure-tone threshold at 1000 or 2000 Hz improved. However, even in ears for which pure-tone thresholds at these frequencies did not improve, both OAEs frequently exhibited positive findings. In all ears with a positive result in the glycerol test, positive findings were observed in DPOAE, but not in TEOAE. Of the 2 parameters of TEOAE, FEP always exhibited a positive finding in ears with a positive TEP finding and FEP positivity was higher than that of TEP. In DPOAE, no cases showed a positive finding only at F2 = 2000 Hz, and DPOAE at F2 = 1000 Hz could not be detected in 4 ears due to high noise floor. Overall, positive findings were obtained in 14 ears (63.9%) for TEOAE and 20 ears (90.9%) for DPOAE. In only 1 ear were no positive findings observed in either OAE. The sensitivity of OAE measurement as a diagnostic test for endolymphatic hydrops was higher than that of pure-tone audiometry. Of the 2 OAEs, test sensitivity was much higher for DPOAE than for TEOAE. These results show that OAE measurement detects changes in cochlear function during the glycerol test more sensitively than pure-tone audiometry. They also suggest that FEP is a better indicator than TEP as a parameter of TEOAE, and that DPOAE measurement at F2 = 1000 and 1500 Hz is sufficient for practical clinical use. However, of the 2 OAEs, DPOAE was considered more appropriate than TEOAE for monitoring during the glycerol test because of its high sensitivity in detection of changes in cochlear function. In conclusion, clinical use of OAE, especially DPOAE, as a test complementary to pure-tone audiometry during the glycerol test is very useful and will improve the diagnosis of endolymphatic hydrops.     

甘油对梅尼埃病患者前庭诱发的肌源性电位的影响

目的通过梅尼埃病患者前庭诱发的肌源性电位(vestibulare voked myogenic potential,VEMP)在甘油试验前后的变化情况,了解本项检查在梅尼埃病诊断中的意义。方法对明确诊断为梅尼埃病的10例患者进行甘油试验,比较甘油试验前后前庭诱发的肌源性电位的变化。甘油试验VEMP观察时间段选择两点,服用甘油前及服用甘油后3小时的振幅变化作为指标。结果8例单侧梅尼埃病,其中5例振幅改善(2例振幅增加,3例振幅从无到有),3例甘油试验后VEMP的振幅变差。2例双侧梅尼埃病,1例甘油试验后VEMP振幅从无到有,1例VEMP振幅改善。结论梅尼埃病患者甘油试验后,VEMP变化有以下三种情况:①从无到有;②引出的振幅降低;③引出的振幅提高。甘油试验纯音听力检查结合VEMP的甘油试验有助于梅尼埃病的诊断。     

Visualization of endolymphatic hydrops and correlation with audio-vestibular functional testing in patients with definite Meniere's disease

Objectives

Visulization of endolymphatic hydrops has been reported using magnetic resonance imaging (MRI) in patients with Meniere's disease. However, the relationship between the endolymphatic hydrops visualized by MRI and audio-vestibular functional tests have not been sufficiently investigated, such as pure tone audiometry (PTA), electrocochleography (EcoG), and vestibular evoked myogenic potential (VEMP).

Methods

Here we attempted to visualize endolymphatic hydrops in patients with Meniere's disease using 3 Tesla (3 T)-MRI following intratympanic gadolinium-diethylene-triamnie petaaetic acidbis (Gd-DTPA) injection and correlated the presence of hydrops with auditory testing. Following intratympanic Gd-DTPA contrast injections in 26 patients diagnosed as having definite Meniere's disease, 3D-fluid-attenuated inversion recovery (3D-FLAIR) sequence imagings were performed. The PTA, EcoG, and VEMP testing was done bilaterally. Patients had typical results of auditory testing for Meniere's disease.

Results

The 3D-FLAIR MRI clearly demonstrated endolymphatic hydrops with signal voids in the cochlea (81%) and saccule (69%) in the definite Meniere's disease group. Auditory tests verified that the visualized cochlear hydrops (basal turn) was correlated with a high tone hearing threshold in PTA and an abnormal EcoG. Though the absence of VEMP did not correlate with vestibular hydrops on MRI, large vestibular hydrops were detected by imaging. This study demonstrates that endolymphatic hydrops could be visualized by 3D-FLAIR MRI in Meniere's disease patients.

Conclusion

Cochlea hydrops and vestibular (saccular) hydrops are readily visualized using these techniques. Hydrops, as visualized on MRI, may be a reliable means to diagnosis Meniere's disease; this is supported by appropriate correlations with auditory vestibular functional testing.     

Comparison between 3D-FLAIR and 3D-real IR MRI sequences with visual classification method in the imaging of endolymphatic hydrops in Meniere's disease

BackgroundClinically, the evidence of endolymphatic hydrops (EH) in Meniere's disease (MD) primarily relies on audiological examinations, such as glycerol tests and electrocochleography, to suggest the presence of EH indirectly. However, these techniques lack sensitivity and specificity, and they do not sufficiently assess the degree of EH. This study aims to explore the application of three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and three-dimensional real inversion recovery (3D-real IR) sequence imaging of EH in MD and to assess the image quality and grading of EH.MethodsThe study included 50 patients with definite MD. The 3D-FLAIR and 3D-real IR sequence images were performed 24 h after bilateral intratympanic injection of gadolinium. The image quality of both sequences was reviewed by two experienced radiologists. The vestibular and cochlear EH grades of both sequences were reviewed by two experienced otologists using a visual grading method. The Cohen's kappa and Pearson tests were used to analyze the data.ResultsThe reliability of image quality between the two radiologists was excellent (0.7 < kappa < 0.9). There were significant statistical differences in the image quality between the 3D-real IR and 3D-FLAIR sequences (p = 0.023 and p = 0.035, respectively). The reliability for the grading of vestibular and cochlear EH between the two otologists was excellent (0.7 < kappa < 0.9). The 3D-real IR sequence detected more severe hydrops than did the 3D-FLAIR sequence (p < 05).ConclusionThe image quality of the 3D-real IR sequence is better than that of the 3D-FLAIR sequence, and there are differences in the vestibular and cochlear EH grades of both sequences. The sensitivity of the 3D-real IR sequence in the cochlea is higher. The method of visual grading can be applied to both technologies when combined with 3D-real IR.     

Diagnostic assessment of patients with Meniere's disease through caloric testing and the video-head-impulse test

IntroductionMeniere's disease is a labyrinth disease that usually presents with episodes of spontaneous vertigo associated with sensorineural hearing loss, tinnitus and ipsi- and unilateral aural fullness in most cases. Vestibular function tests, video-head-impulse test and the caloric test, are not specific for diagnosis of the disease, but may show alterations that help to evaluate the functional impairment.ObjectiveTo describe the results obtained at the caloric test and video-head-impulse test in patients with definite Meniere's disease and compare them between symptomatic, asymptomatic ears and those of the control group.MethodsCross-sectional and observational study including patients with definite Meniere's disease diagnosed according to the Bárány Society criteria (2015) and healthy individuals (control group) undergoing caloric test and video-head-impulse test. All subjects were assessed by neurotological anamnesis and audiological evaluation (pure-tone, vocal and immittance audiometry) to characterize the sample. The findings obtained at the caloric test and video-head-impulse test were described and compared between the symptomatic and asymptomatic ears of patients with Meniere's disease and those of the control group.ResultsThirty-two patients with definite Meniere's disease were evaluated, with a mean age of 45.7 years, mostly females (68.8%) and unilateral disease. The control group consisted of 20 healthy individuals, with a mean age of 44.7 years, mostly females (70.0%). The groups were homogeneous in relation to age and gender. The patients’ main complaint was vertigo (71.9%), and most patients had more than six episodes in the last six months (71.9%). Moderate sensorineural hearing loss was present in 38.5% of patients. The prevalence of hyporeflexia at the caloric test was higher in symptomatic (56.4%) and asymptomatic (36%) ears of patients with Meniere's disease compared to the ears of control subjects (7.5%), p < 0.001 and p = 0.004, respectively. Video-head-impulse test alterations in the lateral semicircular canals were more frequent in the symptomatic ears of patients with Meniere's disease than in the ears of control subjects (p = 0.026).ConclusionMost patients with definite Meniere's disease showed hyporeflexia at the caloric test and video-head-impulse test with normal function in the symptomatic ear. Vestibular hyporeflexia at the caloric test was more frequent in the symptomatic and asymptomatic ears of patients with Meniere's disease than in the control group. The video-head-impulse test showed more alterations in the lateral semicircular canals.     

Correlation of semi-quantitative findings of endolymphatic hydrops in MRI with the audiometric findings in patients with Meniere's disease

Purpose: To investigate the correlation between vestibular hydrops (VH), cochlearhydrops (CH), vestibular aqueduct non-visibility (VANV), and visually increased perilymphatic enhancement (VIPE) with the findings of pure-tone audiometry (PTA) in Meniere’s disease (MD) patients.Methods: In this cross-sectional study, 53 ears belonging to 48 patients were divided into two groups and evaluated. In group “MD patients,” there were 24 ears of 19 patients diagnosed with the definite MD (14 patients with unilateral and 5 patients withbilateral involvements). The “control group” consisted of 29 non-symptomatic ears belonging to patients diagnosed with unilateral sudden sensory-neural hearing loss or unilateral schwannoma. All the patients underwent 2 sessions of temporal bone MRI using the same 3T system: an unenhanced axial T1, T2, and 3D-FLAIR MRI, an intravenous gadolinium-enhanced axial T1 fat-sat, and 4 h after the injection, an axial 3D-T2 cube and 3D-FLAIR session. VH, CH, VANV, and VIPE were assessed. Subsequently, the correlation between EH indices and PTA findings (in three frequency domains of low, middle, and high) were evaluated, and the predictive value of MRI was calculated.Results: VH was significantly correlated with the hearing threshold in the low, middle, and high-frequency domains. CH was also correlated with the hearing threshold in the low and middle domains. Contrarily, VIPE was not associated with hearing thresholds, and VANV was only correlated with the hearing threshold in low frequencies.Conclusion: The grade of VH, CH, and VANV were significantly correlated with the hearing thresholds in PTA.     

鼻咽癌组织中血管内皮因子VEGF、转移抑制基因nm23和肿瘤抑制基因p16的表达及意义

目的分析鼻咽癌组织中血管内皮因子(VEGF)、转移抑制基因nm23、肿瘤抑制基因p16的表达与鼻咽癌预后的关系.方法采用SP法检测VEGF、nm23及p16在40例鼻咽癌组织中的表达,分析它们与鼻咽癌复发、转移、患者生存期的相关性.结果鼻咽癌组织VEGF、nm23、p16的阳性表达率分别为55.0%(22/40)、57.5%(23/40)和27.5%(11/40),阳性表达与鼻咽癌患者有无转移及生存期长短有相关性.结论鼻咽癌组织中VEGF、nm23、p16的表达可作为评估鼻咽癌患者预后的参考因素.     

瞬态诱发耳声发射甘油试验对初次发作眩晕的诊断价值

目的：探讨瞬态诱发耳声发射（TEOAE）甘油试验对初次发作眩晕的诊断价值。方法：对28例眩晕初次发作,纯音听阈（PTT）正常,无耳鸣及耳胀满感,病史及临床特征不支持非梅尼埃病的眩晕患者进行PTT及TEOAE甘油试验。结果：28例中,4例服甘油后PTT及TEOAE均无改变,其各项观察值在正常范围;TEOAE甘油试验阳性20例（单耳16例,双耳4例）,其中2例（2耳）服甘油前TEOAE未引出,服甘油后可引出,TEOAE甘油试验阳性耳,服甘油前、后TEOAE各观察值均低于正常人标准;4例PTT甘油试验阳性,但服甘油前后TEOAE均未引出。结论：TEOAE甘油试验可作为将首次发作眩晕而听力正常患者早期诊断为梅尼埃病及鉴别诊断的常规方法。     

Prognostic value of the expression of p53 and bcl-2 in patients with laryngeal carcinoma

Previous studies have yielded inconsistent results on the prognostic significance of p53 and bcl-2 in head and neck cancer. The aim of this study was the evaluation of p53 and bcl-2 protein expression in laryngeal squamous cell carcinoma and to clarify the relationship between them. All patients with laryngeal carcinoma were treated during the period 1991–1993. In the present study, p53 and bcl-2 expression in paraffin sections from 50 cases of laryngeal squamous cell carcinoma were analysed and correlated with routine clinico-pathological parameters. The expressions of p53 and bcl-2 were examined by immunohistochemical staining. Immunoreactivity for p53 was observed in 45 (90%) of carcinomas and bcl-2 immunoreactivity in 7 (14%). No significant correlation between the p53 or bcl-2 expression and patients’ T- or N-stage, histological grading, or overall survival was found. Received: 2 May 2001 / Accepted: 7 June 2001     

Dexamethasone does not affect endolymphatic hydrops (EH) in patients with Meniere's disease within 24 h,and intratympanic administration of gadolinium plus dexamethasone simplifies high-quality imaging of EH using a novel protocol of 7 min

BackgroundIntratympanic administration of gadolinium chelate allows for a better visualization of endolymphatic hydrops (EH) using MRI than intravenous injection and was recently further improved to facilitate high-quality imaging of EH in 7 min. The aim of the present study was to simplify the intratympanic administration protocol by mixing gadolinium chelate with therapeutic dexamethasone and to evaluate the effects of this mixture on the visualization of EH in MRI.Materials and methodsIn an in vitro study, the potential impact of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) on the stability of dexamethasone was evaluated by analyzing dynamic changes in dexamethasone with high-performance liquid chromatography (HPLC) after mixing with Gd-DTPA. Ten patients with definite Meniere's disease (MD) were recruited to study the potential interference of dexamethasone on MRI visualization of EH, and 49 patients with MD were recruited to evaluate the effect of intratympanic injection of Gd-DTPA mixed with dexamethasone on MRI of EH using a 3T MR machine and a novel heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery reconstructed using a magnitude plus zero-filled interpolation (hT₂FLAIR-MZFI) sequence.ResultsThe retention times and peak area of dexamethasone in HPLC were not modified by the addition of Gd-DTPA. EH grading in the cochlea and vestibule was not influenced in any ear by intratympanic injection of dexamethasone. Excellent inner ear images were obtained from all patients, and EHs with various grades were displayed. There were significant correlations between diagnosis and cochlear EH (p < 0.01, Spearman's Rho), between diagnosis and vestibular EH (p < 0.01, Spearman's Rho), and between cochlear and vestibular EH (p < 0.01, Spearman's Rho). The distribution of Gd-DTPA plus dexamethasone negatively correlated with the grade of vestibular EH. Injury of the endolymph-perilymph barrier was detected in one cochlea and three vestibules of 59 inner ears with MD.ConclusionsIntratympanic administration of Gd-DTPA plus dexamethasone yielded high-quality MRI images of EH in patients with MD using a novel 7-min protocol and simplified the clinical application. Intratympanic administration of Gd-DTPA plus dexamethasone might be used to test its therapeutic effect in future work.Level of evidence3.     

Clinical usefulness of the rotatory,caloric, and vestibular evoked myogenic potential test in unilateral peripheral vestibular pathologies

Abstract

Objective: The aim of this study was to investigate the diagnostic capacity of three different rotatory tests, and to investigate the clinical effectiveness of the caloric, rotatory, and vestibular evoked myogenic potential (VEMP) test. Design and study sample: Several rotatory tests—sinusoidal harmonic acceleration test (SHAT), pseudorandom rotation test (PRRT), velocity step test (VST)—and a caloric and a VEMP test, were given to 77 patients (mean age 52 years) with a unilateral peripheral vestibular pathology, and 80 control subjects (mean age 48 years). Results: For the rotatory test, the highest diagnostic capacity was obtained with the 0.01 Hz SHAT frequency, followed by 0.1 and 0.05 Hz. A higher diagnostic accuracy was reached for the caloric and VEMP test. The caloric test demonstrated high sensitivity and specificity values, but the 0.01 Hz SHAT rotation appeared more sensitive, and the VEMP more specific, than the caloric test. Conclusion: A selection of the 0.01, 0.05, and 0.1 Hz SHAT rotations is suggested as the most ideal rotatory test protocol, and a combination of rotatory, caloric, and VEMP testing will result in a more complete examination of our vestibular system.

Sumario

Objetivos: El objetivo de este estudio fue investigar la capacidad diagnóstica de tres diferentes pruebas rotatorias e investigar la efectividad clínica de las pruebas calóricas, rotatorias y de potenciales evocados vestibulares biogénicos (VEMP). Diseñ: Se aplicaron algunas pruebas rotatorias (prueba de aceleración sinusoidal armónica (SHAT), prueba de rotación pseudo-aleatoria (PRRT), prueba de velocidad de pasos (VST), prueba calórica y VEMP, a setenta y siete pacientes (edad promedio de 52 añs) con patología vestibular periférica unilateral y a 80 sujetos de un grupo control (edad media de 48 añs). Resultados: Para la prueba rotatoria, la más alta capacidad diagnóstica se obtuvo con la frecuencia SHAT 0.01, seguida por 0.1 y 0.05 Hz. La máxima precisión diagnóstica se alcanzó con las pruebas calórica y VEMP. La prueba calórica demostró altos valores de sensibilidad y especificidad, pero la de rotación SHAT en 0.01 pareció más sensitiva y el VEMP, más específico que la prueba calórica. Conclusiones: Se sugiere una selección de rotaciones SHAT de 0.01, 0.05 y 0.1 como protocolo ideal de pruebas rotatorias y una combinación de las pruebas rotatorias, calóricas y de VEMP, para lograr un examen más completo del sistema vestibular.     

变应性鼻炎患者鼻腔分泌物中IL-4、IL-13及骨膜蛋白与患者病情程度的相关性研究

目的 以变应性鼻炎患者的鼻腔分泌物为研究对象,为临床诊断和药物靶点找到新的思路。方法 本研究收集了诊断为变应性鼻炎患者和正常人的鼻腔分泌物,分别采用ELISA法检测样品中白介素-4(IL-4)、白细胞介素-13(IL-13)和骨膜蛋白(POSTN),同时采集样品时采用鼻部症状总评分(TNSS)评价方法评价试验组患者,得出指标量,并进行相关性分析。结果 试验组患者鼻腔分泌物中IL-4、IL-13以及POSTN的含量显著高于正常人(P＜0.05),试验组中IL-4、IL-13与POSTN具有显著的相关性(R＞0.5)、POSTN与患者发病程度具有显著的相关性(R＞0.5)。结论 POSTN似乎在变应性鼻炎的发病机制中起着十分重要的作用,IL-4和IL-13在诱发变应性鼻炎时可能会合成POSTN,且与患者的症状密切相关。检测患者鼻腔分泌物POSTN含量,可协助诊断和判定变应性鼻炎的病情程度。     

Dexamethasone does not affect endolymphatic hydrops (EH) in patients with Meniere's disease within 24 h,and intratympanic administration of gadolinium plus dexamethasone simplifies high-quality imaging of EH using a novel protocol of 7 min

BackgroundIntratympanic administration of gadolinium chelate allows for a better visualization of endolymphatic hydrops (EH) using MRI than intravenous injection and was recently further improved to facilitate high-quality imaging of EH in 7 min. The aim of the present study was to simplify the intratympanic administration protocol by mixing gadolinium chelate with therapeutic dexamethasone and to evaluate the effects of this mixture on the visualization of EH in MRI.Materials and methodsIn an in vitro study, the potential impact of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) on the stability of dexamethasone was evaluated by analyzing dynamic changes in dexamethasone with high-performance liquid chromatography (HPLC) after mixing with Gd-DTPA. Ten patients with definite Meniere''s disease (MD) were recruited to study the potential interference of dexamethasone on MRI visualization of EH, and 49 patients with MD were recruited to evaluate the effect of intratympanic injection of Gd-DTPA mixed with dexamethasone on MRI of EH using a 3T MR machine and a novel heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery reconstructed using a magnitude plus zero-filled interpolation (hT₂FLAIR-MZFI) sequence.ResultsThe retention times and peak area of dexamethasone in HPLC were not modified by the addition of Gd-DTPA. EH grading in the cochlea and vestibule was not influenced in any ear by intratympanic injection of dexamethasone. Excellent inner ear images were obtained from all patients, and EHs with various grades were displayed. There were significant correlations between diagnosis and cochlear EH (p < 0.01, Spearman''s Rho), between diagnosis and vestibular EH (p < 0.01, Spearman''s Rho), and between cochlear and vestibular EH (p < 0.01, Spearman''s Rho). The distribution of Gd-DTPA plus dexamethasone negatively correlated with the grade of vestibular EH. Injury of the endolymph-perilymph barrier was detected in one cochlea and three vestibules of 59 inner ears with MD.ConclusionsIntratympanic administration of Gd-DTPA plus dexamethasone yielded high-quality MRI images of EH in patients with MD using a novel 7-min protocol and simplified the clinical application. Intratympanic administration of Gd-DTPA plus dexamethasone might be used to test its therapeutic effect in future work.Level of evidence3.     

Inhibition of phosphodiesterase 3, 4, and 5 induces endolymphatic hydrops in mouse inner ear,as evaluated with repeated 9.4T MRI

Conclusion: The data indicate important roles for phosphodiesterase (PDE) 3, 4, 5, and related cAMP and cGMP pools in the regulation of inner ear fluid homeostasis. Thus, dysfunction of these enzymes might contribute to pathologies of the inner ear.

Objective: The mechanisms underlying endolymphatic hydrops, a hallmark of inner ear dysfunction, are not known in detail; however, altered balance in cAMP and cGMP signaling systems appears to be involved. Key components of these systems are PDEs, enzymes that modulate the amplitude, duration, termination, and specificity of cAMP and cGMP signaling.

Method: To evaluate the role of PDE3, 4, and 5 and associated cAMP and cGMP pools in inner ear function, the effect of cilostamide (PDE3 inhibitor), rolipram (PDE4 inhibitor), and sildenafil (PDE5 inhibitor), administrated via mini-osmotic pumps, on mouse inner ear fluid homeostasis was evaluated using 9.4T in vivo MRI in combination with intraperitoneally administered Gadolinium contrast. Also, using human saccule as a model, the expression of PDEs and related signaling molecules and targets was studied using immunohistochemistry.

Results: PDE3, PDE4, as well as PDE5 inhibitors resulted in the development of endolymphatic hydrops. Furthermore, PDE3B, PDE4D, and some related signaling components were shown to be expressed in the human saccule.