耳蜗电图配合甘油试验对梅尼埃病的诊断意义

对５５例眩晕患者以耳蜗电图配合甘油试验观察耳蜗电图的变化，结果３３例梅尼埃病（ＭＤ）患者甘油试验前耳蜗电图优势ＳＰ／ＡＰ占７３％，甘油试验阳性率为５２％，服甘油后优势ＳＰ／ＡＰ比值降至正常或减少１５％以上，从而进一步证实优势ＳＰ是内淋巴积水的表现；以耳蜗电图配合甘油试验较纯音测听的甘油试验诊断ＭＤ更为客观。     

耳蜗电图在梅尼埃病诊断中的价值

迄今尚缺乏诊断梅尼埃病的敏感且特异的客观试验，７０年代以来，若干研究探讨了耳蜗电图（Ｅｌｅｃｔｒｏｃｏｃｈｌｅｏｇｒａｍ，ＥＣｏｃｈＧ）在梅尼埃病诊断中的价值，认为典型的改变是－ＳＰ异常增大，导致－ＳＰ／ＡＰ比值增高，以及－ＳＰ－ＡＰ复合波形异常增宽。各家报告－ＳＰ／ＡＰ诊断梅尼埃病阳性率从３２％至８７％．本文报告了９７例１００耳梅尼埃病鼓室内法检测的耳蜗电图结果，４９例－ＳＰ／ＡＰ比值异常增高，阳性率４９％；波型异常增宽１７耳，总阳性率６６％．眼震电图检测的阳性率６１％．耳蜗电图和眼震电图改变一致的４３耳，二者总阳性率为８４％。对各家阳性率不一致的原因作了分析。认为耳蜗电图－ＳＰ／ＡＰ比值诊断梅尼埃病的敏感性不如文献报告的那么乐观，在目前尚无更敏感更特异的诊断手段的情况下，耳蜗电图和眼震电图在梅尼埃病的诊断中起着相互印证和相互补充的作用。     

乙状窦后径路前庭神经离断和内淋巴囊分流联合手术治疗梅尼埃病

１９８５年发表的美国耳鼻咽喉－头颈外科学会确定的梅尼埃病诊断标准如下：①２次或更多次自发性眩晕发作，每次持续２０分钟或更长；②至少有一次听力下降的记录；③伴有耳呜或耳胀感。梅尼埃病病因不明，病理上可见有内淋巴积水，膜迷路肿胀和弯曲。具某种特异性的检查方法为甘油脱水试验和耳蜗电图（ＥｃｏＧ）。ＥｃｏＧ包括ＡＰ，ＳＰ和ＣＭ，其中ＳＰ值增高（＞１０ｍＶ）是内耳功能障碍的典型表现，ＳＰ值升高使ＳＰ／ＡＰ比值增加，当比值＞３５％时，提示内耳有积水。梅尼埃病患者通常ＳＰ＞５ｍＶ，ＳＰ／ＡＰ比值常高于正常。Ｓ…     

-SP/AP 比值对梅尼埃病的诊断价值

为进一步探讨－ＳＰ／ＡＰ＞０．４对梅尼埃病的诊断价值，对７０例７６耳梅尼埃病进行了耳蜗电图（ＥＣｏｃｈＧ）测试，并与突发性聋、噪声聋和药物中毒性聋４９耳，正常听力２０耳的结果作了比较，分析了不同刺激强度、不同听力损失对－ＳＰ的引出、－ＳＰ／ＡＰ比值的影响和在以上病变中的表现，结果表明：①正常耳在７５ｄＢｎＨＬ刺激级的－ＳＰ／ＡＰ比值为０．３９±０．０２，突发性聋和噪声聋分别在７５和６５ｄＢｎＨＬ刺激级时＞０．４５；②从６５～５５ｄＢｎＨＬ刺激级所有耳的－ＳＰ／ＡＰ都有一个陡然下降的趋势，只有梅尼埃病患者－ＳＰ／ＡＰ比值陡然下降的刺激强度与听力损失程度相关；③－ＳＰ／ＡＰ均值在≤７５ｄＢｎＨＬ刺激级时呈线性增大，在＞７５ｄＢｎＨＬ刺激级时不再增大或呈非线性，甚至减小。因此，以－ＳＰ／ＡＰ＞０．４为分界线诊断梅尼埃病应慎重；是否提示７５ｄＢｎＨＬ可以作为检诊刺激级有待研究。听力损失如超过８０ｄＢＨＬ，再用－ＳＰ／ＡＰ＞０．４作检诊方法则无实际意义。     

耳蜗电图在梅尼埃病诊断中的价值

迄今尚缺乏诊断梅尼埃病的敏感且特异的客观试验，７０年代以来，若干研究探讨了耳蜗电图在梅尼埃病诊断中的价值，认为典型的改变是－ＳＰ异常增大，导致－ＳＰ－ＡＰ比值增高，以及－ＳＰ－ＡＰ复合波形异常增宽。各家报告－ＳＰ－ＡＰ诊断梅尼病阳性率从３２％至８７％。     

耳蜗电图对梅尼埃病的诊断

这项前瞻性的研究对象是具有高度暗示梅尼埃病征候的病人，分析了他们耳蜗电图的记录，并与未被考虑为梅尼埃病耳的耳蜗电图进行了比较。耳蜗电图的记录是将一个穿鼓膜针置于圆窗龛处获得的。分析１ｋＨ２短纯音和９０ｄＢ短声引出的总合电位（ＳＰ）及总合电位与动作电位之比（ＳＰ／ＡＰ），所有被怀疑的患者给予一个１０等级的梅尼埃病记分。对给予７分或更高分的耳（梅尼埃病耳：ｎ＞５００）和给予３分或更低分的耳（对照耳：ｎ＞９００）进行比较。结果证实在对照耳和梅尼埃病耳的 １ｋＨｚ短纯音引出的 ＳＰ和 ＳＰ／ＡＰ是不同的。…     

梅尼埃病的声导抗检查

为了解口服脱水剂前后梅尼埃病耳的听力学变化情况，以期评价其诊断价值，对梅尼埃病３１例４８耳、其他眩晕病２０例４０耳、健康人２０例４０耳进行服甘油或尿素前后的纯音听阈、６７８Ｈｚ探测音峰静态声导纳（Ｙａ）及峰静态声导（Ｇａ）、共振频率及共振频率处的峰补偿静态声导纳（ΔＹ）及峰补偿静态声导（ΔＧ）、ＥＣｏｃｈＧ的－ＳＰ／ＡＰ比值及ＳＰ－ＡＰ（Ｎ１）波宽测定。结果发现，尿素组与甘油组的脱水试验异常率（阳性＋回跳）相近，统计学上无差异，故将两组结果合并计算。梅尼埃病组脱水试验的纯音听阈异常率为３２／４８（６６．６７％），６７８Ｈｚ探测音Ｇａ异常率为３０／４８（６２．５０％），共振频率处ΔＧ异常率为３３／４８（６８．７５％），－ＳＰ／ＡＰ比值的阳性率为２５／４８（５２．０８％），ＳＰ－ＡＰ（Ｎ１）波宽阳性率为３２／４８（６６．６７％）。χ２检验，各种阳性率之间差异无显著性。以纯音听阈脱水试验阳性耳数为基准，七项指标完全异常者为１７／３２耳，其诊断价值是相同的。服用甘油前后的共振频率处ΔＧ值及６７８Ｈｚ探测音的Ｇａ值的变化，可作为梅尼埃病的客观诊断的参考。     

不同听力检测方法甘油试验的结果比较

目的比较纯音测听甘油试验、耳蜗电图甘油试验、畸变产物耳声发射(DPOAE)甘油试验对梅尼埃病的诊断价值。方法选择63例梅尼埃病和63例非梅尼埃病眩晕患者,分为A、B、C三组,每组包括21例梅尼埃病患者和21例非梅尼埃病眩晕患者,在服用甘油前和服用甘油后1、2、3h分别观察三组患者纯音测听(A组)、耳蜗电图(B组)和DPOAE(C组)的变化,比较三组间甘油试验阳性率。结果 A组梅尼埃病患者纯音测听甘油试验阳性率最高为38.10%(18/21),B组耳蜗电图甘油试验阳性率最高为52.38%(11/21),C组DPOAE甘油试验阳性率最高为57.14%(12/21)。结论耳蜗电图和DPOAE的甘油试验较纯音测听的甘油试验更为准确,能在一定程度上提高对梅尼埃病的诊断率。     

梅尼埃病的听-前庭功能诊断的Logistic回归分析

目的:采用多指标的Logistic回归分析方法探讨梅尼埃病临床特征及耳蜗与前庭功能损害的特征.方法:36例梅尼埃病患者和30例其他外周性眩晕对照组进行临床资料分析,完成纯音测听、Metz重振测试、耳蜗电图、甘油试验、ABR等听力学检查以及双温试验、摇头眼震试验、Fukuda踏步试验.对临床体征、耳蜗与前庭功能检查的各项指标进行单因素χ2 分析,然后进行多因素Logistic回归分析.结果:①波动性听力下降、四联征出现的个数、Tullio现象、耳蜗电图-SP/AP幅值比、Metz重振试验、甘油试验在梅尼埃组与非梅尼埃组间差异有统计学意义(P<0.05);②建立了以耳蜗电图(X1)、甘油试验(X2)、症状的个数(X3)、波动性听力下降(X4)为变量的梅尼埃病Logistic回归预测方程:Logit(p)=-9.443+3.110 X1 +5.015X2 +2.506 X3 +3.963 X4.Logistic模型预报正确率为95.5%,ROC曲线下面积为0.993.结论:梅尼埃病的临床表现特征性明显,配合耳蜗-前庭功能的客观检查,可与其他外周性眩晕相鉴别,相关因素的Logistic回归预测方程可对梅尼埃病进行辅助诊断.     

几项耳功能检查在梅尼埃病诊断中的意义

目的：探讨前庭功能检查[前庭双温试验和前庭诱发肌源性电位（VEMP）检查]及耳蜗电图在梅尼埃病诊治中的意义。方法：梅尼埃病患者行纯音测听、听性脑干反应测听、前庭双温试验（冷热气或冷热水）、VEMP检查和耳蜗电图检查（单侧或双侧耳蜗电图检查）。结果：①前庭双温试验：病程0～5年,冷热试验CP值异常的百分率为56．9％;6～10年为75．9％;11年以上为50．0％。前庭双温试验的总阳性率为61．6％。冷热试验CP值与病程短相关（P〈0．05）。②VEMP：病程0～5年,VEMP异常的百分率为57．4％;6～10年为60．0％;11年以上组为57．1％。VEMP的总阳性率为58．0％。VEMP正常和异常的患者病程差异无统计学意义（P〉0．05）。③耳蜗电图：病程0～5年,-SP／AP异常的百分率为72．1％;6～10年为73．3％;〉11年为81．3％。总阳性率为73．7％。-SP／AP正常和一SP／AP异常的患者病程差异无统计学意义（P〉0．05）。结论：梅尼埃病的诊断仍以临床症状为基础,结合耳蜗电图、前庭双温试验和VEMP检查,可达到早期诊断、提高确诊率的目的。     

Prognosis of low-tone sudden deafness - does it inevitably progress to Meniere's disease?

CONCLUSION: We conclude that not all low-tone sudden deafness (SD) patients suffered from endolymphatic hydrops even if they had vertigo attack at the onset and that electrocochleography (ECochG) was a useful prognostic tool. OBJECTIVES: To investigate whether low-tone SD was a precursor of Meniere's disease and whether patients with low-tone SD suffered from endolymphatic hydrops. PATIENTS AND METHODS: This was a retrospective case review in the university hospital. A total of 184 patients with low-tone SD were divided into two groups with single and recurrent episodes. The progress, follow-up audiograms, and ECochG results of the patients were reviewed and compared with those of patients with high-tone SD and Meniere's disease. RESULTS: In all, 83 of 177 patients with low-tone SD unaccompanied by vertigo had recurrent hearing loss; 15 of the 83 developed vertiginous attacks. The remaining 94 patients had a single episode. Three of the seven patients with low-tone SD accompanied by vertigo had recurrent hearing loss; two of the three were subsequently confirmed to have Meniere's disease. The other four had a single episode. No difference in rate of progress from SD to Meniere's disease was observed among the low-tone and the high-tone SD groups. The average -SP/AP of each group with a single episode is smaller than that of other groups with recurrent episodes and Meniere's disease.     

Clinical significance of the summating potential in Menière's disease

Transtympanic (TT) electrocochleography (ECochG) data recorded with click stimuli and tone bursts (1, 2, 4, and 8 kHz) were evaluated in 50 patients with Meniere's disease and compared with the data from control groups of 10 sensorineural hearing impaired patients and 5 subjects with normal hearing. The mean summating potential (SP) amplitude was larger in the Meniere's disease group for 1, 2, and 8 kHz. The low frequency (1 or 2 kHz) SP decreased in 59% of the Meniere's disease patients during a glycerol dehydration test, whereas subjective hearing improved in only 29%. The use of ECochG with the monitoring of SP thus improves the sensitivity of the glycerol test for the detection of endolymphatic hydrops. There appeared no clear relation between clinical observations and the ECochG data either before or after glycerol. However, the Meniere's disease patients with a large negative SP at low frequencies also had larger action potential (AP) and often had short-term symptoms. The present report confirms the usefulness of measuring the SP in the diagnosis of Meniere's disease.     

Ménière病前庭及听功能相关性分析

为了解Meniere病患者的位听功能，对按AAO－HNS标准诊断为Meniere病121例（166耳）患者的临床检查结果，进行追溯性研究。位听功能统计结果证明：①耳蜗与前庭受损程度有相关性，经趋势及x2检验为正相关（P＜0．01），即听力损失越重半规管不对称比值越大：②听力损失与ECochG优势－SP有关，听力损失越重，－SP／AP异常率越高，差异有显著性。③听力损失与甘油试验阳性率有关，轻度受损甘油试验阳性率低（22．2％），听力损失严重者甘油试验的阳性率增高（84．6％），差异有显著性，ECochG与甘油试验比较，前者更敏感；④各种听力图中上坡及峰型曲线甘油试验阳性率最高为69．0％，下坡及槽型曲线阳性率为33．3％，差异有显著性。诊断Meniere病客观依据不多，听力图、ECochG、前庭功能、甘油试验等联合检查是重要的诊断依据和选择治疗的准则。     

Clinical electrocochleography in Menière's disease

Transtympanic electrocochleography (ECochG) was performed on 137 definite Menière ears, 29 normal ears and 383 ears with other diseases. The average SP/AP amplitude ratio (SP/AP) was significantly larger than that of normal subjects in the following four disease groups whose causes are thought to be endolymphatic hydrops: 1) definite Menière's disease, 2) suspected Menière's disease, 3) delayed endolymphatic hydrops and 4) labyrinthine syphilis. The SP amplitude could not provide any information for a differential diagnosis of endolymphatic hydrops from normal subjects nor from other sensorineural deafness . The upper 99% confidence limit of normal SP/AP using a 100dBSPL click was 0.37 for 29 subjects. In patients with Menière's disease the relationship between SP/AP and clinical data such as pure tone threshold, audiogram pattern, results of glycerol test and duration of illness from the first vertiginous attack to the test were investigated. In patients with severe hearing loss, the number of those showing SP/AP of greater than 0.37 was much higher than in patients with less severe hearing loss. There were no relationship, however, between SP/AP and duration of illness, or audiogram pattern, or glycerol test. ECochG was recorded before and after intravenous administration of 50 gr of glycerol (10% solution, 500ml), and a significant decrease of SP/AP was found in 21 Menière ears. However, there were no change of SP/AP after oral administration of 50 gr of glycerol (50% solution, 100ml) and isosorbide (70% solution, 2.0gr/kg of body weight). After endolymphatic sac surgery a decrease of SP/AP of 10% or more was found in 5 ears, an increase of SP/AP in 3 ears, and no change of SP/AP in 3 ears. In the patients showing no change of SP/AP after the surgery, numerical values of vertigo by AAOHNS were higher than in patients showing an increase or a decrease of SP/AP. The results demonstrate the usefulness of ECochG in diagnosis of endolymphatic hydrops and indicate a possibility of monitoring the state of hydrops after administration of glycerol and endolymphatic sac surgery.     

A clinical study of electrocochleography in Menière's disease

Electrocochleography (ECochG) of 168 ears with definite Meniere's disease was studied. The results were compared with recordings from 29 normal ears and 444 ears with other types of sensorineural hearing loss. It is shown that the SP/AP ratio is much more useful than SP amplitude for detecting endolymphatic hydrops. There was little difference in the mean values of SP/AP from those proposed by many other investigators; the mean values all being near 0.25. From 0.30 to 0.40 of SP/AP was considered adequate as the upper limit. Following intravenous administration of glycerol, a significant decrease in SP/AP was found in 21 Meniere's ears. However, there was no change of SP/AP after oral administration of glycerol and isosorbide. This difference may be due to the fact that a larger oral than intravenous administration is necessary to affect SP/AP. Although a postoperative decrease of 10% or more in SP/AP was observed in 5 patients, 10 patients followed up for 2 years or more after surgery did not show a statistically significant change of SP/AP and pure tone threshold. ECochG should be repeatedly recorded to be useful as a monitor for the presence of hydrops. It is discussed whether biochemical or mechanical changes in endolymph may cause a decrease in SP/AP after the use of dehydrating agents and endolymphatic sac surgery.     

Prediction of progression from atypical to definite Ménière's disease using electrocochleography and glycerol and furosemide tests

OBJECTIVE: To investigate whether electrocochleography (ECochG) and glycerol and furosemide tests could predict progression from atypical to definite Ménière's disease (MD). MATERIAL AND METHODS: ECochG and glycerol and furosemide tests were performed in 1569 patients with various cochleovestibular diseases, including definite MD, atypical MD, syphilitic labyrinthitis, delayed endolymphatic hydrops, sudden hearing loss, cochleovestibulopathy and sensorineural hearing loss. Patients with atypical MD were divided into five categories based on their symptoms. RESULTS: A total of 115/118 patients (97%) with definite MD who underwent all 3 tests showed a positive result in at least 1 test. Ninety-nine patients who did not satisfy the diagnostic criteria of definite MD but had vertigo and/or hearing loss at the first visit subsequently progressed to definite MD. It was retrospectively found that 92% of patients showed at least 1 positive finding in these 3 tests at the initial stage. In those patients who showed a negative test result in either ECochG or the glycerol test, the possibility of progression to definite MD was low. CONCLUSION: The combination of ECochG and the glycerol and furosemide tests was helpful in diagnosing endolymphatic hydrops (ELH). ECochG and the glycerol test were effective tools for predicting the progression to definite MD in patients with atypical MD, sudden hearing loss and other cochleovestibular diseases. Our test results also indicated that the pathological state of atypical MD included both non-ELH and ELH.     

疏波和密波短声诱发的动作电位潜伏期差对梅尼埃病的诊 …

OBJECTIVE: To study the value of condensation and rarefaction clicks evoked action potential (AP) latency difference (LD) in diagnosis of Meniere's disease. METHODS: AP was recorded with ECochG in controls (50 ears) and patients with Meniere's disease(90 ears) and sensorineural hearing loss(SNHL) of other origins(60 ears). LD was calculated and analyzed. RESULTS: LD in patients with Meniere's disease was (0.30 +/- 0.15) ms, which was significantly larger than that of controls(0.18 +/- 0.07) ms and of patients with SNHL of other origins(0.20 +/- 0.10) ms (P < 0.01). In the group of Meniere's disease, LD in patients with the mild and moderate hearing impairment was larger than those with severe hearing loss(P < 0.01) and LD in patients with low tone or high tone auditory sensation curve was larger than those with flat auditory sensation curve(P < 0.01). Positive rate was 4/60(6.7%) in other SNHL patients and 58/90(64.0%) in Meniere's disease group respectively. CONCLUSION: The increase in condensation and rarefaction click evoked AP latency difference can be an objective parameter in diagnosis of Meniere's disease.     

梅尼埃病听力损失程度和类型对短声诱发的SP/AP比值的影响

目的 :探讨耳蜗电图 (ECoch G)在梅尼埃病诊断中听力损失程度和类型 ,对交替短声诱发的负性总和电位 (SP)与动作电位 (AP)比值 (SP/ AP)的影响。方法 :采用鼓膜电极耳蜗电图描记术 ,对梅尼埃病 90耳 (梅尼埃病组 )和其他原因感音神经性聋 6 0耳 (感音神经性聋组 )及正常听力 5 0耳 (正常对照组 )记录了 AP和 SP各参数 ,对结果进行对照分析。结果 :AP潜伏期 3组差异无显著性 ,AP振幅正常对照组高于梅尼埃病组和感音神经性聋组 (P <0 .0 5 ) ,SP振幅正常对照组高于感音神经性聋组 (P <0 .0 1)而低于梅尼埃病组 (P <0 .0 1)。SP/ AP振幅比值梅尼埃病组 (48.0 9± 14 .38) % ,明显高于感音神经性聋组 (2 0 .0 2± 15 .0 0 ) %和正常对照组 (2 3.85±8.0 5 ) % ,(均 P <0 .0 1)。梅尼埃病组 SP/ AP比值与主观纯音听阈呈正相关 (r =0 .5 6 0 1,P <0 .0 1) ,其异常率为 73%。梅尼埃病不同听力损失组中 ,SP/ AP比值轻度耳聋组低于中度和中重度组 (均 P <0 .0 1) ,后两组差异无显著性意义 (P >0 .0 5 )。低频型低于平坦型 (P <0 .0 5 ) ,高频型和前两型相比差异无显著性意义。结论 :SP/ AP振幅比值异常增大有助于梅尼埃病的临床诊断 ,在一定范围内随听阈提高而增大 ,必须有足够的残余听力才能记录质量好的图形。     

A comparison of electrocochleography and high-pass noise masking of auditory brainstem response for diagnosis of Ménière's disease

Abstract Objective: To study differences between electrocochleography (ECochG) and cochlear hydrops analysis masking procedure (CHAMP) in diagnosis of Ménière's disease. Design: Retrospective case review from a tertiary referral center. Study sample: Thirty patients suspected to have Ménière's disease were assessed by ECochG and CHAMP tests. Results: Positivity of ECochG with SP/AP amplitude ratio >.40 or >.35 was compared with CHAMP V-delay or CHAMP R × D. Positive ECochG results were found in 43% (>.40 SP/AP ratio) and 63% (>.35 SP/AP ratio) of patients, comparing to positive CHAMP V delay in 27% and CHAMP R × D in 30% of patients. A significant difference (p <.01) was found between ECochG and CHAMP in diagnostic sensitivity. Also, a positive inter-aural correlation was found in CHAMP results (p <.003), but not in ECochG (p =.082) results. Conclusions: ECochG is a more sensitive test than CHAMP in detecting the presence of endolymphatic hydrops in Ménière's patients. CHAMP covaried interaurally in unilateral Ménière's patients whereas ECochG did not.