Outcome of otolith organ function after treatment of sudden sensorineural hearing loss
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摘要: 目的 探讨突发性聋(突聋)治疗后耳石器功能转归情况，以明确突聋患者治疗后内耳病损的恢复情况及预后判断指标。方法 随访24例突聋患者的听力及眼肌前庭诱发肌源性电位(oVEMP)和颈肌前庭诱发肌源性电位(cVEMP)恢复情况。结果 24例患者，治疗前oVEMP无反应5例，cVEMP无反应8例，oVEMP及cVEMP均无反应11例。治疗后共7例患者表现出oVEMP和/或cVEMP波形恢复，其中3例oVEMP恢复反应，1例cVEMP恢复反应，3例oVEMP及cVEMP均恢复反应。根据治疗后VEMP是否恢复分为恢复组和未恢复组，两组间治疗后听力水平及听力改善程度的差异均有统计学意义(P < 0.01)。多元Logistic回归分析显示，VEMP恢复是影响突聋预后的独立危险因素。结论 VEMP能够检测部分突聋患者的耳石器功能损伤并动态监测其转归，VEMP恢复是影响突聋预后的独立危险因素，对判断预后及确定治疗周期具有重要意义。
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关键词:
- 听觉丧失，突发性 /
- 眼肌前庭诱发肌源性电位 /
- 颈肌前庭诱发肌源性电位 /
- 预后
Abstract: Objective This study aimed to assess the clinical practice value of ocular vestibular evoked myogenic potential(oVEMP) and cervical vestibular evoked myogenic potential(cVEMP) in monitoring the rehabilitation of vestibular function in patients with suddensen sorineural hearing loss(SSHL). Method Twenty-four patients with SSHL were retrospectively enrolled, showing no VEMP response on the affected side but exhibiting VEMP responses after therapies We analyzed the improvement and the restoration of hearing and the parameters of VEMP response. Result After treatment, seven patients showed VEMP recovery, including three cases with both oVEMP and cVEMP recovery, three cases with oVEMP recovery, and one case with cVEMP recovery. Between VEMP recoved group and VEMP unrecoved group, before treatment, no significant difference was found in the thresholds of pure-tone audiometry(PTA). However, after treatment, VEMP recoved group exhibited lower PTA thresholds and better PTA shift (P < 0.01). Multivariate analysis revealed that recovery of VEMP was the independent risk factor for the therapeutic effect of SSHL. Conclusion The Combination of oVEMP and cVEMP is an objective tool for assessing vestibular otolithic end organ function during dynamic functional recovery in SSHL and the recovery of VEMP could predict the auditory improvement. -
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表 1 伴眩晕组及不伴眩晕组病例特点及疗效
组别 例数 年龄/岁 性别 分型 PTA/dB 疗效 男 女 高频型 低频型 平坦型 全聋型 治疗前 治疗后 痊愈 显效 有效 无效 不伴眩晕组 14 50±15 7 7 3 2 5 4 70 ± 13 54 ± 17 0 1 7 6 伴眩晕组 9 44±17 4 5 2 1 4 2 75 ± 16 65 ± 30 0 2 0 7 P 0.39 1.0 1.0 0.51 0.24 0.03 
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表 2 VEMP恢复组及未恢复组临床特点及治疗前后PTA
组别 例数 年龄/岁 性别 是否眩晕 分型 PTA/dB 男 女 是 否 头昏 高频型 低频型 平坦型 全聋型 治疗前 治疗后 ΔPTA 恢复组 7 47±17 4 3 2 5 0 2 0 4 1 68±13 37±15 31±11 未恢复组 17 48±15 7 10 8 8 1 3 3 6 5 73±15 66±20 7±12 P 0.83 0.66 0.41 - 0.47 0.44 < 0.01 < 0.01
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表 3 突聋治疗后VEMP恢复形式及时间
例序 性别 年龄/岁 侧别 分型 是否
眩晕PTA/dB oVEMP cVEMP 治疗前 治疗后 治疗前 治疗后 恢复时间 治疗前 治疗后 恢复时间 1 女 61 左 全聋型 否 91 63 - + 1周 - + 1周 2 女 49 右 平坦型 否 58 43 - + 1个月 + + 0 3 男 36 左 高频型 否 71 43 - + 1周 + + 0 4 女 71 右 平坦型 否 73 41 - + 12个月 + + 0 5 女 50 左 平坦型 是 58 23 + + 0 - + 12个月 6 男 43 右 平坦型 否 53 25 - + 18个月 - + 18个月 7 男 17 右 高频型 是 73 20 - + 1个月 - + 1个月 注：+，引出；-，未引出。
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表 4 Logistic多因素回归分析结果
以治疗前后PTA的差值(dB)为预后指标 以治疗前后PTA变化的百分比(%)为预后指标 VEMP恢复 性别 年龄/岁 病程/d 眩晕 分型 VEMP恢复 性别 年龄/岁 病程/d 眩晕 分型 回归系数(B) -18.117 -4.951 0.241 0.739 8.045 2.899 -0.285 -0.093 0.004 0.01 0.114 0.058 标准误 6.230 5.652 0.199 0.433 5.103 3.892 0.089 0.081 0.003 0.006 0.073 0.056 标准回归系数 -0.527 -0.158 0.230 0.330 0.249 0.141 -0.557 -0.200 0.264 0.293 0.236 0.190 t -2.908 -0.876 1.210 1.705 1.576 0.745 -3.205 -1.157 1.442 1.574 1.558 1.044 P 0.010 0.393 0.243 0.106 0.133 0.467 0.005 0.263 0.167 0.134 0.138 0.311
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