Application of vestibular function examination battery in the staging of vestibular function in Meniere's disease
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摘要: 目的 以前庭功能检查组合为基础探讨梅尼埃病患者前庭器官损害的分期。方法 39例临床确诊为单侧梅尼埃病的患者均行各项听力学检查、前庭功能检查组合：眼源性前庭诱发肌源性电位(oVEMP)、颈源性前庭诱发肌源性电位(cVEMP)、冷热试验。以前庭功能检查组合的结果为基础，将前庭功能分为4期，Ⅰ期：oVEMP、cVEMP、冷热试验均正常；Ⅱ期：oVEMP、cVEMP、冷热试验任一项检查异常；Ⅲ期：oVEMP、cVEMP、冷热试验任两项检查异常；Ⅳ期：oVEMP、cVEMP、冷热试验均异常。结果 39例梅尼埃病患者按本研究前庭功能分期，Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者分别为7.7%(3/39)、30.8%(12/39)、33.3%(13/39)、28.2%(11/39)。依现行梅尼埃病分期，一期、二期、三期、四期患者分别占20.5%(8/39)、43.6%(17/39)、28.2%(11/39)、7.7%(3/39)。一期37.5%(3/8)和二期64.7%(11/17)梅尼埃病患者的前庭靶器官已出现两个及以上的前庭器官功能异常，而梅尼埃病达到四期时全部患者的半规管、球囊、椭圆囊均出现功能异常。本组患者前庭功能分期与梅尼埃病分期分布具有相关性(P < 0.05)。结论 联合oVEMP、cVEMP、冷热试验的前庭功能检查组合，将前庭功能分为4期，可作为传统梅尼埃病以听力为基础的临床分期下患者前庭功能评估的补充。Abstract: Objective To investigate the staging of vestibular organ damage in Meniere's disease, based on the vestibular function examination battery.Methods Thirty-nine patients, clinically diagnosed as unilateral Meniere's disease, underwent audiologic test and vestibular function examination battery, including ocular vestibular evoked myogenic potential(oVEMP), cervical vestibular evoke myogenic potential(cVEMP), and caloric tests. Based on the results of the vestibular function examination battery, the vestibular function was divided into 4 stages. StageⅠ: oVEMP, cVEMP, and caloric tests were normal; stage Ⅱ: any one test of the three examinations was abnormal; stage Ⅲ: two of the three examinations were abnormal; Stage Ⅳ: All the three examinations were abnormal.Results According to the vestibular function staging strategy in this study, patients in stage Ⅰ, Ⅱ, Ⅲ, Ⅳ were 7.7%(3/39), 30.8%(12/39), 33.3%(13/39), 28.2%(11/39) respectively in the 39 Meniere's disease patients. However, according to the current clinical staging strategy of Meniere's disease, patients of stage 1, 2, 3, 4 were 20.5%(8/39), 43.6%(17/39), 28.2%(11/39), and 7.7%(3/39) respectively. 37.5%(3/8) patients in stage 1 and 64.7%(11/17) patients in stage 2 had two or more abnormal vestibular organs. While all the patients in stage 4 had abnormal semicircular canals, utricle, and saccule. The stage of vestibular function was correlated with the distribution of current clinical staging strategy of Meniere's disease(P < 0.05).Conclusion The combination of oVEMP, cVEMP and caloric tests can divide the vestibular function into four stages, which can be used as a supplement to the traditional vestibular evaluation and clinical staging based on audiology in Meniere's disease.
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表 1 梅尼埃病患者不同临床分期与前庭功能分期的比较(n=39)
例 临床分期 前庭功能分期 P Ⅰ期 Ⅱ期 Ⅲ期 Ⅳ期 合计 一期 2 3 2 1 8 0.011 二期 1 5 8 3 17 三期 0 4 3 4 11 四期 0 0 0 3 3 
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