前庭诱发肌源性电位和耳蜗电图对急性低频感音神经性聋预后的预判价值

Value of vestibular evoked myogenic potentials and electrocochleography in predicting the prognosis of acute low-frequency sensorineural hearing loss

摘要:

目的 探讨前庭诱发肌源性电位和耳蜗电图对急性低频感音神经性聋（acute low frequency sensorineural hearing loss，ALFHL）预后的预判价值。方法 收集 2020年1月至2022年6月在重庆医科大学附属第一医院耳鼻咽喉科住院的60例单侧首次ALFHL患者的病历资料。所有患者入院后行耳蜗电图（electrocochleography ，EcochG）、眼性前庭诱发肌源性电位（ocular vestibular evoked myogenic potential，oVEMP）、颈性前庭诱发肌源性电位（cervical vestibular evoked myogenic potential，cVEMP）检查；于治疗开始前，治疗后1周、2周和1月行纯音测听检测。EcochG-SP/AP>0.4和SP/AP面积比>1.92为异常。cVEMP和oVEMP波形引出与否，振幅比（≤1.61）和不对称比（≤0.29），其中任何一项异常为异常。各组间率的比较采用卡方检验、McNemar检验和Mann-Whitney检验，ALFHL预后的危险因素分析采用单因素和多因素二元 logistic 回归分析。结果 60例ALFHL患者中，EcochG、cVEMP和oVEMP异常率分别为26.7%、23.3%和35.0%。EcochG和oVEMP异常率与患者年龄、性别、听力损失水平、治疗起始时间、有无伴耳闷和头晕无相关性。cVEMP异常率在听力损失>40dB HL的ALFHL中显著高于≤40 dB HL的患者（P<0.05）。EcochG、cVEMP和oVEMP异常的患者听力提高程度均低于其正常的患者（P<0.05）。单因素二元logistic回归分析发现，异常的EcochG、cVEMP和oVEMP是ALFHL不痊愈的危险因素（均P<0.05），而多因素二元logistic回归分析发现仅cVEMP和oVEMP是ALFHL不痊愈的独立危险因素（均P<0.05）。结论 异常的cVEMP和oVEMP是ALFHL患者不痊愈的独立危险因素，这可能与ALFHL患者球囊和椭圆囊内淋巴积水严重不易消退有关。检查cVEMP和oVEMP发现其异常，提示ALFHL患者不痊愈风险大。

Abstract:

Objective To investigate the value of vestibular evoked myogenic potentials（VEMPs） and electrocochleography（EcochG） in predicting the prognosis of acute low-frequency sensorineural hearing loss（ALFHL）.Methods Medical records were collected from 60 patients with first-time unilateral ALFHL who were hospitalized in Department of Otolaryngology，The First Affiliated Hospital of Chongqing Medical University from January 2020 to June 2022. All patients underwent the examinations of EcochG，ocular vestibular evoked myogenic potentials（oVEMP），and cervical vestibular evoked myogenic potentials（cVEMP） after admission，and pure tone audiometry was performed before treatment and at 1 week，2 weeks，and 1 month after treatment. An EcochG SP/AP ratio of >0.4 and an SP/AP area ratio of >1.92 were considered abnormal. If cVEMP and oVEMP were not elicited or if the amplitude ratio was ≤1.61 and the asymmetry ratio was ≤0.29，it was considered abnormal. The chi-square test，the McNemar test，and the Mann-Whitney test were used for comparison of rates between groups，and univariate and multivariate binary logistic regression analyses were used to identify the risk factors for the prognosis of ALFHL.Results The abnormal rates of EcochG，cVEMP，and oVEMP were 26.7%，23.3%，and 35.0%，respectively，in the 60 patients with ALFHL. The abnormal rates of EcochG and oVEMP showed no correlation with age，sex，hearing loss level，starting time of treatment，aural fullness，and dizziness. The abnormal rate of cVEMP in the ALFHL patients with hearing loss >40 dB HL was significantly higher than that in the patients with hearing loss ≤40 dB HL（P<0.05）. The patients with abnormal EcochG，cVEMP，and oVEMP had a significantly lower degree of hearing improvement than those with normal results（P<0.05）. The univariate binary logistic regression analysis showed that abnormal EcochG，cVEMP，and oVEMP were risk factors for non-recovery of ALFHL（all P<0.05），while the multivariate binary logistic regression analysis showed that cVEMP and oVEMP were independent risk factors for non-recovery of ALFHL（both P<0.05）.Conclusion Abnormal cVEMP and oVEMP are independent risk factors for non-recovery of ALFHL，which may be associated with the difficulty in the regression of hydrops in the saccule and utricle of ALFHL patients. The detection of abnormal cVEMP and oVEMP indicates a high risk of non-recovery in patients with ALFHL.