Abouzayd Moumainn, Smith Paul F, Moreau Sylvain, Hitier Martin
Department of Otolaryngology Head and Neck Surgery, CHU de Caen, Caen, France.
Department of Pharmacology and Toxicology, Brain Health Research Centre, University of Otago, Dunedin, New Zealand.
Eur Arch Otorhinolaryngol. 2017 Jan;274(1):53-63. doi: 10.1007/s00405-016-4007-4. Epub 2016 Apr 8.
Vestibular function after cochlear implantation is difficult to understand, as subjective vestibular symptoms seem uncorrelated with the results of objective tests. Consequently, clinicians may struggle to decide what assessments to perform for a symptomatic patient. We used a systematic review and meta-analysis approach to enlighten this point. After a study inclusion process, results were classified into four different groups for each test in each study: (1) 'true positive' if the test showed impairment from pre-operative to post-operative in symptomatic patients; (2) 'false positive' if the test showed impairment from pre-operative to post-operative in asymptomatic patients; (3) 'true negative' if the test showed no impairment in asymptomatic patients; and (4) 'false negative' if the test showed no impairment in symptomatic patients. From these groups, sensitivities and specificities of each test were calculated in a meta-analysis. After reviewing more than 3000 references, 16 studies were included, representing 957 patients. The meta-analysis revealed a sensitivity of 0.21 (CI 95 % 0.08-0.40) for the caloric tests, of 0.32 (CI 95 % 0.15-0.54) for the cervical vestibular evoked myogenic potentials (c-VEMP), and of 0.5 (CI 95 % 0.07-0.93) for the head impulse tests. The analysis of prevalence revealed that c-VEMPs were the most often impaired, and the HIT the most often conserved. Our review and meta-analysis revealed that no vestibular test is sensitive enough to be recommended as a single test. Ideally, all the five vestibular sensors should be tested. In clinical practice, we suggest a case-to-case strategy according to patient's symptoms and their suspected origin.
人工耳蜗植入后的前庭功能难以理解，因为主观前庭症状似乎与客观测试结果无关。因此，临床医生可能难以决定对有症状的患者进行何种评估。我们采用系统评价和荟萃分析的方法来阐明这一点。在研究纳入过程之后，将每项研究中每项测试的结果分为四个不同组：（1）“真阳性”，如果测试显示有症状患者术前到术后出现损伤；（2）“假阳性”，如果测试显示无症状患者术前到术后出现损伤；（3）“真阴性”，如果测试显示无症状患者无损伤；（4）“假阴性”，如果测试显示有症状患者无损伤。从这些组中，在荟萃分析中计算每项测试的敏感性和特异性。在查阅了3000多篇参考文献后，纳入了16项研究，代表957名患者。荟萃分析显示，冷热试验的敏感性为0.21（95%置信区间0.08 - 0.40），颈前庭诱发肌源性电位（c-VEMP）的敏感性为0.32（95%置信区间0.15 - 0.54），摇头试验的敏感性为0.5（95%置信区间0.07 - 0.93）。患病率分析显示，c-VEMP最常受损，摇头试验最常保持正常。我们的综述和荟萃分析表明，没有一种前庭测试足够敏感到可以推荐作为单一测试。理想情况下，所有五个前庭感受器都应该进行测试。在临床实践中，我们建议根据患者的症状及其疑似病因采取个案策略。
