Califano L, Salafia F, Melillo M G, Mazzone S
SSD di Audiologia e Foniatria, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy.
Acta Otorhinolaryngol Ital. 2017 Aug;37(4):336-340. doi: 10.14639/0392-100X-1284.
The objectives of this study were to identify signs of vestibular nerve suffering through a bedside vestibular examination protocol in case of sudden sensorineural unilateral hearing loss without spontaneous signs of vestibular impairment and to propose a bed-side vestibular examination based protocol for the focused execution of gadolinium-enhanced magnetic resonance imaging (MRI) only if a vestibular schwannoma is suspected. 96 patients, 52 men, 44 women, mean age 57.73 +/- 12.85 years, suffering from sudden sensorineural unilateral hearing loss, which presented neither vertigo nor spontaneous nystagmus, were enrolled. Pure tone audiometry, tympanometry, measurement of acoustic reflexes and Anderson test to detect adaptation, bedside vestibular examination through head shaking test, vibration test, head impulse test, hyperventilation test and detection of nystagmus in supine and lateral decubitus to search for signs of vestibular impairment were performed. Patients with signs of vestibular impairment and pure tone audiometry threshold at high frequencies better than 70 dB nHL were subjected to auditory brainstem responses. Gadolinium enhanced MRI centred on internal acoustic canals was carried out in all patients with sudden sensorineural unilateral hearing loss. Main outcome measures were signs of vestibular impairment at vestibular bedside examination and presence of vestibular schwannoma on MRI. Signs of vestibular impairment were detected in 22/96 cases (22.9%); a vestibular schwannoma was detected by MRI in 5/96 cases (5.2%), always when vestibular impairment was present. In case of sudden sensorineural unilateral hearing loss, vestibular bedside examination seems to be useful to restrict the suspicion of a vestibular schwannoma to cases with signs of vestibular impairment, reducing the number of MRI exams, with considerable economic savings.
本研究的目的是，在突发单侧感音神经性听力损失且无自发前庭损害体征的情况下，通过床边前庭检查方案来识别前庭神经受损的迹象，并仅在怀疑存在前庭神经鞘瘤时，提出一种基于床边前庭检查的方案，用于有针对性地进行钆增强磁共振成像（MRI）检查。纳入了96例突发单侧感音神经性听力损失的患者，其中男性52例，女性44例，平均年龄57.73±12.85岁，这些患者既无眩晕也无自发眼震。进行了纯音听力测定、鼓室图、声反射测量以及用于检测适应性的安德森试验，通过摇头试验、振动试验、头脉冲试验、过度通气试验以及在仰卧位和侧卧位检测眼震来进行床边前庭检查，以寻找前庭损害的迹象。对有前庭损害迹象且高频纯音听力测定阈值优于70 dB nHL的患者进行听性脑干反应检查。对所有突发单侧感音神经性听力损失的患者进行了以内耳道为中心的钆增强MRI检查。主要观察指标为床边前庭检查时的前庭损害迹象以及MRI上是否存在前庭神经鞘瘤。96例中有22例（22.9%）检测到前庭损害迹象；MRI检测到5例（5.2%）前庭神经鞘瘤，且均在前庭损害存在时发现。对于突发单侧感音神经性听力损失，床边前庭检查似乎有助于将前庭神经鞘瘤的怀疑范围限制在前庭损害迹象的病例中，减少MRI检查的数量，从而节省大量费用。
