Ciccone M M, Scicchitano P, Gesualdo M, Cortese F, Zito A, Manca F, Boninfante B, Recchia P, Leogrande D, Viola D, Damiani M, Gambacorta V, Piccolo A, De Ceglie V, Quaranta N
Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
Department of Science of Educational, Psicology and Communication, University of Bari, Bari, Italy.
Clin Otolaryngol. 2018 Feb;43(1):230-239. doi: 10.1111/coa.12947. Epub 2017 Sep 5.
To evaluate the influence of cerebral venous drainage on the pathogenesis of idiopathic sudden sensorineural hearing loss (ISSHL) and Ménière syndrome (MD).
Observational, prospective, cohort study.
ENT and Cardiology Departments (University of Bari, Policlinico Hospital, Bari, Italy).
We enrolled 59 consecutive patients (32 males, mean age 53.05 + 15.37 years): 40 ISSHL and 19 MD.
All patients underwent physical examination, biochemical evaluation (glycemic and lipid profile, viral serology, C reactive protein, etc), audiometric (tonal, vocal, vestibular evoked myogenic potentials and auditory brainstem response test) and impedentiometric examination. The pure tone average (PTA) was calculated for the following frequencies: 250, 500, 1000, 2000, 3000, 4000, 8000. An echo-color Doppler evaluation of the venous cerebral veins, internal jugular (IJV) and vertebral veins (VV) at supine and 90° position was performed.
No morphological alterations were found both in patients and controls. There were no signs of stenosis, blocked flow, membranes, etc. We found lower minimum, mean and maximum velocities in distal IJVs (P = .019; P = .013; P = .022; respectively) and left VVs (P = .027; P = .008; P = .001; respectively) in supine (0°) position in both MD and ISSHL patients as compared to controls. The same was for orthostatic position (90°). We found negative correlations between the velocities in extracranial veins and PTA values: therefore, the worst the audiometric performance of the subjects, the lower the velocities in the venous cerebral drainage.
Idiopathic sudden sensorineural hearing loss and Ménière syndrome patients showed altered venous flow in IJVs and VVs as compared to controls, independently from posture. This different behavior of venous tone control can influence the ear performance and may have a role in the pathogenesis of both diseases.
评估脑静脉引流对特发性突发性感音神经性听力损失（ISSHL）和梅尼埃病（MD）发病机制的影响。
观察性、前瞻性队列研究。
耳鼻喉科和心脏病科（意大利巴里大学综合医院）。
我们连续纳入了59例患者（32例男性，平均年龄53.05±15.37岁）：40例ISSHL患者和19例MD患者。
所有患者均接受了体格检查、生化评估（血糖和血脂谱、病毒血清学、C反应蛋白等）、听力测定（纯音、言语、前庭诱发肌源性电位和听觉脑干反应测试）以及声阻抗检查。计算以下频率的纯音平均听阈（PTA）：250、500、1000、2000、3000、4000、8000。对仰卧位和90°体位下的脑静脉、颈内静脉（IJV）和椎动脉（VV）进行了彩色多普勒超声评估。
患者和对照组均未发现形态学改变。没有狭窄、血流受阻、膜等迹象。我们发现，与对照组相比，MD和ISSHL患者在仰卧位（0°）时，远端IJV（分别为P = 0.019；P = 0.013；P = 0.022）和左侧VV（分别为P = 0.027；P = 0.008；P = 0.001）的最小、平均和最大流速较低。立位（90°）时情况相同。我们发现颅外静脉流速与PTA值之间存在负相关：因此，受试者的听力测定表现越差，脑静脉引流的流速越低。
与对照组相比，特发性突发性感音神经性听力损失和梅尼埃病患者的IJV和VV血流改变，与体位无关。静脉张力控制的这种不同表现可能会影响耳部功能，并且可能在这两种疾病的发病机制中起作用。
