Kunel'skaya N L, Baybakova E V, Guseva A L, Chugunova M A, Manaenkova E A
L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152; N.I .Pirogov Russian National Research Medical University, Moscow, Russia, 117997.
L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152.
Vestn Otorinolaringol. 2017;82(4):5-8. doi: 10.17116/otorino20178245-8.
The objective of the present study was to evaluate the otolith function in the patients presenting with idiopathic benign paroxysmal positional vertigo (pBPPV) attributable to the occlusion of the posterior semicircular canal (PSCC) of the inner ear with the use of vestibular evoked myogenic potentials (VEMP). Cervical (cVEMP) and ocular VEMP (oVEMP) were measured in 34 patients with idiopathic pBPPV before and 7 days after the treatment by means of reposition maneuvers. The results of the repeated Dix-Hallpike test performed 7 days after the repositioning maneuver were negative in 27 patients and positive in 7 patients. There was no statistically significant difference in the amplitude of cervical VEMP between the healthy and affected ears either before or after the repositioning treatment. The measurement of oVEMP revealed a reduction of the response amplitude on the affected side. The average values of the plnl on the healthy side were 12.84±1.09 and those on the affected side 4.62±0.69 (p<0,05). The successful repositioning treatment resulted in a significant increase of the oVEMP amplitude on the affected side (p<0,05). In the patients presenting with the persistent symptoms of pBPPV, the repositioning maneuvers did not cause an appreciable increase in the amplitude of oVEMP on the affected side (p<0.05). The results of the present study give evidence that pBPPV of the posterior semicircular canal is associated with the impairment of the function of the receptor structures of the utriculus and the preserved function of the succulus as suggested by the reduction of the oVEMP amplitude and clinically significant asymmetry of ocular VEMP on the affected side with intact cervical VEMP on both sides. The successful treatment of pBPPV of PSCC with the use of the liberatory maneuver results in the increase of the oVEMP amplitude on the affected side increases while the response asymmetry between both sides significantly decreases which indicates the repair of the utriculus otolith function.
本研究的目的是利用前庭诱发肌源性电位（VEMP）评估特发性良性阵发性位置性眩晕（pBPPV）患者内耳后半规管（PSCC）阻塞时的耳石功能。对34例特发性pBPPV患者在复位手法治疗前及治疗后7天测量颈肌（cVEMP）和眼肌VEMP（oVEMP）。复位手法治疗7天后重复进行的Dix-Hallpike试验结果在27例患者中为阴性，7例患者为阳性。复位治疗前后，患侧与健侧的颈肌VEMP振幅均无统计学显著差异。oVEMP测量显示患侧反应振幅降低。健侧的plnl平均值为12.84±1.09，患侧为4.62±0.69（p<0.05）。成功的复位治疗导致患侧oVEMP振幅显著增加（p<0.05）。在pBPPV症状持续的患者中，复位手法未导致患侧oVEMP振幅明显增加（p<0.05）。本研究结果表明，后半规管pBPPV与椭圆囊受体结构功能受损及球囊功能保留有关，这表现为oVEMP振幅降低以及患侧眼肌VEMP临床上显著不对称，而双侧颈肌VEMP正常。采用解脱手法成功治疗PSCC的pBPPV可导致患侧oVEMP振幅增加，同时两侧反应不对称性显著降低，这表明椭圆囊耳石功能得到修复。
