Xu M, Chen Z C, Wei X Y, Zhang Y Z, Yang F Y, Zhang C, Chen F Y, Hu J, Cheng Y, Zhang Q
Department of Otorhinolaryngology Head and Neck Surgery，the Second Affiliated Hospital of Xi'an Jiaotong University，Xi'an，710004，China.
Department of Otolaryngology，Xi'an First People's Hospital.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 Aug;33(8):704-708. doi: 10.13201/j.issn.1001-1781.2019.08.006.
The aim of this study is to evaluate the diagnostic value of vestibular-evoked myogenic potential （cVEMP and oVEMP）, caloric test, and cochlear electrogram （EcochG） in patients with Meniere's disease （MD） and non-Meniere's disease. Sixty-four patients （64 ears） with Unilateral Meniere's disease were enrolled in the study group （MD group）, and 127 cases（254 ears） of non-Meniere's disease patients as non-MD group, including vertigo migraine in 40 cases, benign paroxysmal positional vertigo in 48 cases, benign recurrent vertigo in 13 cases, vestibular paroxysmia in 3 cases, vestibular neuritis in 5 cases and other undiagnosed vertigo in 18 cases. Both group undertake cVEMP, oVEMP, caloric test and ECochG. Use Medcale software to draw ROC curve of ECochG and calculate the area under curve（AUC）, Jordan index and optimal diagnostic cut-off points. Make the cut-off point as the point of -SP/AP, then evaluate the sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV） and diagnostic accuracy of cVEMP, oVEMP, caloric test and ECochG in MD group and non-MD group. The AUC of ECochG ROC curve was 0.74, the Jordan index was 0.47 and the cut-off point was 0.4. The sensitivity and specificity of cVEMP（62% and 68%）, oVEMP（61% and 53%） and caloric test（53% and 57%） were all below ECochG（65% and 78%）. The positive predictive value and of ECochG was the highest（61.9%）, the negative predictive value of cVEMP was highest（87.5%）. The diagnostic accuracy of ECochG was highest（74%）, followed with cVEMP（67%）, oVEMP（55%） and caloric test（56%）. Compared with the vestibular function tests, the sensitivity, specificity, diagnostic accuracy and NPV were all higher in ECochG, and the diagnostic benefit can be maximized when -SP/AP value>0.4. So the value of single vestibular function examination in the diagnosis of Meniere's disease is limited. The diagnosis of MD still requires a comprehensive evaluation in combination with medical history, audiological tests and vestibular function examinations.
本研究旨在评估前庭诱发肌源性电位（颈肌前庭诱发肌源性电位和眼肌前庭诱发肌源性电位）、冷热试验及耳蜗电图在梅尼埃病（MD）患者及非梅尼埃病患者中的诊断价值。研究组纳入64例单侧梅尼埃病患者（64耳）作为MD组，非MD组纳入127例非梅尼埃病患者（254耳），其中包括40例眩晕性偏头痛、48例良性阵发性位置性眩晕、13例良性复发性眩晕、3例前庭阵发症、5例前庭神经炎及18例其他未确诊的眩晕。两组均进行颈肌前庭诱发肌源性电位、眼肌前庭诱发肌源性电位、冷热试验及耳蜗电图检查。使用Medcale软件绘制耳蜗电图的ROC曲线并计算曲线下面积（AUC）、约登指数及最佳诊断切点。以-SP/AP值作为切点，然后评估颈肌前庭诱发肌源性电位、眼肌前庭诱发肌源性电位、冷热试验及耳蜗电图在MD组和非MD组中的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）及诊断准确性。耳蜗电图ROC曲线的AUC为0.74，约登指数为0.47，切点为0.4。颈肌前庭诱发肌源性电位（62%和68%）、眼肌前庭诱发肌源性电位（61%和53%）及冷热试验（53%和57%）的敏感性和特异性均低于耳蜗电图（65%和78%）。耳蜗电图的阳性预测值最高（61.9%），颈肌前庭诱发肌源性电位的阴性预测值最高（87.5%）。耳蜗电图的诊断准确性最高（74%），其次是颈肌前庭诱发肌源性电位（67%）、眼肌前庭诱发肌源性电位（55%）及冷热试验（56%）。与前庭功能检查相比，耳蜗电图的敏感性、特异性、诊断准确性及NPV均更高，当-SP/AP值>0.4时诊断效益可最大化。因此，单项前庭功能检查对梅尼埃病的诊断价值有限。梅尼埃病的诊断仍需结合病史、听力学检查及前庭功能检查进行综合评估。
