Department of Otolaryngology-Head and Neck Surgery and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Otol Neurotol. 2021 Jul 1;42(6):e735-e743. doi: 10.1097/MAO.0000000000003084.
Ocular vestibular evoked myogenic potentials (oVEMP) testing in response to air-conducted sound (ACS) has excellent sensitivity and specificity for superior semicircular canal dehiscence syndrome (SCDS). However, patients with SCDS may experience vertigo with the test, and recent works recommend minimizing acoustic energy during VEMP testing.
To develop an oVEMP protocol that reduces discomfort and increases safety without compromising reliability.
Subjects: Fifteen patients diagnosed with SCDS based on clinical presentation, audiometry, standard VEMP testing, and computed tomography (CT) imaging. There were 17 SCDS-affected ears and 13 unaffected ears. In nine (53%) of the SCDS-affected ears surgical repair was indicated, and SCD was confirmed in each. oVEMPs were recorded in response to ACS using 500 Hz tone bursts or clicks. oVEMP amplitudes evoked by 100 stimuli (standard protocol) were compared with experimental protocols with only 40 or 20 stimuli.
In all three protocols, oVEMP amplitudes in SCDS-affected ears were significantly higher than in the unaffected ears (p < 0.001). 500 Hz tone bursts evoked oVEMPs with excellent (>90%) sensitivity and specificity in each of the three protocols. However, in the unaffected ears, lowering to 20 stimuli reduced the detection of oVEMP responses in some ears. Following surgical repair, oVEMPs normalized in each of the protocols.
In oVEMP testing using ACS for SCDS, reducing the number of trials from 100 to 40 stimuli results in a more tolerable and theoretically safer test without compromising its effectiveness for the diagnosis of SCDS. Reducing to 20 stimuli may degrade specificity with clicks.
针对上半规管裂综合征（SCDS），空气传导声诱发的眼肌前庭诱发肌源性电位（oVEMP）检测具有出色的敏感性和特异性。然而，SCDS 患者在接受测试时可能会出现眩晕，最近的研究建议在 VEMP 测试中尽量减少声能。
开发一种 oVEMP 方案，在不影响可靠性的前提下，减轻不适感并提高安全性。
研究对象：根据临床表现、听力测试、标准 VEMP 测试和计算机断层扫描（CT）成像诊断为 SCDS 的 15 例患者。共有 17 只 SCDS 受累耳和 13 只未受累耳。在 SCDS 受累耳中，有 9 只（53%）需要手术修复，且每只均证实存在 SCD。使用 500 Hz 短音或 click 刺激，记录 ACS 诱发的 oVEMP。将 100 次刺激（标准方案）诱发的 oVEMP 振幅与仅 40 次或 20 次刺激的实验方案进行比较。
在所有三种方案中，SCDS 受累耳的 oVEMP 振幅均明显高于未受累耳（p<0.001）。在三种方案中，500 Hz 短音均可诱发 oVEMP，具有很好的敏感性（>90%）和特异性。然而，在未受累耳中，降至 20 次刺激会降低一些耳中 oVEMP 反应的检测率。手术后，每种方案中的 oVEMP 均恢复正常。
在使用 ACS 进行 SCDS 的 oVEMP 测试中，将测试次数从 100 次减少到 40 次，可使测试更耐受，从理论上更安全，而不会影响其诊断 SCDS 的有效性。减少到 20 次刺激可能会降低 click 时的特异性。
