Audiology and Neurotology Department, ENT, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Science, Intervention and Technology, ENT Unit, Karolinska Institutet, Stockholm, Sweden.
Audiol Neurootol. 2023;28(3):219-229. doi: 10.1159/000528407. Epub 2023 Jan 12.
The aim of this study was to develop a clinical test for body sounds' hypersensitivity in superior canal dehiscence syndrome (SCDS).
Case-control study, 20 patients affected by SCDS and body sounds' hypersensitivity and 20 control matched subjects tested with a new test called ankle audiometry (AA). The AA consisted of a psychoacoustic hearing test in which the stimulus was substituted by a controlled bone vibration at 125, 250, 500, and 750 Hz, delivered at the medial malleolus by a steel spring-attached bone transducer prototype B250. For each subject, it was defined an index side (the other being non-index), the one with major symptoms in cases or best threshold for each tested frequency in controls. In 3 patients, the AA was measured before and after SCDS surgery.
The AA thresholds for index side were significantly lower in SCDS patients (115.6 ± 10.5 dB force level [FL]) than in control subjects (126.4 ± 8.56 dB FL). In particular, the largest difference was observed at 250 Hz (-16.5 dB). AA thresholds in patients were significantly lower at index side in comparison with non-index side (124.2 ± 11.4 dB FL). The response obtained with 250 Hz stimuli outperformed the other frequencies, in terms of diagnostic accuracy for SCDS. At specific thresholds' levels (120 dB FL), AA showed relevant sensitivity (90%) and specificity (80%) for SCDS. AA did not significantly correlate to other clinical markers of SCDS such as the bone and air conducted hearing thresholds and the vestibular evoked myogenic potentials. The AA thresholds were significantly modified by surgical intervention, passing from 119.2 ± 9.7 to 130.4 ± 9.4 dB FL in 3 patients, following their relief in body sounds' hypersensitivity.
AA showed interesting diagnostic features in SCDS with significantly lower hearing thresholds in SCDS patients when compared to healthy matched subjects. Moreover, AA could identify the affected or more affected side in SCDS patients, with a significant threshold elevation after SCDS surgery, corresponding in body sounds' hypersensitivity relief. Clinically, AA may represent a first objective measure of body sounds' hypersensitivity in SCDS and, accordingly, be an accessible screening test for SCDS in not tertiary audiological centers.
本研究旨在为上半规管裂综合征（SCDS）患者的体声过敏开发一种临床测试。
病例对照研究，20 例 SCDS 患者和体声过敏患者为病例组，20 例匹配的对照受试者为对照组，采用一种新的测试方法，称为踝测听（AA）。AA 包括一个心理声学听力测试，其中刺激被 125、250、500 和 750 Hz 的受控骨振动代替，通过钢弹簧附着的骨换能器原型 B250 施加于内踝。对于每个受试者，定义一个指数侧（另一侧为非指数侧），在病例中为症状更严重的一侧，在对照组中为每个测试频率的最佳阈值。在 3 例患者中，在 SCDS 手术前后测量了 AA。
SCDS 患者的 AA 阈值（115.6±10.5dB 力级）明显低于对照组（126.4±8.56dB FL）。特别是，在 250Hz 时观察到最大差异（-16.5dB）。与非指数侧相比，SCDS 患者的指数侧 AA 阈值明显更低（124.2±11.4dB FL）。以 250Hz 刺激获得的响应在诊断 SCDS 的准确性方面优于其他频率。在特定阈值水平（120dB FL），AA 对 SCDS 具有显著的敏感性（90%）和特异性（80%）。AA 与 SCDS 的其他临床标志物如骨导和气导听力阈值以及前庭诱发肌源性电位无显著相关性。在 3 例患者中，手术干预后，AA 阈值从 119.2±9.7 显著升高至 130.4±9.4dB FL，同时体声过敏缓解。
AA 在 SCDS 中显示出有趣的诊断特征，与健康匹配的对照组相比，SCDS 患者的听力阈值明显降低。此外，AA 可以识别 SCDS 患者的受累或更受累侧，SCDS 手术后阈值显著升高，与体声过敏缓解相对应。临床上，AA 可能是 SCDS 体声过敏的第一个客观测量指标，因此，在非三级听力中心，AA 可能是一种用于筛查 SCDS 的可行测试。
