Shen Jiali, Ma Xiaobao, Zhang Qing, Chen Jianyong, Wang Lu, Wang Wei, He Kuan, Sun Jin, Zhang Qin, Chen Xiangping, Duan Maoli, Jin Yulian, Yang Jun
Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
ENT Department, Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China.
Front Neurol. 2023 Jul 20;14:1237516. doi: 10.3389/fneur.2023.1237516. eCollection 2023.
The cause of idiopathic sudden sensorineural hearing loss (ISSNHL) remains unknown. It has been found that the functional status of the vestibular otolith is relevant to its prognosis; however, the evaluation of the vestibular otolith (intra-labyrinth) and superior and inferior vestibular nerve pathways (retro-labyrinth) in ISSNHL patients is not well-documented.
This study aimed to investigate the functional status of the vestibular otolith and conductive pathway in patients with unilateral ISSNHL and analyze the correlations between vestibular evoked myogenic potentials (VEMPs) and hearing improvement after treatment.
A total of 50 patients with unilateral ISSNHL underwent a battery of audio-vestibular evaluations, including pure tone audiometry, middle ear function, air-conducted sound-cervical VEMP (ACS-cVEMP), ACS-ocular VEMP (ACS-oVEMP), galvanic vestibular stimulation-cervical VEMP (GVS-cVEMP), and GVS-ocular VEMP (GVS-oVEMP). The results of auditory and VEMPs were retrospectively analyzed.
The abnormal rates of ACS-cVEMP, ACS-oVEMP, GVS-cVEMP, and GVS-oVEMP in affected ears were 30, 52, 8, and 16%, respectively. In affected ears, the abnormal rate of ACS-oVEMP was significantly higher than that of ACS-cVEMP ( = 0.025), while it was similar between GVS-cVEMP and GVS-oVEMP ( = 0.218). Compared with GVS-cVEMP, affected ears presented with a significantly higher abnormal rate of ACS-cVEMP ( = 0.005), and the abnormal rate of ACS-oVEMP was significantly higher than that of GVS-oVEMP ( < 0.001). No significant difference existed in latency and amplitude between affected and unaffected ears in ACS-VEMPs or GVS-VEMPs ( > 0.05). The abnormal rate of VEMPs in the poor recovery group was significantly higher than that of the good recovery group ( = 0.040). The abnormality percentages of ACS-oVEMP and GVS-oVEMP in the poor recovery group were significantly higher than that of the good recovery group ( = 0.004 and 0.039, respectively). The good hearing recovery rates were 76.47% in the normal VEMPs group, 58.33% in the intra-labyrinth lesion group, and 22.22% in the retro-labyrinth lesion group. Hearing recovery worsened as a greater number of abnormal VEMPs was presented.
Besides Corti's organ, the impairment of otolithic organs was prominent in patients with ISSNHL. The normal VEMPs group had the highest rate of good recovery, followed by the intra-labyrinth lesion group and the retro-labyrinth lesion group presented with the lowest recovery rate. Abnormalities in ACS-oVEMP and/or GVS-oVEMP were indicators of a poor prognosis.
特发性突发性感音神经性听力损失（ISSNHL）的病因尚不清楚。已发现前庭耳石的功能状态与其预后相关；然而，关于ISSNHL患者前庭耳石（迷路内）及前庭上下神经通路（迷路后）的评估报道较少。
本研究旨在探讨单侧ISSNHL患者前庭耳石及传导通路的功能状态，并分析前庭诱发肌源性电位（VEMP）与治疗后听力改善之间的相关性。
共50例单侧ISSNHL患者接受了一系列听-前庭评估，包括纯音听力测定、中耳功能、气导声音-颈肌VEMP（ACS-cVEMP）、ACS-眼肌VEMP（ACS-oVEMP）、直流电前庭刺激-颈肌VEMP（GVS-cVEMP）和GVS-眼肌VEMP（GVS-oVEMP）。对听觉和VEMP结果进行回顾性分析。
患耳中ACS-cVEMP、ACS-oVEMP、GVS-cVEMP和GVS-oVEMP的异常率分别为30%、52%、8%和16%。在患耳中，ACS-oVEMP的异常率显著高于ACS-cVEMP（P = 0.025），而GVS-cVEMP和GVS-oVEMP之间相似（P = 0.218）。与GVS-cVEMP相比，患耳中ACS-cVEMP的异常率显著更高（P = 0.005），且ACS-oVEMP的异常率显著高于GVS-oVEMP（P < 0.001）。在ACS-VEMPs或GVS-VEMPs中，患耳与未患耳之间的潜伏期和波幅无显著差异（P > 0.05）。恢复较差组的VEMP异常率显著高于恢复良好组（P = 0.040）。恢复较差组中ACS-oVEMP和GVS-oVEMP的异常率显著高于恢复良好组（分别为P = 0.004和0.039）。VEMP正常组的听力良好恢复率为76.47%，迷路内病变组为58.33%，迷路后病变组为22.22%。出现异常VEMP的数量越多，听力恢复越差。
除柯蒂氏器外，ISSNHL患者的耳石器官损害也较为突出。VEMP正常组的良好恢复率最高，其次是迷路内病变组，迷路后病变组的恢复率最低。ACS-oVEMP和/或GVS-oVEMP异常是预后不良的指标。
