Department of Otolaryngology-Head and Neck Surgery, Second Xiangya Hospital, Central South University, Changsha 410011.
Clinical Medical Research Center for Otology in Hunan Province, Changsha 410011.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2024 May 28;49(5):679-686. doi: 10.11817/j.issn.1672-7347.2024.230578.
Acoustic neuroma (AN) is a benign tumor that usually affects a patient's hearing and balance function. For the screening and diagnosis of AN, the traditional approach mainly relies on audiological examination and magnetic resonance imaging (MRI), often ignoring the importance of vestibular function assessment in the affected area. As an emerging method of vestibular function detection, video head impulse test (vHIT) has been widely used in clinic, but research on its use in AN diagnosis is relatively limited. This study aims to explore the value of vHIT in the diagnosis of AN, vestibular dysfunction assessment, and postoperative compensation establishment in unilateral AN patients undergoing unilateral AN resection through labyrinthine approach.
This retrospective study was conducted on 27 AN patients who underwent unilateral AN resection via labyrinthine approach from October 2020 to March 2022 in the Department of Otolaryngology-Head and Neck Surgery, the Second Xiangya Hospital, Central South University. vHIT was performed 1 week before surgery to assess vestibular function, pure tone audiometry (PTA) was used to assess hearing level, and ear MRI was used to assess tumor size. Follow-up vHIT was conducted at 1 week, 1 month, 6 months, and 1 year post-surgery. The correlation of vHIT with hearing and tumor size was analyzed.
Preoperative vHIT showed that the posterior semicircular canal on the affected side was the most common semicircular canal with reduced vestibulo-ocular reflex (VOR) gain. There was a correlation between the VOR gain of vHIT on the affected side and the hearing level (=-0.47, <0.05) or tumor size (=-0.54, <0.01). The results of vHIT on the affected side showed that the hearing level and mean VOR gain of the anterior semicircular canal increased slightly with time, and the amplitude and saccade percentage of the dominant saccades of the 3 semicircular canals increased, while the latency time decreased, with the most obvious changes occurring 1 week post-surgery.
vHIT can effectively monitor the changes of vestibular function in AN patients before and after surgery and has application value in assisting the diagnosis of vestibular dysfunction in AN patients.
听神经瘤（AN）是一种良性肿瘤，通常会影响患者的听力和平衡功能。对于 AN 的筛查和诊断，传统方法主要依赖于听力学检查和磁共振成像（MRI），往往忽略了受影响区域前庭功能评估的重要性。视频头脉冲试验（vHIT）作为一种新兴的前庭功能检测方法，已在临床上广泛应用，但关于其在 AN 诊断中的应用研究相对较少。本研究旨在通过迷路入路单侧 AN 切除术探讨 vHIT 在单侧 AN 患者中的诊断价值、前庭功能障碍评估以及术后单侧 AN 患者前庭代偿的建立。
回顾性分析 2020 年 10 月至 2022 年 3 月中南大学湘雅二医院耳鼻咽喉头颈外科 27 例行迷路入路单侧 AN 切除术的 AN 患者的临床资料。所有患者于术前 1 周内行 vHIT 检查以评估前庭功能，行纯音测听（PTA）以评估听力水平，行耳部 MRI 以评估肿瘤大小。术后 1 周、1 个月、6 个月及 1 年分别进行随访 vHIT。分析 vHIT 与听力及肿瘤大小的相关性。
术前 vHIT 显示，患侧后半规管的前庭眼反射（VOR）增益降低最为常见。患侧 vHIT 的 VOR 增益与听力水平（=-0.47，<0.05）或肿瘤大小（=-0.54，<0.01）呈负相关。患侧 vHIT 结果显示，术后随时间推移，前半规管的听力水平和平均 VOR 增益略有升高，3 个半规管的优势扫视的振幅和扫视百分比增加，潜伏期时间缩短，术后 1 周时变化最明显。
vHIT 能有效监测 AN 患者术前、术后的前庭功能变化，在辅助诊断 AN 患者的前庭功能障碍方面具有应用价值。
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