4000 Hz oVEMP辅助诊断上半规管裂一例

郭蔷;林颖;查定军

1:空军军医大学第一附属医院耳鼻咽喉头颈外科

摘要
目的 探讨上半规管裂综合征(superior canal dehiscence syndrome, SCDS)的听力学表现及检测方法。方法 回顾性分析1例SCDS患者的临床资料,包括纯音测听、声导抗、前庭功能检查及影像学检查等。给予手术治疗,探查确认瘘口,以筋膜、骨粉和骨蜡夹击法填塞上半规管瘘口。结果 患者主诉“双耳听力下降伴反复眩晕3年”来院就诊。纯音测听示双耳低频混合性聋,声导抗双耳呈A型鼓室图,CT提示双侧上半规管局部骨壁菲薄伴破裂,500 Hz颈性前庭诱发肌源性电位(cVEMP)右侧阈值降低至65 dB nHL,右侧振幅671.1μV较左侧振幅(97.60μV)异常增大;500 Hz眼性前庭诱发肌源性电位(oVEMP)右侧振幅27μV,左侧未记录到波形;4 000 Hz oVEMP右侧引出,左侧未引出。结合患者症状和体征最终确诊为右侧SCDS。术后1年电话随访患者术耳听力无明显下降,眩晕发作明显减少。结论 SCDS不能仅依据影像学发现进行诊断,4 000 Hz oVEMP可辅助鉴别诊断及确定受损侧别。
关键词
半规管裂综合征;前庭诱发肌源性电位;CT
基金项目(Foundation):
空军军医大学学校科技发展基金项目(2022XC037);; 西京医院学科助推项目(XJZT19MDT02)
作者
郭蔷;林颖;查定军
参考文献

[1]姜树军,单希征,杨本涛.巴拉尼协会《上半规管裂综合征诊断标准》解读[J].北京医学,2022,44(8):760-762.

[2]邢玥,凌霞,王钰茹,等.前庭性偏头痛诊断标准(更新):Bárány协会及国际头痛协会共识文件[J].神经损伤与功能重建,2022,17(10):559-562.

[3]Smetak MR,Cass ND,Manzoor NF,et al.Vestibular migraine confounds management of superior canal dehiscence syndrome[J].Otol Neurotol,2022,43(7):835-839.

[4]Fernandez IJ,Molinari G,Presutti L.Decision making in patients with concomitant otosclerosis and superior semicircular canal dehiscence:a systematic review of the literature[J].Otol Neurotol,2021,42(1):e1-e9.

[5]Manzari L,Burgess AM,McGarvie LA,et al.An indicator of probable semicircular canal dehiscence:ocular vestibular evoked myogenic potentials to high frequencies[J].Otolaryngol Head Neck Surg,2013,149(1):142-145.

[6]Lin K,Lahey R,Beckley R,et al.Validating the utility of high frequency ocular vestibular evoked myogenic potential testing in the diagnosis of superior semicircular canal dehiscence[J].Otol Neurotol,2019,40(10):1353-1358.

[7]Curthoys IS,Burgess AM,Manzari L,et al.A single fast test for semicircular canal dehiscence-oVEMP n10 to 4 000 Hz-depends on stimulus rise time[J].Audiol Res,2022,12(5):457-465.

[8]Curthoys IS,Manzari L.A simple specific functional test for SCD:VEMPs to high frequency (4 000 Hz) stimuli-their origin and explanation[J].Front Neurol,2020,11:612075.

[9]Curthoys IS,Grant JW,Burgess AM,et al.Otolithic receptor mechanisms for vestibular-evoked myogenic potentials:a review[J].Front Neurol,2018,9:366.

[10]刘博,傅新星,吴子明,等.前庭诱发肌源性电位临床检测技术专家共识[J].中华耳科学杂志,2019,17(6):988-992.

[11]宋新雨,王林娥.前庭诱发肌源性电位临床应用进展[J].听力学及言语疾病杂志,2020,28(5):596-600.

[12]Xu Z,Wang Z,Zhong B,et al.Effects of aging on ocular vestibular-evoked myogenic potential using ER-3A insert earphone and B81 bone vibrator[J].Front Neurolgy,2022,13:956996.

[13]Eberhard KE,Chari DA,Nakajima HH,et al.Current trends,controversies,and future directions in the evaluation and management of superior canal dehiscence syndrome[J].Front Neurol,2021,12:638574.

本文信息

PDF(897K)

本文作者相关文章

郭蔷林颖查定军