耳石复位后残余头晕患者VEMP波形观察

Clinical observation on waveform parameters of vestibular evoked myogenic potentials(VEMP) in residual dizziness after canalith repositioning

王志斌;张小莉;高下

1:南京医科大学鼓楼临床医学院耳鼻咽喉头颈外科

2:上海中医药大学附属曙光医院安徽医院耳鼻咽喉头颈外科眩晕门诊

摘要
目的 观察良性阵发性位置性眩晕(benign paroxysmal positional vertigo, BPPV)管石症成功复位后残余头晕(residual dizziness, RD)患者前庭诱发肌源性电位(vestibular evoked myogenic potentials, VEMP)波形指标,探讨RD可能的发病机制。方法 收集首次发病、特发、成功复位后单侧BPPV管石症患者73例,其中RD组31例,无RD组42例,对两组行VEMP检查,比较两组患者VEMP引出率及波形指标。结果 RD组VEMP引出率、振幅比及不对称率(%)低于无RD组,差异有统计学意义(P<0.05);而两组间潜伏期、N1-P1波间期及振幅无明显差异(P>0.05)。结论 BPPV成功复位后的RD可能与耳石器功能异常有关。
关键词
良性阵发性位置性眩晕;残余头晕;前庭诱发肌源性电位
基金项目(Foundation):
安徽省中医药传承创新科研项目(2024ZYYXH124);; 安徽省卫健委技术推广项目(SYJS202005)
作者
王志斌;张小莉;高下
参考文献

[1] YETISER S,SALTURK Z.A review of the quality of life after therapeutic maneuvers in patients with benign paroxysmal positional vertigo[J].Iran J Otorhinolaryngol,2021,33(119):339-346.

[2] GIOMMETTI G,LAPENNA R,PANICHI R,et al.Residual dizziness after successful repositioning maneuver for idiopathic benign paroxysmal positional vertigo:a review[J].Audiol Res,2017,7(178):31-37.

[3] KIM H A,LEE H.Autonomic dysfunction as a possible cause of residual dizziness after successful treatment in benign paroxysmal positional vertigo[J].Clin Neurophysiol,2014,125(3):608-614.

[4] WU P,CAO W,HU Y,et al.Effects of vestibular rehabilitation,with or without betahistine,on managing residual dizziness after successful repositioning manoeuvres in patients with benign paroxysmal positional vertigo:a protocol for a randomised controlled trial[J].BMJ Open,2019,9(6):e026711.

[5] VADUVA C,ESTéBAN-SáNCHEZ J,SANZ-FERNáNDEZ R,et al.Prevalence and management of post-BPPV residual symptoms[J].Eur Arch Otorhinolaryngol,2018,275(6):1429-1437.

[6] 蔡媛媛,周婧,谢艳,等.睡眠对后半规管良性阵发性位置性眩晕的影响[J].听力学及言语疾病杂志,2022,30(3):235-238.

[7] 宋璞,胡燕,赵莉,等.良性阵发性位置性眩晕复位后残余头晕的影响因素及预测模型的建立[J].中华耳科学杂志,2024,22(5):732-736.

[8] OH K H,SUH K D,LEE Y H,et al.Clinical utility of cervical vestibular-evoked myogenic potentials in predicting residual dizziness after benign paroxysmal positional vertigo[J].Clin Neurophysiol,2019,130(1):95-100.

[9] ?ZGIRGIN O N,KINGMA H,MANZARI L,et al.Residual dizziness after BPPV management:exploring pathophysiology and treatment beyond canalith repositioning maneuvers[J].Front Neurol,2024,15:1382196.

[10] KIM E J,OH S Y,KIM J S,et al.Persistent otolith dysfunction even after successful repositioning in benign paroxysmal positional vertigo[J].J Neurol Sci,2015,358(1-2):287-293.

[11] SEO T,SHIRAISHI K,KOBAYASHI T,et al.Residual dizziness after successful treatment of idiopathic benign paroxysmal positional vertigo originates from persistent utricular dysfunction[J].Acta Otolaryngol,2017,137(11):1149-1152.

[12] 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.良性阵发性位置性眩晕诊断和治疗指南(2017)[J].中华耳鼻咽喉头颈外科杂志,2017,52(3):173-177.

[13] 韩朝,谢岳霖.VEMP技术在耳源性眩晕中的应用[J].中医眼耳鼻喉杂志,2018,8(2):98-102,117.

[14] FIFE T D,COLEBATCH J G,KERBER K A,et al.Practice guideline:cervical and ocular vestibular evoked myogenic potential testing.Report of the guideline development,dissemination,and implementation subcommittee of the American Academy of Neurology[J].Neurology,2017,89(22):2288-2296.

[15] 田永胜,张彦,马荣,等.管石复位治疗后出现残余症状的良性阵发性位置性眩晕患者VEMP特点[J].临床耳鼻咽喉头颈外科杂志,2018,32(11):845-849.

[16] YETISER S,INCE D,GUL M.An analysis of vestibular evoked myogenic potentials in patients with benign paroxysmal positional vertigo[J].Ann Otol Rhinol Laryngol,2014,123(10):686-695.

[17] HEUBERGER M,SA■LAM M,TODD N S,et al.Covert anti-compensatory quick eye movements during head impulses[J].PLoS One,2014,9(4):e93086.

[18] KIM H J,PARK J,KIM J S.Update on benign paroxysmal positional vertigo[J].J Neurol,2021,268(5):1995-2000.