Potential Confounding Factors May Influence the Association Between Configurations of the Vertebrobasilar System and the Incidence of Idiopathic Sudden Sensorineural Hearing Loss and Canal Paresis
Potential Confounding Factors May Influence the Association Between Configurations of the Vertebrobasilar System and the Incidence of Idiopathic Sudden Sensorineural Hearing Loss and Canal Paresis
复制标题
潜在的混杂因素可能影响椎基底系统的配置与特发性突发感音神经性听力损失和耳管麻痹发生率之间的关联
DOI：
10.1097/mao.0000000000002605
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发表时间：
2020
影响因子：
2.1
通讯作者：
Tsutsumi Takeshi
中科院分区：
文献类型：
--
作者：
Maruyama Ayako;Kawashima Yoshiyuki;Fujikawa Taro;Makabe Ayane;Ito Taku;Takeda Takamori;Tsutsumi Takeshi
目的：探讨椎基底动脉系统结构对特发性突发性感音神经性聋和神经管轻瘫发生率的影响。研究设计：病例回顾。地点：第三转诊中心。患者：2011年1月至2017年12月收治的248例特发性突发性感音神经性聋患者和152例原因不明的单侧神经管轻瘫患者。144例Bell‘s面瘫或桥小脑角肿瘤患者的对侧作为对照。主要观察指标：1)桥小脑角区小脑前/后下动脉(AICA/PICA)的分支模式。2)基底动脉(BA)弯曲方向。3)椎动脉(VA)占优势。结果：ISSNHL和CP患者患侧和健侧AICA/PICA血管环进入内听道的发生率均显著高于对照组(P<0.05)。基底动脉弯曲在ISSNHL组和CP组明显多于对照组(p<；0.05)，而BA弯曲的方向与ISSNHL或CP的偏侧性无关。慢性阻塞性肺病患者非对称性VA的发生率显著高于对照组(P=0.0304)，而非对称性VA的发生率与对照组无显著差异。值得注意的是，尽管ISSNHL和CP组的血管构型不规则的发生率都很高，但ISSNHL和CP组的患耳和健耳之间的发生率没有显著差异。结论：椎基底动脉系统的血管构型不是ISSNHL和CP的直接原因。相反，他们认为存在影响血管构型和ISSNHL和CP发展的混杂因素。
Objective:To investigate the impact of configurations of the vertebrobasilar system on the incidence of idiopathic sudden sensorineural hearing loss (ISSNHL) and canal paresis (CP).Study Design:Retrospective case review.Setting:Tertiary referral center.Patients:Two hundred and forty-eight consecutive patients diagnosed with ISSNHL and 152 patients with unilateral CP of an uncertain cause who were managed between January 2011 and December 2017. The contralateral side of 144 patients with Bell's palsy or cerebellopontine angle tumor served as a control.Interventions:All patients underwent magnetic resonance cisternography. CP was diagnosed based on caloric testing.Main Outcome Measures:1) Branching patterns of the anterior/posterior inferior cerebellar artery (AICA/PICA) in the cerebellopontine angle area. 2) The direction of the basilar artery (BA) curvature. 3) Vertebral artery (VA) dominance.Results:The incidence of vascular loops of the AICA/PICA entering the internal acoustic canal was significantly higher on both the affected and unaffected sides in patients with ISSNHL and CP in comparison to controls (p< 0.05). The curved BA was observed more frequently in the ISSNHL and CP groups than in the control group (p< 0.05), whereas the direction of the BA curvature was not associated with the laterality of ISSNHL or CP. The incidence of asymmetric VA in CP patients was significantly higher than that in controls (p= 0.0304), while no significant difference was observed between ISSNHL patients and controls. Remarkably, while the incidence rate of irregular vascular configurations was high in both the ISSNHL and CP groups, there was no marked difference between the affected and unaffected ears of the ISSNHL and CP groups.Conclusions:Our results indicate that the vascular configurations of the vertebrobasilar system do not directly cause ISSNHL and CP. Instead, they suggest the presence of confounding factors that influence the vascular configurations and the development of ISSNHL and CP.