Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal
Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal
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DOI：
10.1007/s00405-015-3867-3
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发表时间：
2016-09-01
影响因子：
2.6
通讯作者：
Apeksha, Kumari
中科院分区：
文献类型：
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作者：
Singh, Niraj Kumar;Apeksha, Kumari
良性阵发性位置性眩晕（BPPV）构成了周围前庭病变人群的主要比例。虽然半规管内自由漂浮的耳石是BPPV症状的原因，但耳石碎片的来源主要被认为是耳石器官。因此，其中一个或两个耳石器官的病理出现了一个逻辑命题。颈和眼前庭诱发肌源电位（cemp和oVEMP）作为耳石器官功能完整性的测试，有望用于研究耳石与BPPV的关系。虽然最近的证据暗示了cemp的模棱两可的发现，但关于oVEMP的研究很少。此外，这两种可能性从未在同一组BPPV患者中被探索过。因此，本研究旨在通过cemp和oVEMP评估后管BPPV患者耳石器官的功能完整性。31名单侧后管BPPV患者和31名年龄和性别匹配的健康对照者接受了500 Hz声脉冲诱发cemp和oVEMP。结果显示，cVEMP参数组间差异无统计学意义（p < 0.05）。oVEMP的延迟相关参数也有类似的趋势。但BPPV患者患耳的峰间振幅明显小于正常耳和健康对照（p < 0.05）。BPPV组耳间振幅差比显著高于正常对照组（p < 0.05）。此外，oVEMP的敏感性和特异性也远远优于cemp。因此，本研究的结果显示后管BPPV累及的是胞囊而不是囊，因此，oVEMP似乎比cemp更适合于后管BPPV患者的临床研究。
Benign paroxysmal positional vertigo (BPPV) constitutes a major proportion of the population with peripheral vestibulopathies. Although the freely floating otoconia within the semicircular canals is responsible for the symptoms of BPPV, the source of the otoconia debris is mainly believed to be the otolith organs. Therefore, the pathology in either or both the otolith organs appears a logical proposition. Cervical and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP), being the tests for functional integrity of the otolith organs, appear promising for investigating otolith involvement in BPPV. While recent evidences are suggestive of equivocal findings for cVEMP, there are only a few studies on oVEMP. Additionally, both these potentials have never been explored in the same set of individuals with BPPV. Therefore, the present study aimed to evaluate the functional integrity of the otolith organs through cVEMP and oVEMP in individuals with posterior canal BPPV. Thirty-one individuals with unilateral posterior canal BPPV and 31 age- and gender-matched healthy controls underwent 500 Hz tone-burst-evoked cVEMP and oVEMP. The results demonstrated no significant group difference on any of the cVEMP parameters (p > 0.05). A similar trend was noticed for the latency-related parameters of oVEMP. However, the peak-to-peak amplitude was significantly smaller in the affected ears of individuals with BPPV than their unaffected ears and the ears of healthy controls (p < 0.05). The BPPV group showed significantly higher inter-aural amplitude difference ratio than the healthy controls (p < 0.05). Further, the sensitivity and specificity of oVEMP were also found to be far superior to those of cVEMP. Thus, the outcome of the present study revealed involvement of utricle rather than saccule in posterior canal BPPV, and therefore, oVEMP appears to be better suited to clinical investigation than cVEMP in individuals with posterior canal BPPV.