Assessment of the Clinical Utility of Cervical and Ocular Vestibular Evoked Myogenic Potential Testing in Elderly Patients
Assessment of the Clinical Utility of Cervical and Ocular Vestibular Evoked Myogenic Potential Testing in Elderly Patients
复制标题
DOI：
10.1097/mao.0000000000000793
复制
发表时间：
2015-08-01
影响因子：
2.1
通讯作者：
Lee, Walter T.
中科院分区：
文献类型：
--
作者：
Piker, Erin G.;Baloh, Robert W.;Lee, Walter T.
目的评估患者的年龄或性别是否与双侧颈椎或眼前庭诱发肌源性电位（cemp或oVEMP）缺失有关。研究设计：回顾性病例回顾。SettingTertiary中心。患者前庭测试正常（即热量和旋转椅正常），接受cemp和/或oVEMP测试的患者。传导性听力损失患者和单侧VEMP结果异常的患者被排除在外，因为他们表现出可能的单侧前庭损伤的证据。共有895名患者符合cemp标准，297名患者符合ovemp标准。主要观察指标：500 hz 125 db pSPL空气传导刺激引起的cemp和oVEMP反应的存在或不存在。结果采用奇比和置信区间进行logistic回归。与20多岁的成年人相比，50多岁和60多岁的患者双侧无cemp反应的几率是他们的6倍，而70多岁和80多岁的患者则是22倍以上。40岁、50岁和60岁患者双侧无oVEMP反应的可能性是40岁、50岁和60岁患者的6倍，70岁患者的可能性是13倍。结论：在大部分主诉头晕的老年患者中，对空气传导刺激的双侧svemp缺失，而其他方面的前庭和听觉测试均与他们的年龄相符。结合其他异常前庭表现，VEMP反应的缺失可能是有价值的。然而，孤立的双侧缺失VEMP的功能后果尚不清楚，可能为老年患者的诊断提供最小的信息。在双侧没有反应的情况下，应使用更强烈的交流刺激或考虑骨传导振动。
ObjectivesTo assess whether patient age or sex was predictive of a bilaterally absent cervical or ocular vestibular evoked myogenic potential (cVEMP or oVEMP).Study DesignRetrospective case review.SettingTertiary center.PatientsPatients presenting with normal vestibular tests (i.e. normal caloric and rotational chair) who underwent cVEMP and/or oVEMP testing.Patients with conductive hearing loss were excluded as were those with unilaterally abnormal VEMP results because they presented with evidence of a possible unilateral vestibular impairment. A total of 895 patients met criteria for cVEMPs and 297 for oVEMPs.Main Outcome MeasuresThe presence or absence of cVEMP and oVEMP responses elicited with a 500-Hz 125-dB pSPL air conduction stimulus.ResultsA logistic regression was performed including odd ratios and confidence intervals. Compared with adults in their 20s, the odds of bilaterally absent cVEMP responses are 6 times greater for patients in their 50s and 60s and over 22 times greater for patients in their 70s and 80s. A bilaterally absent oVEMP response is 6 times more likely for patients in their 40s, 50s, and 60 and 13 times greater for patients in their 70s.ConclusionsVEMPs in response to air conduction stimuli are bilaterally absent in a large percentage of older patients complaining of dizziness who otherwise have normal vestibular and auditory testing for their age. In combination with other abnormal vestibular findings, an absence of VEMP responses may be of value. However, the functional consequence of an isolated bilaterally absent VEMP is not known and may provide minimal information to an older patient's diagnostic picture. In cases where the response is bilaterally absent, a more intense AC stimulus should be used or bone conducted vibration should be considered.