Vestibular evoked myogenic potentials in the prognosis of sudden hearing loss - a systematic review

Abstract Introduction: Sudden hearing loss is an otorhinolaryngological emergency that often leads to severe damage to the auditory and vestibular function. The vestibular evoked myogenic potential is a test that allows a noninvasive evaluation of the otolithic system function and vestibulospinal and vestibulo-ocular pathways. Objective: To evaluate the importance of vestibular evoked myogenic potential in determining the prognosis of patients with sudden hearing loss. Methods: A search for articles published up to December 2018 was performed in the PubMed, Cochrane, VHL and LILACS databases using MeSH descriptors. Retrospective and prospective articles were included containing cervical or ocular vestibular evoked myogenic potential in sudden hearing loss patients and information on associated vertigo and/or dizziness. Results: Sixteen of 62 initially selected articles met the inclusion criteria and were analyzed. Regarding the methodology of the evaluated studies, 8 studies were prospective, six were retrospective, one contained part of the data from a retrospective analysis and another part from a prospective analysis, and one study was cross-sectional. A total of 872 patients were evaluated (50.22% males and 49.77% females) with a mean age of 51.26 years. Four hundred and twenty-six patients (50.35%) had vertigo and/or dizziness associated with sudden hearing loss. The cervical vestibular evoked myogenic potential was performed in all studies, but only seven assessed the ocular vestibular evoked myogenic potential. The cervical vestibular evoked myogenic potential showed alterations in 38.65% of 846 evaluated ears, whereas ocular vestibular evoked myogenic potential showed alterations in 47.88% of 368 evaluated ears. The hearing recovery rate was analyzed by 8 articles, with 63.4% of 410 evaluated ears showing hearing recovery. Conclusions: The studies suggest that the assessment of the vestibular system using vestibular evoked myogenic potential seems to be important in the prognosis of sudden hearing loss. For better follow-up of patients with sudden hearing loss, the emphasis should not be limited to the cochlea, but also include the diagnosis and treatment of vestibular abnormalities, regardless of the presence of vertigo.

引言：突发性听力损失是耳鼻咽喉科急症，常可造成听觉与前庭功能的严重损害。前庭诱发肌源性电位（vestibular evoked myogenic potential）是一项无创检测技术，可用于评估耳石系统功能以及前庭脊髓、前庭眼通路的状态。
研究目的：评估前庭诱发肌源性电位在判断突发性听力损失患者预后中的价值。
研究方法：本研究检索了截至2018年12月发表于PubMed、Cochrane、VHL及LILACS数据库的相关文献，检索采用医学主题词（MeSH）进行构建。纳入符合以下条件的回顾性或前瞻性研究：包含突发性听力损失患者的颈性或眼性前庭诱发肌源性电位检测数据，且记录有伴随眩晕和/或头晕的相关信息。
研究结果：初始检索共获得62篇文献，其中16篇符合纳入标准并被纳入分析。在所纳入的研究中，8项为前瞻性研究，6项为回顾性研究，1项同时包含回顾性与前瞻性分析数据，剩余1项为横断面研究。本综述共纳入872例患者，其中男性占50.22%，女性占49.77%，患者平均年龄为51.26岁。426例（50.35%）患者存在与突发性听力损失相关的眩晕和/或头晕症状。所有研究均开展了颈性前庭诱发肌源性电位检测，但仅7项研究同时评估了眼性前庭诱发肌源性电位。颈性前庭诱发肌源性电位在846例受检耳中的异常检出率为38.65%，眼性前庭诱发肌源性电位在368例受检耳中的异常检出率为47.88%。共有8项研究分析了患者的听力恢复情况，410例受检耳中63.4%实现了听力恢复。
研究结论：现有研究表明，通过前庭诱发肌源性电位评估前庭系统，对突发性听力损失的预后判断具有重要价值。为更好地随访突发性听力损失患者，临床关注重点不应仅局限于耳蜗，还应包括前庭异常的诊断与治疗，无论患者是否存在眩晕症状。