Cervical vestibular evoked myogenic potentials and video head impulse test in Ménière disease

Abstract Introduction: Ménière's disease is among the most frequent causes of vestibular disorders. Although it is a clinical diagnosis, a better understanding of the pathophysiology and clinical course of the disease through tests would allow improvement in the prognosis and more effective treatments. Objectives: To describe the results of the cervical vestibular evoked myogenic and video head impulse test in patients with a defined diagnosis of Ménière's disease and to correlate them with disease duration. Methods: The sample consisted of 50 participants, of whom 29 comprised the study group and 21 the control group. The individuals were submitted to a questionnaire, otoscopy, audiometry and vestibular function assessment through the cervical vestibular evoked myogenic potential and video head impulse test. Results: For the video head impulse test, lateral canal gain values below 0.77 were considered abnormal and for the vertical channels, below 0.61. The percentages of normality were 82.76% for lateral, 89.65% for posterior and 91.37% for anterior canals. For the cervical vestibular evoked myogenic potential, the upper limits of normal for latencies were defined as 18.07 ms for p13 and 28.47 ms for n23; and in the SG, 19.57% showed prolongation of latency of p13 and 4.35% of wave n23, whereas 18.96% did not show biphasic potential. Conclusions: For the video head impulse test, a decreased gain of the vestibulo-ocular reflex for the lateral canal was observed, with a higher incidence of overt type corrective saccades compared to the control group. For the cervical vestibular evoked myogenic potential, there was a significant difference between the groups for the inter-amplitude parameter, including for asymptomatic ears. There was no correlation between the results of the tests and disease duration.摘要引言：梅尼埃病（Ménière's disease）是最为常见的前庭障碍病因之一。尽管该疾病以临床诊断为核心，但通过检测手段深化对其病理生理学机制与临床病程的认知，可助力改善患者预后并制定更具针对性的有效治疗方案。 研究目的：本研究旨在描述确诊梅尼埃病患者的颈性前庭诱发肌源性电位（cervical vestibular evoked myogenic potential）与视频头脉冲试验（video head impulse test）结果，并分析上述检测结果与疾病病程时长的相关性。 研究方法：本研究共纳入50名受试者，其中29名纳入梅尼埃病研究组，21名纳入正常对照组。所有受试者均接受问卷调查、耳镜检查、听力学检测，以及通过颈性前庭诱发肌源性电位与视频头脉冲试验完成的前庭功能评估。 研究结果：针对视频头脉冲试验，半规管增益异常判定阈值为：水平半规管增益低于0.77视为异常，垂直半规管增益低于0.61视为异常。各半规管的正常检测占比分别为：水平半规管82.76%、后半规管89.65%、前半规管91.37%。对于颈性前庭诱发肌源性电位，正常潜伏期上限定义为：p13波18.07ms，n23波28.47ms；研究组中，19.57%的受试者存在p13波潜伏期延长，4.35%的受试者存在n23波潜伏期延长，另有18.96%的受试者未出现双相电位。 研究结论：视频头脉冲试验结果显示，研究组患者的水平半规管前庭眼反射（vestibulo-ocular reflex）增益显著降低，且显性矫正扫视的发生率高于对照组。颈性前庭诱发肌源性电位检测中，两组间的波幅差参数存在显著差异，该差异在无症状耳中同样存在。未发现两项检测结果与疾病病程时长存在相关性。