甘油试验中不同听力学检测方法的对比分析

发布时间：2018-07-25 19:29

【摘要】：目的发作性旋转性眩晕伴耳鸣、耳聋是梅尼埃病的典型表现,其最显著的病理特征是内耳膜迷路积水。根据美国耳鼻咽喉头颈外科协会和听-平衡委员会制定的梅尼埃病诊断的指导方针仍是主要根据临床表现和纯音测听。对于症状不典型的可疑患者可行耳蜗电图、耳声发射、甘油试验等听力-前庭功能检查。本文探讨并比较发病期纯音测听甘油试验、耳蜗电图甘油试验、畸变产物耳声发射(DPOAE)甘油试验对梅尼埃病的诊断价值,及施行甘油试验的时机。方法本研究共选择175例受试者,包括112例临床诊断为梅尼埃病和非梅尼埃病眩晕患者63例,每一例非梅尼埃病眩晕患者的选择与梅尼埃病患者中的一例同期就诊,两者在年龄、性别上相匹配。将这175例受试者按随机数字方法分为A、B、C三组,A组由36例梅尼埃病患者与21例非梅尼埃病眩晕患者组成,B组、C组均由38例梅尼埃病患者和21例非梅尼埃病眩晕患者组成。在服用甘油前和服用甘油后1h,2h,3h分别观察三组患者纯音测听,耳蜗电图和DPOAE的变化,并进行比较。A、C两组MD病甘油试验阳性的患者于间歇期再次行甘油试验,阳性病例与前次进行比较。结果梅尼埃病患者甘油试验阳性率较非梅尼埃病眩晕患者显著增高,梅尼埃病患者纯音测听甘油试验阳性率最高为47.2%(17/36),耳蜗电图甘油试验阳性率最高为57.9%(22/38),DPOAE甘油试验阳性率最高为65.8%(25/38),阳性例数最高均出现在服甘油后2小时。非梅尼埃病眩晕患者中仅5例出现甘油试验阳性,包括椎-基底动脉功能不全、突发性耳聋伴眩晕及迟发性膜迷路积水等。A、C两组发病期甘油试验出现阳性的患者间歇期再次出现甘油试验阳性的例数分别为10、15。间歇期MD患者甘油试验阳性率明显低于发作期,且阳性率与病程无关。结论甘油试验为梅尼埃病的诊断提供依据,耳蜗电图和DPOAE的甘油试验较纯音测听的甘油试验更为准确,对梅尼埃病患者进行甘油试验检查时可将纯音测听与耳蜗电图和/或DPOAE结合起来,提高该病的诊断率。发病期施行甘油试验阳性率高于间歇期,所以临床上怀疑为MD患者,尽量在发病期施行甘油试验。
[Abstract]:Objective paroxysmal rotational vertigo with tinnitus and deafness are typical manifestations of Meniere's disease. The guidelines for the diagnosis of Meniere's disease, developed by the American Association of Otolaryngology and head and neck surgery and the Auto-Equalization Committee, remain primarily based on clinical manifestations and pure tone audiometry. ECoG, otoacoustic emission, glycerol test and other hearing-vestibular function tests are feasible for suspicious patients with atypical symptoms. The diagnostic value of pure tone audiometry glycerol test, electrocochlear glycerol test and distortion product otoacoustic emission (DPOAE) glycerol test in Meniere's disease was discussed and compared. Methods A total of 175 subjects were enrolled in this study, including 112 patients with meniere disease and 63 patients with non Meniere disease vertigo. Each patient with non Meniere disease vertigo was treated at the same time as one patient with Meniere's disease. Gender match. The 175 subjects were randomly divided into three groups: group A consisted of 36 patients with Meniere's disease and 21 patients with non Meniere disease vertigo. Group C consisted of 38 patients with Meniere disease and 21 patients with non Meniere disease vertigo. The changes of pure tone audiometry, electrocochocardiography and DPOAE were observed before and 1 hour after taking glycerol, respectively. The glycerol test was performed again in two groups of patients with MD disease glycerol test. Positive cases were compared with previous cases. Results the positive rate of glycerol test in patients with Meniere disease was significantly higher than that in patients with vertigo of non-Meniere disease. The highest positive rate of pure tone audiometry glycerol test was 47.2% (17 / 36) in patients with Meniere's disease, and the highest positive rate was 57.9% (22 / 38) in electrocochlear glycerol test. The highest positive rate of DPOAE glycerol test was 65.8% (25 / 38) in patients with Meniere's disease. Glycerol test positive was found in only 5 of the patients with non-Meniere disease vertigo, including vertebrobasilar insufficiency. The patients with sudden deafness accompanied with vertigo and delayed membranous labyrinth hydrops and so on. The positive rate of glycerol test in intermittent MD patients was significantly lower than that in attack stage, and the positive rate was not related to the course of disease. Conclusion Glycerol test can provide evidence for the diagnosis of Meniere's disease. The glycerol test of ECoG and DPOAE is more accurate than that of pure tone audiometry. In order to improve the diagnostic rate of Meniere's disease, pure tone audiometry can be combined with electrocochocardiography and / or DPOAE in glycerol test in patients with Meniere's disease. The positive rate of glycerol test in the onset period was higher than that in the intermission period, so clinically suspected to be MD patients, glycerol test should be carried out as far as possible in the onset period.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R764

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