【摘要】：目的 突發(fā)性耳聾(sudden deafness, SD)是耳鼻咽喉頭頸外科常見(jiàn)的耳科疾病,是一種原因不明的在短時(shí)間內(nèi)聽(tīng)力突然下降的疾病。目前大多認(rèn)為與內(nèi)耳微循環(huán)障礙、病毒感染、窗膜破裂、變態(tài)反應(yīng)、血管紋功能不良及代謝障礙等有關(guān)。突發(fā)性耳聾患者常伴有眩暈,故對(duì)于突發(fā)性耳聾患者前庭功能的研究日益深入,現(xiàn)有的研究通過(guò)對(duì)突發(fā)性耳聾患者進(jìn)行前庭功能檢查證實(shí)其存在前庭功能障礙,也表明前庭功能正常與否對(duì)突發(fā)性耳聾的預(yù)后有一定的影響。前庭自旋轉(zhuǎn)試驗(yàn)(Vestibular Autorotation Test, VAT)是通過(guò)前庭眼動(dòng)反射(/estibulo-ocular Reflex, VOR)評(píng)估前庭功能的新興高頻檢查方法之一,其檢測(cè)頻率為2.0～6.0Hz,其頻率范圍接近于人體日常生活的正常運(yùn)動(dòng)頻率,廣泛的應(yīng)用于前庭疾病的檢查及前庭功能的評(píng)估。本文通過(guò)正常人與突發(fā)性耳聾伴眩暈患者的VAT結(jié)果比較分析,探討突發(fā)性耳聾伴眩暈的VAT結(jié)果特性及其成因,為臨床上突發(fā)性耳聾患者的前庭系統(tǒng)的功能評(píng)估及前庭康復(fù)等方面提供可靠有效的依據(jù)。 方法 設(shè)定正常人為對(duì)照組,突發(fā)性耳聾伴眩暈患者為實(shí)驗(yàn)組,進(jìn)行對(duì)照試驗(yàn)研究。正常對(duì)照組為我院醫(yī)護(hù)人員及家屬共78例,男41例,女37例,年齡10～82歲,平均44.8±9.4歲,聽(tīng)力和視力要求正常,既往無(wú)耳科學(xué)相關(guān)病史(如耳鳴耳聾、中耳炎,也無(wú)平衡障礙、眩暈等),無(wú)高血壓病、糖尿病、心腦血管疾病、神經(jīng)科疾病、頸椎病等病史,無(wú)煙酒嗜好。實(shí)驗(yàn)組病例為2009年3月至2011年5月就診于天津市第一中心醫(yī)院耳鼻咽喉頭頸外科的突發(fā)性耳聾伴眩暈患者229例,男97例,女132例,年齡14～79歲,平均49.7±11.6歲。突發(fā)性耳聾的診斷符合中華醫(yī)學(xué)會(huì)耳鼻咽喉科學(xué)會(huì)制定的診斷依據(jù),神經(jīng)學(xué)檢查無(wú)中樞病變體征,影像學(xué)排除聽(tīng)神經(jīng)瘤、顱腦缺血或出血性病變。應(yīng)用美國(guó)WSR的VAT檢測(cè)儀對(duì)兩組研究對(duì)象分別進(jìn)行水平、垂直VAT測(cè)試。VAT檢測(cè)共有水平眼動(dòng)增益、垂直眼動(dòng)增益、水平眼動(dòng)相位、垂直眼動(dòng)相位、水平眼動(dòng)非對(duì)稱五項(xiàng)指標(biāo)。增益等于眼動(dòng)速度/頭動(dòng)速度,是VOR的強(qiáng)度指標(biāo),正常增益接近1,異常結(jié)果具有高、低增益兩種；相位的實(shí)質(zhì)是與頭動(dòng)輸入信息相對(duì)應(yīng)的眼動(dòng)信息輸出的時(shí)間差異,代表VOR對(duì)適宜刺激的反應(yīng)敏感度,VOR相位異常結(jié)果具有高、低相位兩種,兩者的本質(zhì)都屬于相位延遲,高相位提示更嚴(yán)重的相位延遲。而非對(duì)稱值則取自各頻率左右方向的眼動(dòng)速度比,表示左右側(cè)前庭系統(tǒng)功能的強(qiáng)度差異,各個(gè)頻率的非對(duì)稱正常參考值為0±10%,負(fù)值表示左側(cè)、正值則為右側(cè)。在VAT水平及垂直測(cè)試的增益和相位、水平非對(duì)稱五項(xiàng)參數(shù)指標(biāo)中出現(xiàn)一項(xiàng)或一項(xiàng)以上異常即評(píng)定為該試驗(yàn)陽(yáng)性,水平或垂直測(cè)試中的增益及相位任意一項(xiàng)異常均記為增益或相位異常。統(tǒng)計(jì)分析應(yīng)用SPSS16.0統(tǒng)計(jì)軟件,計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(x±s)或中位數(shù)表示,并進(jìn)行正態(tài)分布檢驗(yàn),計(jì)數(shù)資料以百分率表示,進(jìn)行t檢驗(yàn)與χ2檢驗(yàn)。P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1對(duì)照組與系統(tǒng)自帶正常參考值比較：對(duì)照組的水平增益、水平相位、垂直增益及垂直相位四項(xiàng)指標(biāo)在頻率為2,3,4,5,6Hz的頻段的均值與參考值比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。非對(duì)稱值在頻率為2,3,4,5,6,7,8,9,10Hz的頻段的均值與參考值比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。 2實(shí)驗(yàn)組的結(jié)果分析：實(shí)驗(yàn)組229例中VAT異常者為214例(93.4%),增益異常為156例(68.1%),相位異常為182例(79.5%),非對(duì)稱異常143例(62.4%)； 2.1增益異常包括：僅水平增益異常為103例(44.9%),僅垂直增益異常為19例(8.3%),水平增益與垂直增益均異常34例(14.8%)；高增益92例(40.2%),低增益98例(42.8%),二者比較卡方檢驗(yàn),差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05；水平增益中高增益者64例(27.9%),低增益者73例(31.9%),二者比較卡方檢驗(yàn),差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05；垂直增益中高增益者28例(12.2%),低增益者25例(10.9%),二者比較卡方檢驗(yàn),差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。 2.2相位異常包括：僅水平相位異常為47例(20.5%),僅垂直相位異常為65例(28.4%),水平相位與垂直相位均異常70例(30.6%)；高相位198例(86.5%),低相位54例(23.6%),二者比較卡方檢驗(yàn),差異有統(tǒng)計(jì)學(xué)意義,P0.05；水平相位中高相位者65例(28.4%),低相位者52例(22.7%),二者比較卡方檢驗(yàn),差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05；垂直相位中高相位者133例(58.1%),低相位者2例(0.9%),二者比較卡方檢驗(yàn),差異有統(tǒng)計(jì)學(xué)意義,P0.05。 3對(duì)照組與實(shí)驗(yàn)組比較： 3.1對(duì)照組與實(shí)驗(yàn)組的VAT陽(yáng)性結(jié)果比較：對(duì)照組78例中VAT異常率為9%(7例),增益異常率為5.1%(4例),相位異常率為6.4%(5例),非對(duì)稱異常率3.8%(3例)；實(shí)驗(yàn)組229例中VAT異常率為93.4%.(214例),增益異常率為68.1%(156例),相位異常率為79.5%(182例),非對(duì)稱異常率62.4%(143例)。以上兩組各陽(yáng)性率比較卡方檢驗(yàn),P值均=0.000,差異均有統(tǒng)計(jì)學(xué)意義。 3.2對(duì)照組與實(shí)驗(yàn)組的VAT五項(xiàng)指標(biāo)結(jié)果均值比較： 3.2.1兩組水平增益比較：在頻率為2,3,4,5,6Hz的頻段的均值比較t檢驗(yàn),在4Hz處兩組的水平增益均值差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05,在2、3、5、6Hz處兩組水平增益均值的差異均具有統(tǒng)計(jì)學(xué)意義,P值均0.05。 3.2.2兩組水平相位比較：在頻率為2,3,4,5,6Hz的頻段的均值比較t檢驗(yàn),在2Hz處兩組的水平相位均值差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05,在3、4、5、6Hz處兩組水平相位均值的差異均具有統(tǒng)計(jì)學(xué)意義,P值均0.05。 3.2.3兩組垂直增益比較：在頻率為2,3,4,5,6Hz的頻段的均值比較t檢驗(yàn),在3、4、5Hz處兩組的垂直增益均值差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05,在2、6Hz處兩組垂直增益均值的差異均具有統(tǒng)計(jì)學(xué)意義,P值均0.05。 3.2.4兩組垂直相位比較：在頻率為2,3,4,5,6Hz的頻段的均值比較t檢驗(yàn),差異均具有統(tǒng)計(jì)學(xué)意義,P值均0.05。 3.2.5兩組非對(duì)稱結(jié)果比較：在頻率為2、3、4、5、6、7、8、9、10Hz的頻段的均值比較t檢驗(yàn),差異均具有統(tǒng)計(jì)學(xué)意義,P均0.05。 結(jié)論 本實(shí)驗(yàn)室的VAT正常值與系統(tǒng)的參考值相符,結(jié)果客觀可靠。VAT的增益指標(biāo)在突發(fā)性耳聾伴眩暈患者可以存在高增益,也可以存在低增益；高增益提示前庭中樞功能減退使得前庭眼反射亢進(jìn),低增益提示前庭末梢感應(yīng)能力下降,其增益的高低與其病因和前庭損傷范圍有關(guān)。其相位指標(biāo)在突發(fā)性耳聾伴眩暈患者中呈現(xiàn)垂直相位全頻段增高的特征,提示其前庭眼反射延遲。其非對(duì)稱均存在異常,可以提示病變的側(cè)別。VAT的增益指標(biāo)有益于突發(fā)性耳聾伴眩暈患者前庭系統(tǒng)損傷的定性評(píng)估和病因分析。
[Abstract]:objective
Sudden deafness (sudden deafness, SD) is a common ear disease in otolaryngology head and neck surgery. It is an unknown cause of sudden hearing loss in a short period of time. Most of them are considered to be related to internal ear microcirculation disorder, virus infection, rupture of the window membrane, allergy, dysfunction of blood tube and metabolic disorders. It is often accompanied by vertigo, so the study of vestibular function in patients with sudden deafness is becoming more and more in-depth. The current study shows vestibular dysfunction through the examination of the vestibular function of sudden deafness, and the vestibular function has a certain influence on the prognosis of sudden deafness. Vestibular self rotation test (Vestibular A) Utorotation Test, VAT) is one of the new high frequency examination methods to evaluate vestibular function through the vestibular eye movement reflex (/estibulo-ocular Reflex, VOR). The frequency range is 2 to 6.0Hz, and its frequency range is close to the normal motion frequency of human daily life. It should be widely used for the examination of vestibular diseases and the evaluation of vestibular function. VAT results of patients with sudden deafness and vertigo were compared and analyzed, and the characteristics and causes of sudden deafness and vertigo were discussed in order to provide a reliable and effective basis for the evaluation of the vestibular system and the vestibular rehabilitation in patients with sudden deafness.
Method
The normal control group, the patients with sudden deafness and vertigo, was studied in the experimental group. The normal control group was 78 cases of medical staff and family members in our hospital, 41 males and 37 females, the average age of 10~82 years, the average age of 44.8 + 9.4 years, and the normal hearing and visual acuity, without the history of ear science related (such as tinnitus deafness, otitis media, nor flat) There were no hypertension, diabetes, cardiovascular and cerebrovascular diseases, neurologic diseases, cervical spondylosis, and non-smoking alcohol addiction. The experimental group were 229 cases of sudden deafness and vertigo in the Department of Otolaryngology and head and neck surgery of Tianjin First Central Hospital from March 2009 to May 2011, 97 men, 132 women, 14~79 years old, and flat. All 49.7 + 11.6 years of age. The diagnosis of sudden deafness accords with the diagnostic basis established by the Chinese Medical Association of otorhinolaryngology. Neurologic examination has no signs of central lesions, imaging to exclude acoustic neuroma, cerebral ischemia or hemorrhagic lesions. Two groups of studies on the image were performed by the American WSR VAT detector, and the vertical VAT test was used for.VAT detection. There are five indexes of horizontal eye movement gain, vertical eye movement gain, horizontal eye movement phase, vertical eye movement phase, and horizontal eye movement. The gain is equal to the eye movement speed / head speed, it is the strength index of VOR, the normal gain is close to 1, the abnormal result is high, and the low gain is two. The essence of the phase is the eye movement information corresponding to the head moving input information. The difference in time represents the response sensitivity of VOR to the appropriate stimulus, and the results of the VOR phase anomaly are high and low phase two, both of which are phase retardation, and the high phase indicates a more serious phase delay. The asymmetric value is taken from the eye movement velocity ratio in the direction of each frequency, indicating the intensity difference between the left and right vestibule system functions. The asymmetric normal reference value of each frequency is 0 + 10%, the negative value is on the left side, and the positive value is right. In the VAT level and the vertical test gain and phase, one or more anomalies occur in the horizontal asymmetric five parameter index, which is evaluated as the test positive, the gain and the phase any exception in the horizontal or vertical test are all recorded as Gain or phase anomaly. Statistical analysis is applied to SPSS16.0 statistical software. The measurement data is expressed in mean number of standard deviation (x + s) or median, and the normal distribution is tested. The count data is expressed as a percentage, and the difference between the t test and the chi 2 test.P0.05 is statistically significant.
Result
The comparison between the 1 control groups and the normal reference values of the system: the mean and the reference values of the four indexes of the control group, the horizontal gain, the horizontal phase, the vertical gain and the vertical phase in the frequency band of 2,3,4,5,6Hz, were not statistically significant, and the mean and reference value of the P0.05. asymmetric value at the frequency of 2,3,4,5,6,7,8,9,10Hz was compared with the reference value. The difference was not statistically significant, P0.05.
2 Analysis of the results of the 2 experimental group: 214 cases (93.4%) were abnormal in 229 cases in the experimental group, 156 cases (68.1%) with abnormal gain, 182 cases (79.5%) and 143 (62.4%) with unsymmetrical abnormality.
2.1 gain abnormality included only 103 cases (44.9%), only 19 cases (8.3%) and 34 cases (14.8%) of horizontal gain and vertical gain, high gain 92 (40.2%) and 98 low gain (42.8%). The difference was not statistically significant, P0.05; high gain in the level gain 64 cases (27.9%), low increase. 73 cases (31.9%), the two were compared with the chi square test, the difference was not statistically significant, P0.05, the high gain in the vertical gain 28 cases (12.2%), the low gain 25 cases (10.9%), the two compared with the chi square test, the difference was not statistically significant, P0.05.
2.2 phase abnormalities include only 47 cases (20.5%), only 65 cases (28.4%) and 70 cases (30.6%) of horizontal and vertical phase anomalies; high phase 198 cases (86.5%), 54 cases of low phase (23.6%), two, statistically significant difference, P0.05, 65 cases (28.4%), low phase in high phase in horizontal phase, low phase There were 52 cases (22.7%), the two were compared with the chi square test, the difference was not statistically significant, P0.05, the high phase in the vertical phase was 133 cases (58.1%), the low phase was 2 cases (0.9%), the two were compared with the chi square test, the difference was statistically significant, P0.05.
The 3 control group compared with the experimental group.
The VAT positive results between the 3.1 control group and the experimental group were compared: the abnormal rate of VAT in the control group was 9% (7 cases), the gain abnormal rate was 5.1% (4 cases), the phase abnormal rate was 6.4% (5 cases), and the asymmetric abnormal rate was 3.8% (3 cases); the abnormal rate of VAT in the experimental group was 93.4%. (214), the gain abnormal rate was 68.1% (156 cases), and the phase anomaly rate was the non pair. The abnormal rate was 62.4% (143 cases). The positive rates of the above two groups were compared with chi square test, and the P values were all =0.000, the differences were statistically significant.
3.2 the comparison of the five indicators of VAT between the control group and the experimental group was:
3.2.1 two groups of horizontal gain comparison: the average value of the frequency band of 2,3,4,5,6Hz is compared with t test, and there is no significant difference in the mean value of the two groups at 4Hz, P0.05, the difference of the average level gain of the two groups at 2,3,5,6Hz is statistically significant, and the P value is 0.05.
3.2.2 two groups of horizontal phase comparison: the average value of the frequency band of 2,3,4,5,6Hz is compared with t test. There is no significant difference in the mean phase mean difference between the two groups at 2Hz, P0.05, the difference of the average level of the horizontal phase in the two groups of 3,4,5,6Hz is statistically significant, and the P value is 0.05.
3.2.3 two groups of vertical gain comparison: the average value of the frequency band of 2,3,4,5,6Hz is compared with t test. There is no statistically significant difference in the mean value of vertical gain in the two groups at 3,4,5Hz, P0.05, the difference of the mean value of the vertical gain in the two groups of 2,6Hz is statistically significant, and the P value is 0.05.
3.2.4 Two groups of vertical phase comparison: in the frequency of 2,3,4,5,6 Hz band mean comparison t test, the difference was statistically significant, P value was 0.05.
3.2.5 Comparisons of asymmetric results between the two groups: T-test for mean values at frequencies of 2,3,4,5,6,7,8,9,10 Hz showed statistically significant differences (P 0.05).
conclusion
The normal value of VAT in our laboratory coincide with the reference value of the system. Results the gain index of an objective and reliable.VAT can have high gain and low gain in patients with sudden deafness and vertigo. High gain suggests vestibular hypersplenism in vestibular central function, and low gain suggests a decrease in the ability of vestibular terminal induction. It is related to the extent of the cause of the vestibule and the range of vestibule injury. The phase index of the patients with sudden deafness and vertigo is characterized by high vertical phase full frequency, suggesting that the vestibule reflex delay is delayed. Its asymmetry is abnormal. It can suggest that the gain index of the diseased side.VAT is beneficial to the vestibular system loss in the patients with sudden deafness and vertigo. Qualitative assessment and etiological analysis of injury.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R764.04

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相關(guān)碩士學(xué)位論文 前1條

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