突發性耳聾患者之前庭誘發肌性電位

目的：前庭誘發肌性電位（vestibular evoked myogenic potential, VEMP）為近年來新開發的前庭功能檢查。其反應乃利用極大閾值的音刺激來檢測球囊頸反射。由於其作用機轉及反射路徑不明處仍多，因此進行本研究。病人與方法：突發性耳聾病人，接受tone burst音（95 dBHL, 500Hz）單耳刺激，以檢測其VEMP反應之出現與否。結果：十名病人中，男性3名，女性7名，平均年齡40歲。十例病耳中，有9耳（90%）VEMP呈陽性反應，其中7耳之平均聽力閾值超過90dB。溫差測驗異常者有4耳，但4耳之VEMP均呈陽性反應。病變耳VEMP之I（p13）波、II（n23）波之潛時與I-II波間振幅，各為16.1±3.0 ms、21.9±2.2 ms、23.6±8.6 µV；相較於健側耳（對照耳）之14.9±2.1 ms、20.3±1.8 ms、27.8±8.7 µV，兩組間均無統計學上之差異。有1例為慢性中耳炎併生突發性耳聾，以tone burst音刺激未能誘發VEMP反應；但改以前額敲擊法，則可誘發VEMP反應。結論：VEMP的反應路徑，乃經由下前庭神經的球囊頸反射，其出現與否，與感音性聽力喪失、溫差反應之有無，並無相關；但傳音性聽力喪失的存在，會影響VEMP反應的出現。

關鍵字

前庭誘發肌性電位；突發性耳聾；球囊頸反射

並列摘要

Objective: Vestibular evoked myogenic potential (VEMP) is a newly developed examination for assessing the sacculocollic reflex which can be induced by a loud tone burst. This study was performed to performed to elucidate the mechanism and pathways of the VEMP. Patients and Methods: Ten patients (3 mean and 7 women) with sudden deafness were subjected to a VEMP test by tone burst (965 dBHL, 500Hz). Results: Nine (90%) of the ten ears with lesions had normal VEMPs, of which seven had a pure tone average of more than 90 dBHL. Four ears had canal palsy, but normal VEMPs. In comparison to weave I (p13) latency, wave II (n23) latency, and wave I-II amplitude showed no differences between the ears with lesions and control ears (16.1±3.0 ms, 21.9±2.2 ms, and 23.6±8.6 µV versus 14.9±2.1 ms, 20.3±1.8 ms, and 27.8±8.7 µV, respectively). Tapping instead of tone burst stimulation successfully evokes a VEMP response in an ear with chronic otitis media. Conclusions: VEMP is generated via the inferior vestibular nerve, which is unrelated to the hearing level or caloric response, but can be attenuated by conductive hearing loss.

並列關鍵字

vestibular evoked myogenic potential (VEMP) ； sudden deafess ； sacculo-collic reflex

國際替代計量

突發性耳聾患者之前庭誘發肌性電位

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