摘要
目的探讨突发性聋伴良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)患者治疗前后主观视觉垂直线(subjective visual vertical,SVV)变化及与耳石器功能转归的关系。方法回顾性纳入2020年6月至2023年7月郑州大学第一附属医院耳科收治的突发性聋伴BPPV患者100例为研究对象。根据听力损失累及频率和程度分为低频下降型12例、高频下降型18例、平坦下降型32例、全聋型38例。根据SVV正中位(0°)高低分为低水平组15例,中水平组33例,高水平组52例。多因素分析SVV水平对听力曲线的影响,比较不同SVV水平患者临床资料,多因素分析SVV与治疗效果的关系,分析不同听力曲线、不同SVV水平与耳石器功能转归相关性。结果低频下降型、高频下降型、平坦下降型、全聋型头正中位SVV-0°、头左倾斜30°(SVV-L30°)、头左倾斜45°(SVV-L45°)、头左倾斜90°(SVV-L90°)、头右倾斜30°(SVV-R30°)、头右倾斜45°(SVV-R45°)、头右倾斜90°(SVV-R90°)、颈性前庭诱发肌源性电位、眼性前庭诱发肌源性电位比较,差异均有统计学意义(P<0.05);SVV-0°是突发性聋伴BPPV严重程度的独立危险因素。低水平组、中水平组、高水平组耳石器功能特征、临床疗效比较,差异均有统计学意义(P<0.05);随着SVV水平升高,相关性效应值降低,趋势性检验存在统计学意义(P<0.05);SVV水平不同的患者耳石器功能参数比较,差异均有统计学意义(P<0.05);限制性立方样条模型分析显示,不同性别SVV水平与突发性聋伴BPPV程度不存在非线性关系。结论SVV-0°是突发性聋伴BPPV严重程度的危险因素,偏斜角度越大,疾病程度越重;SVV在判断耳石器功能方面具有重要意义,临床需引起重视。
Objective To report before and after treatment changes of subjective visual vertical(SVV)in in patients with idiopathic sudden sensorineural hearing loss(ISSNHL)and concomitant benign paroxysmal positional vertigo,and their relationship with otolithotic function outcomes.Methods A retrospective analysis was performed on 100 cases of ISSNHL and BPPV admitted to the Department of Otology,the First Affiliated Hospital of Zhengzhou University,from June 2020 to July 2023.Hearing loss was categorized as low frequency sliding(n=12),high frequency sliding(n=18),all frequency sliding(n=32)or total deafness(n=38).SVV deviation from the median(0°)was categorized as low(n=15),medium(n=33)or high(n=52).Multiple variable analysis was conducted for potential effects of SVV deviation on hearing,and clinical data of cases with different levels of SVV deviation were compared.Multiple variable analysis was also conducted for relationship between SVV deviation and treatment outcomes,and correlations between hearing and SVV deviation as well as otolithol function outcomes.Results The SVV-0°,SVV-L30°,SVV-L45°,SVV-L90°,SVV-R30°,SVV-R45°,SVV-R90°,cVEMP and oVEMP results demonstrated statistically significant differences among the four types of hearing loss(P<0.05).SVV-0°results were an independent risk factor for increased severity in sudden hearing loss with concomitant BPPV.Otolith functional characteristics and clinical outcomes showed statistically significant differences among low,medium and high SVV deviation groups(P<0.05),with decreasing correlation as SVV deviation increased(P<0.05).Otolith function parameters also showed statistically significant differences in relation to different levels of SVV deviation(P<0.05).Restricted cubic spline model showed no nonlinear correlation between SVV deviation and disease severity in both genders.Conclusion SVV-0°deviation is a risk factor for severe ISSNHL with concomitant BPPV with a positive correlation.SVV test plays an important role in assessing otolith function and is of great clinical value.
作者
李兴程
徐静
LI Xingcheng;XU Jing(Department of Aurology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华耳科学杂志》
北大核心
2025年第6期721-727,共7页
Chinese Journal of Otology
关键词
突发性聋
良性阵发性位置性眩晕
主观视觉垂直线
耳石器功能转归
idiopathic sudden sensorineural hearing loss
benign paroxysmal positional vertigo
subjective visual vertical lines
otolithiasis functional prognosis
作者简介
通信作者:李兴程,硕士,副主任医师,研究方向:耳科基础与临床,Email:fcclixc@zzu.edu.cn。
