ORIGINAL RESEARCH
Vestibular-Evoked Myogenic Potential Findings in Patients with Unilateral Idiopathic Sudden Sensorineural Hearing Loss
Tek Taraflı Ani İşitme Kayıplı Hastalarda Vestibüler Uyarılmış Miyojenik Potansiyel Bulguları
Received Date : 09 Jan 2020
Accepted Date : 21 Feb 2020
Available Online : 27 Feb 2020
Güler BERKİTENa, Belgin TUTARa, Ziya SALTÜRKa, Tolgar Lütfi KUMRALa, Muhammed Enis EKİNCİĞLUa, Yavuz UYARa, Ömür BİLTEKİN TUNAa
aİstanbul Okmeydanı Training and Research Hospital, Clinic of Otorhinolaryngology Head and Neck Surgery, İstanbul, TURKEY
Doi: 10.24179/kbbbbc.2020-73470 - Makale Dili: EN
KBB ve BBC Dergisi. 2020;28(3):240-6
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: We investigated vestibular function in patients
with unilateral idiopathic sudden sensorineural hearing loss
(ISSNHL) and vertigo, and assessed the relationship between hearing
loss grade and cervical vestibular-evoked myogenic potentials
(cVEMPs) and ocular VEMP (oVEMPs) findings. Material and
Methods: The study included 31 patients diagnosed with unilateral
ISSNHL and vertigo, and 26 healthy individuals (control group) with
VEMP. In all participants, pure tone audiometry was used to assess the
hearing threshold, and cVEMP and oVEMP tests were used to assess
vestibular system function. The P1/N1 latency, P1-N1 interval and amplitude
asymmetry ratio (AAR) were measured in the VEMP test. Additionally,
the relationship between the VEMP findings and the degree
of hearing loss was assessed. Results: We found no significant differences
in VEMP parameters (N1 latency, P1-N1 interval, and amplitude)
between the affected and control group ears (p>0.05). In contrast, the
cVEMP P1 latency and AARs were significantly different between the
patient and control groups (p=0.019 and 0.015, respectively). No significant
differences were found in VEMP parameters (P1 latency, N1 latency,
P1-N1 interval, and amplitude) or AAR in the patients with
profound and nonprofound hearing loss in the cVEMP and oVEMP
tests (p>0.05). Conclusions: Vestibular otolithic dysfunction can be
detected using cVEMP and oVEMP in patients with ISSHL and vertigo.
The VEMP amplitude asymmetry and VEMP responses have high
diagnostic value in patients with ISSNHL with vestibular symptoms.
Abnormal cVEMP responses provide more information than oVEMP
responses about vestibular otolithic damage in patients with ISSHL.
Although the saccule and utricle were affected in ISSNHL, the extent
of saccular and utricular damage did not correspond to the amount of
hearing loss.
Keywords: VEMP (Vestibular-evoked myogenic potentials); sudden hearing loss; inner ear
ÖZET
Amaç: Tek taraflı idiyopatik ani sensorinöral işitme kaybı
(ISSNHL) ve vertigo hastalarında vestibüler fonksiyonu araştırdık ve
işitme kaybı derecesi ile servikal vestibüler uyarılmış miyojenik potansiyel
(cVEMP) ve oküler VEMP (oVEMP) bulguları arasındaki ilişkiyi
değerlendirdik. Gereç ve Yöntemler: Çalışmaya tek taraflı
ISSNHL ve vertigo tanısı konmuş 31 hasta ve VEMP'li 26 sağlıklı birey
(kontrol grubu) dahil edildi. Tüm katılımcılarda işitme eşiğini değerlendirmek
için saf ses odyometrisi, vestibuler sistem fonksiyonunu değerlendirmek
için cVEMP ve oVEMP testleri kullanıldı. VEMP testinde
P1/N1 latansı, P1-N1 aralığı, ve Amplitüd asimetrisi oranı (AAR) ölçüldü.
Ayrıca VEMP bulguları ile işitme kaybı derecesi arasındaki ilişki
değerlendirildi. Bulgular: Etkilenen ve kontrol grubu kulakları arasında
VEMP parametrelerinde (N1 latans, P1-N1 aralığı ve amplitüd)
önemli bir fark bulamadık (p> 0,05). Buna karşılık, cVEMP P1 latansı
ve AAR hasta ve kontrol grupları arasında anlamlı olarak farklıydı (sırasıyla
p = 0,019 ve 0,015). cVEMP ve oVEMP testlerinde derin ve kanıtlanmamış
işitme kaybı olan hastalarda VEMP parametreleri (P1
latansı, N1 latansı, P1-N1 aralığı ve amplütüd) veya AAR'da anlamlı
fark bulunmadı (p> 0,05). Sonuç: Vestibüler otolitik disfonksiyon
ISSHL ve vertigo hastalarında cVEMP ve oVEMP kullanılarak tespit
edilebilir. Vestibüler semptomları olan ISSNHL hastalarında VEMP
amplitüd asimetrisi ve VEMP yanıtları yüksek tanı değerine sahiptir.
Anormal cVEMP yanıtları ISSHL hastalarında vestibüler otolitik hasarla
ilgili oVEMP yanıtlarından daha fazla bilgi sağlar. Her ne kadar
sakkülve utrikul ISSNHL'de etkilenmiş olsa da, sakküler ve utriküler
hasarın derecesi işitme kaybı derece ile korele değildir.
Anahtar Kelimeler: VEMP (Vestibuler uyarılmış miyojenik potansiyel); ani işitme kaybı; iç kulak
KAYNAKLAR
- Stachler RJ, Chandrasekhar SS, Archer SM, Rosenfeld RM, Schwartz SR, Barrs DM, et al; American Academy of Otolaryngology-Head and Neck Surgery. Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg. 2012;146(3 Suppl):S1-35.[Crossref] [PubMed]
- Castro TM, Costa LA, Nemezio ME, Fonseca LJ. Bilateral sudden deafness. Braz J Otorhinolaryngol. 2011;77(5):678.[Crossref] [PubMed]
- Wilson W, Veltri RW, Laird N, Sprinkle PM. Viral and epidemiologic studies of idiopathic sudden hearing loss. Otolaryngol Head Neck Surg. 1983;91(6):653-8.[Crossref] [PubMed]
- Byl Jr FM. Sudden hearing loss: eight years' experience and suggested prognostic table. Laryngoscope. 1984;94(5 Pt 1):647-61.[Crossref] [PubMed]
- Laird N, Wilson WR. Predicting recovery from idiopathic sudden hearing loss. Am J Otolaryngol. 1983;4(3):161-4.[Crossref] [PubMed]
- Nakashima T, Yanagita N. Outcome of sudden deafness with and without vertigo. Laryngoscope. 1993;103(10):1145-9.[Crossref] [PubMed]
- Rosengren SM, Welgampola MS, Colebatch JG. Vestibular evoked myogenic potentials: past, present and future. Clin Neurophysiol. 2010;121(5):636-51.[Crossref] [PubMed]
- Rosengren SM, Kingma H. New perspectives on vestibular evoked myogenic potentials. Curr Opin Neurol. 2013;26(1):74-80.[Crossref] [PubMed]
- Iwasaki S, McGarvie LA, Halmagyi GM, Burgess AM, Kim J, Colebatch J G, et al. Head taps evoke a crossed vestibulo-ocular reflex. Neurology. 2007;68(15):1227-9.[Crossref] [PubMed]
- Iwasaki S, Takai Y, Ozeki H, Ito K, Karino S, Murofushi T. Extent of lesions in idiopathic sudden hearing loss with vertigo: study using click and galvanic vestibular evoked myogenic potentials. Arch Otolaryngol Head Neck Surg. 2005;131(10):857-62.[Crossref] [PubMed]
- Gussen R. Sudden deafness of vascular origin: a human temporal bone study. Ann Otol Rhinol Laryngol. 1976;85(1 Pt 1):94-100.[Crossref] [PubMed]
- Yoon TH, Paparella MM, Schachern PA, Alleva M. Histopathology of sudden hearing loss. Laryngoscope. 1990;100(7):707-15.[Crossref] [PubMed]
- Rauch SD. Clinical practice. Idiopathic sudden sensorineural hearing loss. N Engl J Med. 2008;359(8):833-40.[Crossref] [PubMed]
- Fujimoto C, Egami N, Kinoshita M, Sugasawa K, Yamasoba T, Iwasaki S. Involvement of vestibular organs in idiopathic sudden hearing loss with vertigo: an analysis using oVEMP and cVEMP testing. Clin Neurophysiol. 2015;126(5):1033-8.[Crossref] [PubMed]
- Zhang Q, Hu J, Xu XD, Chen YF, Zhang Y, Wei JR, et al. [Objective evaluation of otolithic end organs in sudden sensorineural hearing loss patients]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013;48(5):389-93.[PubMed]
- You TZ, Wang SJ, Young YH. Registering grades of sudden deafness to predictt he hearing out come via an inner-ear test battery. Int J Audiol. 2014;53(3):153-8.[Crossref] [PubMed]
- Murofushi T, Halmagyi GM, Yavor RA, Colebatch JG. Absent vestibular evoked myogenic potentials in vestibular neurolabyrinthitis: an indication of inferior vestibular nerve involvement? Arch Otolaryngol Head Neck Surg. 1996;122(8):845-8.[Crossref] [PubMed]
- Murofushi T, Matsuzaki M, Mizuno M. Vestibular evoked myogenic potentials in patients with acoustic neuroma. Arch Otolaryngol Head Neck Surg. 1998;124(5):509-12.[Crossref] [PubMed]
- Wang CT, Young YH. Comparison of the head elevation versus rotation methods in eliciting vestibular evoked myogenic potentials. Ear Hear. 2006;27(4):376-81.[Crossref] [PubMed]
- Cheng PW, Huang TW, Young YH. The influence of clicksversus short tone burst son the vestibular evoked myogenic potentials. Ear Hear. 2003;24(3):195-7.[Crossref] [PubMed]
- Murofushi T, Matsuzaki M, Wu CH. Short tone burst-evoked myogenic potentials on the sternocleidomastoid muscle: are these potentials also of vestibular origin? Arch Otolaryngol Head Neck Surg. 1999;125(6):660-4.[Crossref] [PubMed]
- Murofishi T. Recording and assessing VEMP. In: Murofishi T, Kaga K, eds. Vestibular Evoked Myogenic Potentials, its Basic and Clinical Applications. 1st ed. Tokyo: Springer; 2009. p.25-34.[Crossref]
- Taylor RL, Kong J, Flanagan S, Pogson J, Croxson G, Pohl D, et al. Prevalence of vestibular dysfunction in patients with vestibular schwannoma using video head-impulses and vestibular-evoked potentials. J Neurol. 2015;262(5):1228-37.[Crossref] [PubMed]
- Hong SM, Byun JY, Park CH, Lee JH, Park MS, Cha CI. Saccular damage in patients with idiopathic sudden sensorineural hearing loss without vertigo. Otolaryngol Head Neck Surg. 2008;139(4):541-5.[Crossref] [PubMed]
- Wu CC, Young YH. Vestibular evoked myogenic potentials are intact after sudden deafness. Ear Hear. 2002;23(3):235-8.[Crossref] [PubMed]
- Ogawa Y, Otsuka K, Shimizu S, Inagaki T, Kondo T, Suzuki M. Subjective visual vertical perception in patients with vestibular neuritis and sudden sensorineural hearing loss. J Vestib Res. 2012;22(4):205-11.[Crossref] [PubMed]
- Niu X, Zhang Y, Zhang Q, Xu X, Han P, Cheng Y, et al. The relation ship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss. Acta Otolaryngol. 2016;136(3):225-31.[Crossref] [PubMed]