小剂量庆大霉素鼓室内注射治疗梅尼埃病对球囊功能的影响

Effect of lowdose intratympanic gentatmicin injection on saccule in patients with Meniere’s disease

摘要:

摘要：目的应用颈性前庭诱发肌源性电位（cVEMP）研究小剂量庆大霉素鼓室内注射对球囊功能的影响，以指导临床用药。方法回顾性分析2016年5月—2018年10月行耳内镜下鼓室内注射庆大霉素（30 mg/mL）治疗的26例单侧梅尼埃病患者，于注射前及注射后3周分别行纯音听阈测试（PTA）及cVEMP检查，比较注射前后患者听力及cVEMP结果。结果26例梅尼埃病患者随访12~24个月，眩晕控制率为92.31%（24/26）。注射前患耳平均气导听阈为（61.80±2.79）dBHL，注射后为（64.40±2.51）dBHL，注射前后听力差异无统计学意义（P>0.05）。cVEMP检查提示注射前4例（15.38%）未引出，22例注射前患侧P1平均潜伏期为（16.51±2.46）ms，N1平均潜伏期为（27.57±3.36）ms；注射后12例（46.15%）未引出，其他14例P1平均潜伏期为（18.88±1.84）ms，N1潜伏期（30.57±1.45）ms。可见注射后引出率下降，P1、N1潜伏期延长。注射前后患侧P1、N1潜伏期的结果差异具有统计学意义（P<0.05）。结论鼓室内注射小剂量庆大霉素可抑制或破坏球囊功能，cVEMP检查有助于评价此治疗的有效性及安全性。

关键词:梅尼埃病|颈性前庭诱发肌源性电位|庆大霉素|鼓室内注射

Abstract:

ObjectiveTo explore the application of cervical vestibular evoked myogenic potentials (cVEMP) to evaluate lowdose intratympanic gentamicin injection (ITGI) for the treatment of Meniere’s disease (MD).MethodsClinical data of 26 patients suffering from unilateral MD treated with ITGI (30 mg/mL) in our department between May 2016 and Oct 2018 were analyzed retrospectively. Their hearing thresholds and cVEMPs before and after injection were recorded and analyzed.ResultsThe patients were followed up for 12 to 48 months. The control rate for dizziness was 92.31% (24/26). The average airconducted hearing thresholds before and after injection were (61.80±2.79) and (64.40±2.51) dBHL respectively, and the difference was statistically insignificant (P>0.05). Before injection, cVEMPs were elicited in 22 cases (84.62%) with average P1 latency of (16.51±2.46) ms and N1 latency of (27.57±3.36) ms. After injection, cVEMPs were elicited in 14 cases (53.85%) with average P1 latency of (18.88±1.84) ms and N1 latency of (30.57±1.45) ms. cVEMP comparison revealed reduced elicitation rate and prolonged latencies of P1 and N1 after injection. The differences were statistically significant (P<0.05).ConclusioncVEMP test can be used as a tool to evaluate the safety and effect of ITGI for MD.

Key words:Meniere’s disease|cVEMP| Gentamicin|Intratympanic injection