联合应用视频头脉冲与转椅试验对人工耳蜗植入术后前庭功能的互补评估价值：一项前瞻性队列研究

Complementary Value of Combined Video Head Impulse Test and Rotary Chair Test in Assessing Vestibular Function After Cochlear Implantation: A Prospective Cohort Study

摘要:

目的:前瞻性评估视频头脉冲试验与转椅试验在人工耳蜗植入术后前庭功能动态监测中的价值,探讨二者联合应用的互补性。方法:前瞻性纳入2022年1月至2024年1月行单侧人工耳蜗植入的感音神经性聋患者110例。于术前1周(基线)及术后1周、1个月、3个月、6个月、1年,分别行视频头脉冲试验(vHIT)、转椅试验(RCT)及眩晕障碍量表(DHI-C)评估。分析vHIT增益值、RCT对称性等客观参数与DHI-C主观评分的动态变化规律、两种检查方法的一致性、相关性及其联合应用效能。结果:术后早期(1周-1个月),植入侧vHIT增益值显著下降(P<0.001),术后1个月达最低点(0.65±0.19),1年后(0.86±0.11)仍低于术前(0.92±0.09),RCT对称性(0.04Hz、0.08Hz)仅在术后1周一过性升高(P<0.001)。术后1周,vHIT与RCT对前庭功能异常的判定一致性一般(Kappa=0.402),两者结果呈弱负相关(r=-0.287, P=0.003)。单一vHIT、单一RCT及两者联合的异常检出率分别为65.45%、38.18%和78.18%,联合检出率高于任一单一方法(P<0.05)。术后早期DHI-C变化与vHIT增益下降幅度呈中度负相关(r=-0.523),术后中远期DHI-C与RCT对称性呈正相关(r=0.413)。术后1周vHIT增益变化量及术后3个月RCT对称性可共同预测术后6个月DHI-C总分(调整后R2=0.324)。结论:vHIT与RCT分别从高频与中低频、单侧与双侧不同维度反映人工耳蜗植入术后前庭功能的动态变化,具有明确互补价值。联合应用可更全面评估前庭损伤与代偿过程,并为早期干预及康复策略的制定提供客观依据。

Abstract:

Objective: To prospectively evaluate the value of video head impulse test (vHIT) and rotary chair test (RCT) in dynamically monitoring vestibular function after cochlear implantation (CI), and to explore the complementary value of their combined application. Methods: A total of 110 patients with sensorineural hearing loss who underwent unilateral CI between January 2022 and January 2024 were prospectively enrolled. Assessments including vHIT, RCT, and the Dizziness Handicap Inventory-Chinese version (DHI-C) were performed at preoperative baseline (1 week before surgery) and at 1 week, 1 month, 3 months, 6 months, and 1 year postoperatively. The dynamic changes of objective parameters (vHIT gain, RCT symmetry) and subjective DHI-C scores, the consistency and correlation between the two test methods, and the efficacy of their combined application were analyzed. Results: In the early postoperative period (1 week to 1 month), the vHIT gain on the implanted side decreased significantly (P<0.001), reaching its nadir at 1 month (0.65 ± 0.19). At 1 year postoperatively (0.86 ± 0.11), it remained lower than the preoperative baseline (0.92 ± 0.09). RCT symmetry (at 0.04 Hz and 0.08 Hz) showed only a transient increase at 1 week postoperatively (P<0.001). At 1 week postoperatively, the agreement between vHIT and RCT in defining "vestibular dysfunction" was fair (Kappa=0.402). A weak negative correlation was observed between the two measures (r=-0.287, P=0.003). The detection rates of vestibular dysfunction were 65.45% for vHIT alone, 38.18% for RCT alone, and 78.18% for the combined interpretation. The combined detection rate was significantly higher than that of either method alone (P<0.05). In the early postoperative period, changes in DHI-C scores showed a moderate negative correlation with the extent of vHIT gain decrease (r=-0.523). In the medium to long term (3 months to 1 year postoperatively), DHI-C scores were positively correlated with RCT symmetry (r=0.413). The change in vHIT gain at 1 week postoperatively and RCT symmetry at 3 months postoperatively jointly predicted the DHI-C total score at 6 months postoperatively (adjusted R2=0.324). Conclusion: vHIT and RCT reflect the dynamic changes of vestibular function after CI from different dimensions—high-frequency vs. mid-low frequency, and unilateral vs. bilateral—demonstrating clear complementary value. Their combined application provides a more comprehensive assessment of vestibular impairment and compensation processes, offering an objective basis for formulating early intervention and rehabilitation strategies.