优化cVEMP检测：2000 Hz短纯音提升上半规管裂的诊断准确性

Toward Optimizing cVEMP: 2,000-Hz ToneBursts Improve the Detection of Superior Canal Dehiscence.

优化cVEMP检测：2000 Hz短纯音提升上半规管裂的诊断准确性

Noij KS1, Herrmann BS2,3, Guinan JJ Jr2,4, Rauch SD5,6.

Audiol Neurootol. 2019 Jan 24;23(6):335-344.

背景

The cervical vestibular evokedmyogenic potential (cVEMP) test measures saccular and inferior vestibular nervefunction. The cVEMP can be elicited with different frequency stimuli andinterpreted using a variety of metrics. Patients with superior semicircularcanal dehiscence (SCD) syndrome generally have lower cVEMP thresholds andlarger amplitudes, although there is overlap with healthy subjects. The aim ofthis study was to evaluate which metric and frequency best differentiatehealthy ears from SCD ears using cVEMP.

颈前庭诱发肌源性电位（cVEMP）测试检测椭圆囊和下前庭下神经功能。cVEMP可以用不同的频率刺激引发并使用各种参数指标来解读。具有上半规管裂（SCD）综合征的患者通常具有较低的cVEMP阈值和较大的振幅，尽管与健康受试者存在重叠。本研究的目的是评估使用哪种刺激频率cVEMP能最好地区分健康的耳和SCD耳。

方法：

Twenty-one patients with SCD and 23age-matched controls were prospectively included and underwent cVEMP testing at500, 750, 1,000 and 2,000 Hz. Sound level functions were obtained at allfrequencies to acquire threshold and to calculate normalized peak-to-peakamplitude (VEMPn) and VEMP inhibition depth (VEMPid). Third window indicator(TWI) metrics were calculated by subtracting the 250-Hz air-bone gap from theipsilateral cVEMP threshold at each frequency. Ears of SCD patients weredivided into three groups based on CT imaging: dehiscent, thin or unaffected.The ears of healthy age-matched control subjects constituted a fourth group.

纳入21名SCD患者和23名年龄匹配的对照组进行前瞻性研究，并在500,750,1,000和2,000 Hz进行cVEMP测试。在所有频率下获得阈值并标准化峰 - 峰振幅（VEMPn）和VEMP抑制深度（VEMPid）。第三窗指标（TWI）为通过从每个频率的同侧cVEMP阈值减去250Hz的气骨差来计算。根据CT成像将SCD患者分为三组：裂开的，薄的或未受影响。健康年龄匹配的对照受试者构成第四组。

结果：

Comparing metrics at all frequenciesrevealed that 2,000-Hz stimuli were most effective in differentiating SCD fromnormal ears. ROC analysis indicated that for both 2,000-Hz cVEMP threshold and for2,000-Hz TWI, 100% specificity could be achieved with a sensitivity of 92.0%.With 2,000-Hz VEMPn and VEMPid at the highest sound level, 100% specificitycould be achieved with a sensitivity of 96.0%.

比较所有频率的指标显示，2,000-Hz刺激在区分SCD和正常耳方面最有效。ROC分析表明，对于2000-Hz cVEMP阈值和2000-Hz TWI，可以实现100％的特异性，灵敏度为92.0％。使用最高声级的2,000 Hz VEMPn和VEMPid，可以实现100％的特异性，灵敏度为96.0％

结论：

The best diagnostic accuracy of cVEMP inSCD patients can be achieved with 2,000-Hz tone burst stimuli, regardless ofwhich metric is used.

无论使用哪种衡量标准，使用2000-Hz短纯音刺激都可以实现cVEMP在SCD患者中的最佳诊断准确性。