Correlation Analysis Between The Detection Results Of O-VEMP And SVV/SVH In AVS Patients

OBJECTIVE: To investigate the correlation between ocular vestibular evoked myogenic potential(o-VEMP)and subjective visual vertical line(SVV)as well as subjective visual horizontal line(SVH)detection results in patients with otogenic acute vestibular syndrome(AVS.It is expected that SVV/SVH can be used to assess the vestibular function of patients with AVS when traditional vestibular function tests are intolerable and VEMPs tests cannot yield ideal results.METHODS: A total of 76 patients with acute vestibular syndrome who visited the Deafness and Vertigo Clinic of the First Affiliated Hospital of Dalian Medical University from December 2018 to December 2019 and had a disease course of less than 21 days were selected.Through detailed history and inquiry,auditory function tests were performed,including pure tone audiometry,acoustic immittance,stapedius reflex,vestibular function tests including dual temperature test,electromyography,video head pulse test,vestibular evoked myogenic potential VEMPs test,and SVV/SVH test(0°head position,left inclination 45 ° head position,and right inclination 45 ° head position,respectively).Binary Logistic statistical analysis was used to analyze the correlation and clinical significance between the abnormal side of o-VEMP and the detection results of SVV/SVH,with P ≤ 0.05 indicating that the results had significant correlation.RESULTS:1.General data: 76 patients,including 40 males(52.6%,40/76)and 36 females(47.4%,36/76);aged 26-65 years,mean(48.46 ± 9.827)years;positive rate of history of chronic systemic diseases 19.7%,including 10 patients(13.2%,10/76)with hypertension,3 patients(3.9%,3/76)with diabetes,1 patient(1.3%,1/76)with heart disease,and 1 patient(1.3%,1/76)with hypertension,diabetes and heart disease.2.Results of auditory function tests: Of the 76 patients,74 underwent pure tone audiometry,and 17(23.6%,17/74)had abnormal PTA,including 9(12.5%,9/74)with abnormal PTA in the left ear,7(9.4%,7/76)with abnormal PTA in the right ear,and 1(1.4%,1/74)with abnormal PTA in both ears.3.Semi-regulation tube function test results:(1)Dual temperature test: 72 of 76 patients underwent dual temperature test,32 patients(41.8%,40/72)had abnormal CP and 21 patients(29.2%,21/72)had abnormal DP.2v-HIT test results: 56 of 76 patients underwent v-HIT examination,of which 29(51..7%,29/56)were abnormal.4.Ophthalmic electromyography: Seventy-two of the 76 patients underwent ophthalmic electromyography:(1)saccade test: abnormal in 19 patients(29.0%,19/76),(2)stable follow-up test: type I in 28 patients(38.9%,28/72),type II in 41 patients(57.0%,41/72),type III in 3 patients(4.2%,3/72),and(3)visual movement test: abnormal in 19 patients(29.0%,19/72)5.otolith function test:(1)c-VEMP: When the potential is not elicited,the side that is not elicited is the abnormal side,and when the potential is elicited,the side with lower amplitude when the asymmetry ratio is > 0.33 is the abnormal side.The results showed that 43(56.6%,43/76)of the 76 patients had normal ears,29(38.1%,29/76)had abnormal c-VEMP asymmetry ratio,and 4(5.3%,4/76)had no elicited ears.(2)o-VEMP: When the potential is not elicited,the side that is not elicited is the abnormal side,and when the potentials are elicited,the side with lower amplitude when the asymmetric ratio is > 0.33 is the abnormal side.The results showed that of the 76 patients,33(43.4%,33/76)had normal ears,27(35.5%,27/76)had abnormal o-VEMP amplitude asymmetry ratio,and 16(21.1%,16/76)were not elicited in either ear.(3)SVV/SVH: 49 patients(64.5%,49/76)had abnormal SVV-0 °,25 patients(32.9%,25/76)had abnormal SVV-L45 °,and 33 patients(43.4%,33/76)had abnormal SVV-R45 °;46 patients(60.5%,46/76)had abnormal SVH-0 °,32 patients(42.1%,32/76)had abnormal SVH-L45 °,and 34 patients(44.8%,34/76)had abnormal SVH-R45 °.After the positive distribution test,the data of each group did not meet the normal distribution.6.Statistical analysis: The patients were divided into groups according to o-VEMP left ear abnormality/normal and right ear abnormality/normal,respectively,and labeled as groups A and B to establish binary logistic regression models.(1)There was no independent statistical significance in regression analysis of SVV/SVH between the two groups in head midline sitting position,head left inclination 45 ° sitting position and head right inclination 45 ° sitting position;(2)After multivariate correction in group A,the model fit P value was 0.026,with statistical significance.SVH 0 ° was negatively correlated(P = 0.023,OR = 0.862,95% CI: 0.759 – 0.980)and SVH R45 ° was positively correlated(P = 0.027,OR = 1.040,95% CI: 1.004 – 1.076);the model fit P value = 0.007 after adjustment for the addition of absolute value factors,was statistically significant.Among them,the absolute value of SVV 0 ° was positively correlated(P = 0.05,OR = 1.189,95% CI: 1.000-1.414),the absolute value of SVV R45 ° was negatively correlated(P = 0.042,OR = 0.921,95% CI: 0.851-0.997),SVH 0 ° was negatively correlated(P = 0.003,OR = 0.798,95% CI: 0.687 – 0.928),and SVH R45 ° was positively correlated(P = 0.011,OR = 1.059,95% CI: 1.013-1.107).(3)After correction analysis in group B,the model fit was P > 0.05,and there was no statistical significance in all groups of data.After addition of absolute value factor correction,only the data of SVH R45 ° group showed negative correlation,and the overall regression model fit was P > 0.05,and there was no statistical significance in the model overall.CONCLUSION:1.the sensitivity of the v-Hit test was higher in patients with otogenic AVS(abnormal rate 51.7%).2.There was a correlation between the abnormal side of o-VEMP and the absolute value of SVV data and SVH data in the median position of the head and 45 ° of right inclination position.3.There was a correlation between the side of the o-VEMP anomaly and the direction of deviation of SVH R45 °...