| OBJECTIVE: To verify an effective way to evaluate the function of the utricle in patients with primary BPPV by analyzing the correlation between the lesion profile of primary benign paroxysmal positional vertigo(BPPV)patients and the abnormal side of ocular vestibular evoked myogenic potential(o VEMP).METHODS: Retrospective analysis was made on the clinical data of 80 patients who visited the department of Otolaryngology and Vertigo clinic of the First Affiliated Hospital of Da Lian Medical University from November 2018 to November 2019.All the patients were asked for a detailed medical history,and diagnosed of primary BPPV by Dix-Hallpike and Roll-test(secondary BPPV caused by other causes is excluded),all the patients underwent ocular vestibular evoked myogenic potential examination,subjective visual vertical line and subjective visual horizontal line examination,some patients underwent pure tone threshold test,caloric test.Binary Logistic statistical analysis and contingency table chi-square test were performed to analyze the consistency between the pathological profile of patients with primary BPPV and the abnormal SVV/SVH deviating Angle of o VEMP,the abnormal side of o VEMP test and the abnormal side of SVV and SVH skew angles,P≤0.05 indicated that the results had significant correlation.RESULTS:1.General information: Of the 80 patients,30 were male(37.5%,30/80),50 cases were female(62.5%,50/80).The average age was(48.46±9.827)between 26 and 65 years old.In 80 patients,posterior semicircular canal BPPV 49 cases(61.25%,49/80),the left side was involved in 16 cases,the right side was involved in 33 cases;31 cases of horizontal semicircular canal BPPV(38.75%,31/80),there were 14 cases of left side involvement and 17 cases of right side involvement.2.Pure Tone Threshold Audiometry results: 65 patients with normal hearing(PTA)(84.42%,65/77),12 patients with hearing loss(15.58%,12/77),all of them were mild hearing loss.Among them,there were 10 cases of hearing loss in one ear and 2 cases of hearing loss in both ears.Among the 10 patients with unilateral hearing loss,5 patients had the same hearing loss as BPPV lesions.3.Caloric test results: Of the 80 patients,72 underwent caloric test,among them,there were 41 patients(56.94%,41/72)with normal caloric test results,the results of 31 patients were abnormal(43.06%,31/72),Among the abnormal patients,there were 29 cases(93.55%,29/31)with abnormal CP value and 2 cases(6.45%,2/31)with abnormal DP value.Among the 29 cases with abnormal CP values,13 cases had horizontal semicircular canal BPPV and 5 cases had the same lateral profiles.4.Vestibular Evoked Myogenic Potentia(VEMP)test results: Both sides of o VEMP elicits response waveform and the asymmetry in the 80 patients was higher than that in the normal patients in 28 cases(35%,28/80).52 cases(65%,52/80)had abnormal results.Among them,there were 25 cases without elicited reaction waveform,and 27 cases with abnormal amplitude unsymmetrical ratio,there were 18 cases of abnormal left side and 9 cases of abnormal right side.It can be seen that nearly 2 / 3 of the patients with primary BPPV have abnormal o VEMP results.5.SVV and SVH test results: Among the 80 patients,57 patients(71.25%,57/80)with SVV-0 degree(median head position)were normal,and 23 patients(28.75%,23/80)were abnormal.58 patients(72.5%,58/80)with SVV-L45 degrees(left tilt 45°)were normal,while 22 patients(27.5%,22/80)were abnormal.54 cases(67.5%,54/80)with normal SVV-R45 degree(right tilt of head 45°),26 cases(32.5%,26/80)with abnormal.44 cases(55%,44/80)with SVH-0 degree(median head position)were normal,while 36 cases(45%,36/80)were abnormal.51 cases(63.75%,51/80)with normal SVH-L45 degree(left tilt 45°)and 29 cases(36.25%,29/80)with abnormal.51 cases(63.75%,51/80)with normal SVH-R45 degree(right tilt of head 45°),29 cases (36.25%,29/80)with abnormal.It can be seen that abnormal rates of SVV/SVH in primary BPPV patients account for about 30%,and the abnormal rates of SVH are higher than SVV.6.Correlation analysis:(1)Patients were grouped according to o VEMP left abnormal/normal and right abnormal/normal,respectively.Binary Logistic regression model was established with group A and Group B respectively.(1)When SVV/SVH was at 0 degree of head position,45 degree of left position,and 45 degree of right position,there was no independent statistical significance in the regression analysis of the two groups(P > 0.05).(2)After multi-factor correction,the model fitting degree P value of group A was 0.015,which was statistically significant.o VEMP was positively correlated with SVH-R45°(P = 0.029,OR = 1.055,95%CI = 1.006--1.107).After absolute value correction is added,model fitting degree P value = 0.012,o VEMP is positively correlated with SVH-R45°(P = 0.023,OR = 1.059,95%CI = 1.008--1.113),and there is no correlation with SVV data groups.(3)After correction analysis,P values of group B were all > 0.05,and the data of each group were not statistically significant.After absolute value correction was added,model fitting degree P = 0.016,and o VEMP was negatively correlated with SVV-L45°(P = 0.046,OR = 0.926,95%CI = 0.859--0.999).(2)Patients were divided into left lesions Group A and right lesions group B according to the side of primary BPPV lesions,Binary Logistic regression statistical method was used to analyze the correlation between the lesions of primary BPPV and SVV and SVH skew Angle abnormalities.Conclusion all P values were > 0.05,which showed no statistical significance.(3)Patients were divided into left lesions and right lesions according to the side of primary BPPV lesions,according to the side of o VEMP,the lesions were divided into left abnormal and right abnormal,The contingency table was established,and the chi-square test of the contingency table was used for statistical analysis.The conclusion was that P value > 0.05 was not statistically significant.Conclusion: There was no correlation between the lesion side of BPPV and the abnormal side of o VEMP.CONCLUSION:1.Two thirds of patients with BPPV had abnormal o VEMP and one third had abnormal SVV / SVH.2.In patients with primary BPPV,the results of abnormal side of o VEMP was only correlated with SVV results at 45° left cranial tilt and SVH results at 45° right cranial tilt. |
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