| Objective:1,To analyze the positive rate of audiologic and vestibular assessments in patients with definite Meniere's disease, by using distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR), electrocochleography (ECochG), Metz's recruitment test, the glycerol test, vestibular caloric test, Fukuda stepping test, and to study clinical significance in the diagnosis of Meniere's disease.2,The cochlea and vestibular functions of patients who were diagnosed with Meniere's disease were evaluated from different aspects by different detection techniques of inner ear. The paper attempted to investigate the correlation between the cochlear and vestibular dysfunction, and to find an objective measure system for the study of relationship between the symptoms, the progression of Meniere's disease and the pathophysiology. It would provide evidences for disease diagnosis, treatment selection and curative effect.3,The vestibular dysfunction of Meniere patients could be evaluated by interfering the visual and proprioceptive effects on postural balance with Fukuda stepping test. By comparing the results of vestibular caloric test with Fukuda stepping test. The paper attempted to check the coincidence of the two tests and evaluate the clinical significance of Fukuda stepping test.4,The comprehensive evaluation model in principal components Analysis could be constructed. It could completely synthesize the original variables and reasonably reflect the degree of injury at cochlear and vestibular function. The correlation between the cochlear and vestibular dysfunction could be obtained on this basis. At the same time, the correlation between comprehensive evaluation function and hearing impairment could be studied.Materials & Methods:1. MaterialsDuring May 2009 to January 2011,75 (80ears) patients with Meniere's disease according to 2006 Guiyang diagnosis standard treated in the ENT department of Nanfang hospital, Southern Medical University were chosen to study. Among the 75 patients of Meniere's disease, only 44 patients were identifies as complying with the defined criteria such as average pure-tone threshold <70dBHL and unilateral Meniere's disease. They were primary cases who had no treatment by then.26 men (26 ears),18 women (18 ears). Age ranging from 16 to 68 years old, the mean age was 38.4±15.6 years.Case history was ranging from half a month to 25 years, an average of 51.3±63.5 months. All reported cases had a history of recurrent spontaneous and episodic vertigo,40 cases had a history of hearing loss, tinnitus or aural fullness,5 cases had the phenomenon of spontaneous nystagmus on the treatment. Abnormalities were not found in the patients though general ENT examination. According to hearing impairment, Meniere cases were divided into three groups:Ⅰgroup (≤25 dB) consisted of 6 cases,Ⅱgroup (26～40dB) 13 cases,Ⅲgroup (41～ 70dB) 25 cases. Fifteen healthy subjects with no hearing and balance disorders were assigned to a control group.2.Methods2.1 Audiologic assessmentsPure tone thresholds were obtained with the use of calibrated audiometer (GSI, USA). Arithmetic mean of the three-tone average of thresholds at 0.5,1 and 2 kHz was used to describe hearing level. If the difference between pure tone thresholds and acoustic reflex threshold was less 60dB, Metz's recruitment test was considered as positive, but there was at least one frequency was found among 0.5,1,2 and 4 kHz. Auditory brainstem response was obtained with the use of Smart EP instrument made by American HIS company. The threshold, latencies and wave interval of ABR waveⅠ,ⅢandⅤwere recorded.The response amplitude and signal to noise ratio of distortion product otoacoustic emission were recorded. The electrocochleography was recorded on-invasively from the external ear. The -SP/AP ratio and SP-AP waveform width was recorded at 90 dB nHL,-SP/AP ratio of Meniere's disease patients exceeding 0.4 was considered abnormal. SP-AP waveform width was measured at AP amplitude 1/3. Glycerol was administered orally 2.4 ml/kg of body weight dissolved in the equal amount of the physiological saline. Pure tone audiometry was performed immediately before and 1,2,3h after glycerol administration. The criteria for a positive glycerol test were defined as a pure tone threshold improvement of at least 15dB or 10 dB in two adjacent octaves or 10 dB in three tone frequency.2.2 Vestibular assessmentsFor eye movement recording system, a video goggles, videonystagmography software and equipment (Micromedical, USA) were used. Each side was stimulated with water heated up to 30℃and 44℃. Unilateral weakness was defined as a 25% weak response on one side relative to the other. If the directional preponderance of nystagmus was greater than 30%, the result was considered abnormal.The subjects stood in the center of two concentric circles with eyesblindfolded. They stepped in place with outstretched arms for the prescribed 50steps (110step/min). Their angle of displacement and distance of displacement were measured. The criteria for a positive Fukuda test were defined as displacement distance greater than 100cm Or displacement angle greater than 45°. Audiologic and vestibular assessments were completed within 2 days of treatment. The patients who could not be tested on the first treatment were completed before the cochlea symptoms did not completely disappear.2.3 Analysis of statisticsAll date were statistically treated using statistical software package of SPSS 13.0. The Statistical Comparison of groups was tested by chi-square test and McNemar test. The difference among three groups was analyzed by One-Way ANOVA test. The LSD and Dunnett's T3 test were used when the difference among groups was found. The correlation coefficient test was used for bivariate analysis. The comprehensive evaluation model in principal components analysis was constructed.Results:1,In this study of 44 patient who were diagnosed with Meniere's disease,17 case were passed by distortion product otoacoustic emission test. The positive rate of electrocochleography, Metz's recruitment test and glycerol test and Fukuda test were 63.6,43.2,45.5 and 65.9% respectively. 25 cases were identified as unilateral weakness, and 8 cases were identified as directional preponderance.2,The positive rate of -SP/AP ratio was increased with theⅠ,ⅡandⅢgroup (P<0.05). The auditory threshold,-SP/AP ratio and the positive rates of electrocochleography in the abnormal group of semicircular canals function were significantly higher than normal group, the difference is statistically significant (P<0.05). The positive rate of Metz's recruitment test and glycerol test in group ECochG(+) was significantly higher than that of group ECochG(-) (P<0.05).3,A significant correlation was found between -SP/AP ratio and PTA (r=0.755, P<0.01), The correlation was marginal between -SP/AP ratio and degree of unilateral weakness. Other correlation was not significant.4,The abnormal percentage of Fukuda stepping test in Meniere's disease was 65.9%(29/44), and agreement to vestibular caloric test was 92%(23/25). The statistical analysis showed that there was no significant difference (P=0.289) between Fukuda stepping test and vestibular caloric test. The result ofκcoefficient analysis showed that the goodness of fit was ideal.5,The comprehensive evaluation function of cochlear and vestibular dysfunction were as follows:f1=0.212 x11+0.259 x12+0.429 x 13+0.367 x 14, f2=0.275 x 21+0.375 x 22+0.398 x 23+0.119 x 24. There was a positive correlation between f1 and f2(r=0.395,P=0.008).Conclusion:1,The accuracy of the verification of endolymphatic hydrops in Meniere's disease by various kinds of objective examination is higher.2,The degree of cochlear impairment is related to hearing loss, and aggravates following the hearing loss increment.3,The cochlear impairment of patients with abnormal semicircular canals function are more serious than those patients with normal semicircular canals function.4,There is a positive correlation between cochlear dysfunction and vestibular dysfunction in Meniere's disease.5,The statistical analysis between Fukuda stepping test and vestibular caloric test shows that the goodness of fit is ideal. Fukuda stepping test is a suitable to assess vestibular dysfunction in the initial screening stage.6,The comprehensive evaluation function obtained from the principal component analysis can completely synthesize the original variables, and reasonably reflect the degree of injury at cochlear and vestibular function. It will provide us evidences for disease diagnosis, treatment selection and curative effect. |
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