Study On The Relationship Between High Stimulus Rate Auditory Brainstem Response And The Clinic And Syndrome Types Of Vestibular Migraine

Objective: By collecting,analyzing and summarizing the examination results of patients with vestibular migraine,the clinical value of high stimulus rate auditory brainstem response(high stimulus rate ABRs)in the diagnosis and treatment of vestibular migraine was studied.The aim is to facilitate the diagnosis of vestibular migraine and the differential diagnosis with other vestibular disorders.At the same time,we summarized the clinical characteristics of traditional Chinese medicine(TCM)syndrome types of vestibular migraine,discussed their correlation with high stimulus rate ABRs,and linked the TCM syndrome types with objective examination results,thus providing objective basis for the syndrome differentiation of vestibular migraine.Methods:According to the western medicine diagnosis standard of vestibular migraine and Chinese medicine diagnosis standard of vertigo,90 patients with vestibular migraine and 30 health volunteers were selected from Shandong Qian Foshan hospital and Shandong Provincial hospital from December 2018 to December 2019.The general situation,medical history,and the information of four traditional Chinese medicine diagnostic methods(observation,listening,interrogation,and pulse-taking)were recorded in detail for all participants.In addition,high stimulus rate ABRs,video nystagmography and pure tone audiometry were also performed.The positive detection rates of high stimulus rate ABRs,electroseismogram and pure tone audiometry of vestibular migraine were compared.The elicitation of high stimulus rate ABRs in the remission period and the attack period of vestibular migraine patients were detected and compared.At the same time,we classified the patients with vestibular migraine by TCM syndrome differentiation,then combined with high stimulus rate ABRs test to explore the relationship between the positive results of high stimulus rate ABRs and the syndrome type of vestibular migraine.Results:1.The results of high stimulus rate ABRs were normal in all 30 healthy volunteers,while the results of video nystagmography were abnormal in 2 volunteers.The results of pure tone audiometry showed that 2 volunteers had medium-high frequency hearing loss.2.In 90 patients with vestibular migraine,64(71.1%)patients showed abnormalities in high stimulus rate ABRs,31(34.5%)patients showed abnormalities in electronystagmogram,and 22(24.5%)patients showed abnormalities in pure tone audiometry including 0(0%)patients with low frequency hearing loss,16(17.8%)patients with medium-high frequency hearing loss,and 6(6.7%)patients with full frequency hearing loss.3.In these 86 patients with vestibular migraine,8 of 55(14.5%)patients with vestibular migraine in remission period showed abnormalities in high stimulus rate ABRs,24 of 31(77.4%)patients with vestibular migraine in attack period showed abnormalities in high stimulus rate ABRs.4.Distribution of TCM syndromes in vestibular migraine: 30(33.3%)patients with hyperactivity of liver Yang,25(27.8%)patients with obstruction of phlegm and dampness,20(22.2%)patients with blockage of blood stasis,9(10.0%)patients with deficiency of qi and blood,and 6(6.67%)patients with insufficiency of kidney essence.There was a certain correlation between TCM syndrome type distribution and age(P <0.05).Patients in 18-44 years old mainly belonged to phlegm dampness type,patients in45-60 years old mainly belonged to hyperactivity of liver Yang type,patients in 60-75 years old mainly belonged to deficiency of Qi and blood type.5.There were significant differences between the TCM syndromes of vestibular migraine and the results of high stimulus rate ABRs(P<0.05).Among the patients with positive results in high stimulus rate ABRs,the syndrome type of liver Yang hyperactivity,phlegm and dampness obstruction and blood stasis obstruction accounted for the majority,while the type of Qi and blood deficiency and kidney essence deficiency accounted for the majority in patients with negative results.Conclusion:1.High stimulus rate ABRs can be used in the diagnosis of vestibular migraine,especially in patients with attack period.2.There were some positive rates of pure tone audiometry and video nystagmography in patients with vestibular migraine,but they were far lower than that of high stimulus rate ABRs.Therefore,high stimulus rate ABRs has more clinical value in the diagnosis of vestibular migraine compared with pure tone audiometry and electronystagmogram.3.All TCM Syndromes of vestibular migraine coexist in clinic.The type of liver Yang hyperactivity was the most common type,the type of phlegm and dampness obstruction was the second type,the type of blood stasis obstruction was the third,the type of Qi and blood deficiency was the fourth,and the type of kidney essence deficiency was the least.4.There is a certain correlation between high stimulus rate ABRs and TCM syndromes of vestibular migraine.The results of high stimulus rate ABRs can be the objective basis of TCM syndrome differentiation,especially for the deficiency and excess symptoms of vestibular migraine.The positive results tend to be excess syndrome,while negative results tend to be deficiency syndrome.