Characteristic Analysis Of Vestibular Evoked Myogenic Potential In Sudden Deafness

Purpose:Sudden sensorineural hearing loss,also known as sudden deafness,our country’s Sudden Deafness Diagnostic and Treatment Guidelines(2015)[1] defines it as:sensorineural hearing loss of unknown cause that occurs suddenly within 72 hours,Hearing loss ≥ 20 d BHL in at least two adjacent frequencies.In addition to hearing loss,patients with sudden deafness are accompanied by dizziness,which may be related to the loss of otolith function.Clinical application of vestibular evoked myogenic potentials(VEMP)to evaluate the condition of patients’ otoliths,including cervical vestibular evoked myogenic potentials(cVEMP)and ocular vestibular evoked myogenic potentials(oVEMP).In this study,VEMP was performed in patients with sudden deafness to assess the dysfunction of the otolith(saccule,utricle).Method:A retrospective analysis of 44 patients(44 affected ears and 44 healthy ears)diagnosed as unilateral sudden deafness in the Department of Otolaryngology Head and Neck Surgery,China-Japan Union Hospital of Jilin University from September2018 to February 2021.All patients are hospitalized for otoscope,acoustic immittance,pure tone audiometry,ABR,temporal bone CT,head MRI,cVEMP,oVEMP,and the audiogram of the affected ear was classified according to the 2015 Sudden Deafness Diagnostic and Treatment Guidelines.The Sudden deafness patients were divided into groups according to the degree of hearing loss of affected frequency and the type of hearing loss..We record the extraction rate,asymmetry ratio,latency,and amplitude of VEMP.SPSS 26.0 statistical software was used for analysis.Chi-square test was used to compare the difference of VEMP elicitation rate between affected ears and healthy ears,and the difference analysis of rank sum test was performed on the asymmetric ratio between the two.The difference analysis of P1,N1 latency,amplitude,and asymmetry ratio of VEMP between the affected ear and healthy ear that can elicit VEMP response was performed by rank-sum test.Spearman correlation analysis was used to analyze the relationship between the average hearing threshold of the affected ear and the VEMP amplitude.The chi-square test was used to analyze the relationship between the VEMP elicitation rate and the types and grades of hearing loss,and the chi-square test was used to analyze the relationship between the VEMP elicitation rate and whether it was accompanied by vertigo.The correlation between sudden deafness-related factors(gender,age,hypertension,diabetes,tinnitus)and VEMP elicitation rate was analyzed by chi-square test.Result:1.In patients with sudden deafness,the cVEMP extraction rate of affected ears(59.1%)is lower than that of healthy ears(88.6%)(χ2=9.948,P=0.002).In patients with sudden deafness,the extraction rate of oVEMP(68.2%)in affected ears was lower than that in healthy ears(88.6%)(χ2=5.437,P=0.02).Compared with healthy ears,the P1 latency,N1 latency,and amplitude of cVEMP in affected ears were not statistically different.P1 latency(P=0.749),N1 latency(P=0.985),amplitude(P=0.148);P1 latency of oVEMP in affected ear,N1 latency and amplitude were not statistically different compared with healthy ears,P1 latency(P=0.437),N1 latency(P=0.706),amplitude(P=0.191).2.The cVEMP and oVEMP elicitation rates of patients with different hearing loss grades are significantly different.The cVEMP elicitation rate of patients with severe and very severe sudden deafness(27.3%)is lower than that of patients with mild(87.5%),moderate(77.8%),and moderately severe(56.3%)(χ2=8.631,P=0.035).The oVEMP elicitation rate of patients with severe and very severe sudden deafness(36.4%)is lower than that of patients with mild(62.5%),moderate(88.9%),moderate and severe(81.3%)(χ2=8.291,P=0.040).The sudden deafness was grouped according to the degree of hearing loss,and there was no statistical difference between the cVEMP and oVEMP parameters of the affected ear and the healthy ear.The sudden deafness was grouped according to the classification of hearing loss,and there was no statistical difference between the cVEMP and oVEMP parameters of the affected ear and the healthy ear.3.Comparing the VEMP elicitation rate of patients with sudden deafness in the vertigo group and those without vertigo,using the chi-square test,the cVEMP elicitation rate in the group with vertigo(42.1%)is lower than that in the group without vertigo(72%)(χ2=3.991,P=0.046),the oVEMP extraction rate of the group with vertigo(47.7%)was lower than that of the group without vertigo(84%)(χ2=6.677,P=0.010).The cVEMP amplitude(3.55±2.58 μV)of the group with vertigo was lower than that of the group without vertigo(6.20±6.04 μV),which was statistically different(P=0.030);there was no statistical difference in the P1,N1,and asymmetry ratio of cVEMP,P1 latency(P=0.892),N1 latency(P=0.285),asymmetry ratio(P=0.367);oVEMP P1,N1,amplitude,asymmetry ratio are not statistically different,P1 latency(P=0.625),N1 latency(P=0.722),amplitude(P=0.722),asymmetry ratio(P=0.594).4.Age is related to the cVEMP elicitation rate of affected ears.The elicitation rate of sudden deafness patients aged 46 years or older is 39.1%,and the elicitation rate of patients younger than 19 to 45 years old(81.0%)(χ2=7.943,P=0.005).The cVEMP elicitation rate of sudden deaf patients with diabetes was 22.2%,which was lower than that of patients without diabetes(68.6%)(χ2=6.362,P=0.012).5.There is no significant linear correlation between the average hearing threshold of the affected ear and the amplitude of cVEMP(r=-0.194,P=0.343).There was no significant linear correlation between the average hearing threshold of the affected ear and the oVEMP amplitude(r=-0.324,P=0.114).Conclusion:1.Patients with severe and extremely severe hearing loss have severe cochlear damage,low VEMP elicitation rate,and high possibility of combined saccule and utricle pathway injury.2.Sudden deafness patients with vertigo,diabetes,middle-aged and elderly patients have low VEMP elicitation rate,and vestibular function is more likely to be impaired.The VEMP examination of patients with sudden deafness can find and evaluate the degree of vestibular function damage,which is helpful for the formulation of individualized diagnosis and treatment plans for patients with sudden deafness.