摘要： 目的·探讨嗜酸粒细胞性中耳炎（eosinophilic otitis media，EOM）对患者前庭功能的影响。方法·收集8例确诊的EOM患者（EOM组）资料，另外纳入年龄、性别、病程匹配的16例慢性化脓性中耳炎（chronic suppurative otitis media，CSOM）患者（CSOM组）、16例健康志愿者（对照组）进行比较。所有对象均进行纯音测听、声导抗、视频头脉冲试验（video head impulse test，vHIT）、前庭诱发肌源性电位（vestibular evoked myogenic potential，VEMP）、动态姿势描记图（dynamic posturography，DPG）检查，分析组间差异。结果·EOM组与对照组相比，听力损失类型的构成比差异有统计学意义（
P=0.000），与CSOM组相比差异无统计学意义（
P=0.892）。vHIT中EOM组水平半规管增益值与CSOM组相比差异有统计学意义（
P=0.035），与对照组相比差异无统计学意义（
P=0.220）。EOM组上、后半规管增益值与CSOM组、对照组相比差异均无统计学意义（
P=0.807，
P=0.971，
P=0.683，
P=0.610）。颈源性VEMP（cVEMP）检测与眼源性VEMP（oVEMP）检测中，EOM组的异常率均明显高于对照组（
P=0.002，
P=0.033）；而与CSOM组相比差异均无统计学意义（
P=0.631，
P=0.352）。在cVEMP波形中，EOM组的P1、N1潜伏期较对照组显著延长（
P=0.000，
P=0.000），P1-N1振幅较对照组、CSOM组均显著降低（
P=0.000，
P=0.000）。在oVEMP波形中，EOM组的P1-N1振幅较对照组、CSOM组均显著降低（
P=0.005，
P=0.003）。DPG检测中，EOM组的总体平衡分（
P=0.025）、视觉感觉分（
P=0.017）、前庭感觉分（
P=0.040）、视觉依赖分（
P=0.006）均显著低于对照组；与CSOM组相比，EOM组的总体平衡分显著降低（
P=0.024）。结论·与中性粒细胞介导的感染性中耳炎症相比，EOM倾向于导致更为严重的内耳神经毒性。由于前庭功能障碍具有代偿缓解的特性，EOM患者自身可能缺乏相应主诉，系统全面的前庭功能评估有助于揭示功能残障，进而开展针对性的康复治疗。
关键词: 嗜酸粒细胞性中耳炎, 前庭功能损害, 内耳毒性 Abstract: Objective·To discuss the effect of eosinophilic otitis media (EOM) on vestibular function.
Methods·Data of 8 EOM patients (EOM group) were collected. Additionally, 16 cases of chronic suppurative otitis media (CSOM group) and 16 healthy volunteers (control group) matched with age, gender and course of disease were selected for comparison. All participants were monitored by pure-tone test, acoustic impedence, video head impulse test (vHIT), vestibular evoked muscular potential (VEMP), and dynamic posturography (DPG). And then, date of the three groups were analyzed.
Results·Compared with the control group, there was a statistically significant difference in the composition ratio of the types of hearing loss in the EOM group (P=0.000), while there was no significant difference in the composition ratio between the EOM group and the CSOM group (P=0.892). In vHIT, the gain values of semicircular canals in the EOM group were significantly different from those of the CSOM group (P=0.035), without visible difference from those of the control group (P=0.220). The gain values of upper and posterior semicircular canals in the EOM group were not significantly different from those in both the CSOM group and control group (P=0.807, P=0.971, P=0.683, P=0.610). In cVEMP and oVEMP, the abnormal rate of the EOM group was significantly higher than that of the control group (P=0.002, P=0.033), while being compared with the CSOM group, there was no significant difference (P=0.631, P=0.352). In cVEMP, the incubation periods of P1 and N1 in the EOM group were significantly longer than those in the control group (P=0.000, P=0.000) , and the amplitudes of P1-N1 in the EOM group were lower than those in the control group and CSOM group (P=0.000, P=0.000). In DPG, the composite score (P=0.025), visual score (P=0.017), vestibular score (P=0.040) and visual preference score (P=0.006) of the EOM group were significantly lower than those in the control group. And the composite score of the EOM group was also obviously lower than the CSOM group (P=0.024).
Conclusion·EOM tends to lead to more severe inner ear neurotoxicity than neutrophil-mediated infective middle ear inflammation. Since vestibular dysfunction has the characteristics of compensatory remission, patients with EOM may not have obvious symptoms of vertigo. Systematic and comprehensive assessment of vestibular function is helpful to reveal functional disability, and then targeted rehabilitation therapy can be carried out.
Key words: eosinophilic otitis media, impairment of vestibular function, toxicity of the inner ear PDF全文下载地址:
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