Luftleitungsinduzierte oculäre VEMP: II. Erste klinische Untersuchungen

 

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Zusammenfassung

Hintergrund: Vestibulär evozierte myogene Potenziale (VEMP) finden zunehmend Anwendung in der Differenzialdiagnostik vestibulärer Störungen. Während die Sacculusfunktion mittels AC cVEMP eingeschätzt werden kann, wird in neueren Studien eine vorwiegend utriculär induzierte Reflexantwort der AC oVEMP angenommen. Ziel dieser Pilotstudie war es, den Einsatz der AC oVEMP in der klinischen Praxis bei Patienten mit peripher-vestibulären Störungen zu evaluieren.

Material und Methoden: Bei freiwilligen Patienten (n=21) mit peripheren vestibulären Erkrankungen erfolgte die Ableitung von AC oVEMP, AC cVEMP sowie die Ermittlung der thermischen Erregbarkeit und des Kopfimpulstests. Die VEMP-Stimulationen erfolgten mittels 500 Hz Burstreizung bei 100 dB nHL.

Ergebnisse: AC oVEMP zeigten bei Patienten mit peripher vestibulären Störungen unterschiedliche Ergebnisse, die zur Differenzialdiagnostik vestibulärer Störungen beitragen könnten. AC cVEMP und AC oVEMP konnten aufgrund unterschiedlicher Befundkonstellationen in 3 Typen eingeteilt werden.

Schlussfolgerungen: AC oVEMP können in der klinischen Praxis zur Otolithenfunktionsprüfung bei Patienten mit peripheren vestibulären Störungen eingesetzt werden. Die klinischen Befunde unterstreichen die Bedeutung der AC oVEMP in Ergänzung zu den AC cVEMP im Rahmen der Vestibularisdiagnostik. Für die exakte klinische Interpretation von VEMP-Befunden sind weitere Testverfahren erforderlich.

Abstract

Air Conducted Ocular VEMP: II. First Clinical Investigations

Background: Vestibular-evoked myogenic potentials (VEMP) are widely used to assess vestibular function. Air conducted (AC) cervical VEMP (cVEMP) reflect sacculus and inferior vestibular nerve function. Ocular VEMP (oVEMP) however has been hardly examined up to now. In recent studies it has been assumed that AC oVEMP probably reflects superior vestibular nerve function. The aim of this pilot study was to evaluate clinical application of the AC oVEMP.

Material and methods: AC oVEMP were recorded in patients with peripheral vestibular disorders (n=21). In addition thermal irritation and head impulse test were performed and AC cVEMP were recorded. For intense AC-sound stimulation tone bursts (500 Hz) with 100 dB nHL were used.

Results: In peripheral vestibular disorders AC oVEMP and AC cVEMP could be classified into: • type 1 (inferior vestibular neuritis) with loss of AC oVEMP but normal AC cVEMP, • type 2, probable type of superior vestibular neuritis, showing present AC cVEMP but loss of AC oVEMP, • type 3, probable complete vestibular neuritis, without AC oVEMP and AC cVEMP.

Conclusions: AC oVEMP may be used as an appropriate test for clinical investigation in patients with vestibular disorders. AC oVEMP is an additional, essential test for assessing otolith function beside AC cVEMP. Further vestibular test are necessary for precise clinical interpretation.

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Korrespondenzadresse

PD Dr. Leif Erik Walther

HNO-Gemeinschaftspraxis

Main-Taunus-Zentrum

65843 Sulzbach

Email: Leif.Walther@hno-praxis-sulzbach.de