前庭诱发肌源性电位、冷热试验和耳蜗电图在梅尼埃病诊断中的评估价值∗

Objective: The aim of this study is to evaluate the diagnostic value of vestibular-evoked myogenic potential (cVEMP and oVEMP), caloric test, and cochlear electrogram (EcochG) in patients with Meniere's disease (MD) and non-Meniere's disease.Method: Sixty-four patients (64 ears) with Unilateral Meniere's disease were enrolled in the study group (MD group), and 127 cases(254 ears) of non-Meniere's disease patients as non-MD group, including vertigo migraine in 40 cases, benign paroxysmal positional vertigo in 48 cases, benign recurrent vertigo in 13 cases, vestibular paroxysmia in 3 cases, vestibular neuritis in 5 cases and other undiagnosed vertigo in 18 cases. Both group undertake cVEMP, oVEMP, caloric test and ECochG. Use Medcale software to draw ROC curve of ECochG and calculate the area under curve(AUC), Jordan index and optimal diagnostic cut-off points. Make the cut-off point as the point of -SP/AP, then evaluate the sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and diagnostic accuracy of cVEMP, oVEMP, caloric test and ECochG in MD group and non-MD group. Result: The AUC of ECochG ROC curve was 0.74, the Jordan index was 0.47 and the cut-off point was 0.4. The sensitivity and specificity of cVEMP(62% and 68%), oVEMP(61% and 53%) and caloric test(53% and 57%) were all below ECochG(65% and 78%). The positive predictive value and of ECochG was the highest(61.9%), the negative predictive value of cVEMP was highest(87.5%). The diagnostic accuracy of ECochG was highest(74%), followed with cVEMP(67%), oVEMP(55%) and caloric test(56%). Conclusion: Compared with the vestibular function tests, the sensitivity, specificity, diagnostic accuracy and NPV were all higher in ECochG, and the diagnostic benefit can be maximized when -SP/AP value>0.4. So the value of single vestibular function examination in the diagnosis of Meniere's disease is limited. The diagnosis of MD still requires a comprehensive evaluation in combination with medical history, audiological tests and vestibular function examinations.