CAJ | 학술논문

目的探讨伴眩晕突发性耳聋患者内耳外淋巴液增强MRI特征.方法回顾性分析在耳鼻咽喉头颈外科确诊为伴眩晕的突发性耳聋的43例患者48只耳(38例单侧突发性耳聋,5例双侧突发性耳聋)作为突发性耳聋组,38只单侧突发性耳聋耳对侧无症状耳纯音电测听显示正常.搜集同期单侧耳鸣患者35例,对侧耳35只无耳部病史和不适症状,2次行纯音电测听检查均正常,作为对照组.对突发性耳聋组双侧耳86只、对照组无症状耳35只,共121只耳,行内耳外淋巴液增强MRI检查.采用鼓膜穿刺法向鼓室内注入Gd-DTPA稀释液0.4 ～ 0.5 ml后24 h行3.0T MRI检查.扫描结束后通过原始图像判断内耳外淋巴液增强MRI是否成功,然后计算突发性耳聋组患耳、对照组无症状耳、突发性耳聋组单侧发病患耳和对侧耳的耳蜗底转与相同层面的脑干信号强度比.采用独立样本t检验比较突发性耳聋组患耳与对照组无症状耳耳蜗底转与同层脑干信号强度比的差异;采用配对t检验比较突发性耳聋组单侧发病患者患耳和对侧耳上述强度比的差异.结果 121只内耳外淋巴液增强MRI均获成功.12只(25％,12/48)突发性耳聋患耳见膜迷路积水.突发性耳聋组48只患耳的耳蜗底转与同层脑干信号强度比为2.062±0.907,对照组35只无症状耳的上述强度比为2.703±0.640,差异有统计学意义(t值=3.619,P=O.001).突发性耳聋组38只单侧耳聋患耳信号强度比为1.941±0.860,对侧无症状耳为2.411±0.670,差异也具有统计学意义(t值=3.270,P=0.002).结论伴眩晕突发性耳聋患耳可见膜迷路积水,耳蜗底转外淋巴液增强信号低于无症状耳,提示突发性耳聋患者内耳的圆窗膜渗透性存在异常.
목적 탐토반현훈돌발성이롱환자내이외림파액증강MRI특정.방법 회고성분석재이비인후두경외과학진위반현훈적돌발성이롱적43례환자48지이(38례단측돌발성이롱,5례쌍측돌발성이롱)작위돌발성이롱조,38지단측돌발성이롱이대측무증상이순음전측은현시정상.수집동기단측이명환자35례,대측이35지무이부병사화불괄증상,2차행순음전측은검사균정상,작위대조조.대돌발성이롱조쌍측이86지、대조조무증상이35지,공121지이,행내이외림파액증강MRI검사.채용고막천자법향고실내주입Gd-DTPA희석액0.4 ～ 0.5 ml후24 h행3.0T MRI검사.소묘결속후통과원시도상판단내이외림파액증강MRI시부성공,연후계산돌발성이롱조환이、대조조무증상이、돌발성이롱조단측발병환이화대측이적이와저전여상동층면적뇌간신호강도비.채용독립양본t검험비교돌발성이롱조환이여대조조무증상이이와저전여동층뇌간신호강도비적차이;채용배대t검험비교돌발성이롱조단측발병환자환이화대측이상술강도비적차이.결과 121지내이외림파액증강MRI균획성공.12지(25％,12/48)돌발성이롱환이견막미로적수.돌발성이롱조48지환이적이와저전여동층뇌간신호강도비위2.062±0.907,대조조35지무증상이적상술강도비위2.703±0.640,차이유통계학의의(t치=3.619,P=O.001).돌발성이롱조38지단측이롱환이신호강도비위1.941±0.860,대측무증상이위2.411±0.670,차이야구유통계학의의(t치=3.270,P=0.002).결론 반현훈돌발성이롱환이가견막미로적수,이와저전외림파액증강신호저우무증상이,제시돌발성이롱환자내이적원창막삼투성존재이상.
Objective To explore the contrast perilymphatic MRI characteristics of inner ears with sudden hearing loss with vertigo.Methods Forty three patients with sudden hearing loss with vertigo and 35 patients with unilateral tinnitus diagnosed by the department of Otolaryngology-Head and Neck Surgery were retrospectively included.Forty eight ears (38 ears with unilateral sudden hearing loss and 10 ears in 5 cases with bilateral sudden hearing loss) were regarded as sudden hearing loss group,35 asymptomatic ears (the opposite ears of the unilateral tinnitus ears) as control group.Thirty eight opposite ears of the 38 unilateral sudden hearing loss ears and 35 ears of the control group showed normal in the pure tone audiometry exam.One hundred and twenty one ears (48 hearing loss ears,38 opposite ears of the 38 unilateral sudden hearing loss ears and the 35 control group's ears) underwent contrast perilymphatic MR exams,0.4 to 0.5 ml gadolinium hydrate diluted with saline was injected through the tympanic membrane,twenty four hours later,three-dimensional fluid attenuated inversion recovery (3D-FLAIR) sequence was performed using a 3.0 T MRI scanner.After the contrast perilymphatic MR exam,success in the exam was judged through the raw image.The signal intensity ratio (SIR) of cochlea basal turn and homolateral brain stem was quantitatively calculated.The SIR difference of 48 ears with sudden hearing loss and 35 asymptomatic ears in control group was analyzed by t test.The SIR difference of the 38 unilateral sudden hearing loss ears and the contralateral asymptomatic ears was also analyzed.The presence of endolymphatic hydrops was judged.Results The contrast perilymphatic MRI of 121 inner ears with intratympanic gadolinium injection were all successful.Endolymphatic hydrops were observed in 12 sudden hearing loss ears with the occurrence rate of 25％(12/48).The SIR of basal turn and homolateral brain stem of the sudden hearing loss ears (2.062±0.907) were lower than the SIR of the control groups' asymptomatic ears (2.703± 0.640) with significant difference between them (t=3.619,P=0.001),the SIR of basal turn and homolateral brain stem of the unilateral sudden hearing loss ears (1.941 ±0.860) were also lower than the SIR of the contralateral asymptomatic ears (2.411±0.670) with statistical difference between them (t =3.270,P=0.002).Conclusions Endolymphatic hydrops were observed in sudden hearing loss with vertigo.The SIR of the cochlea in sudden hearing loss ears were lower than that of the asymptomatic ears,indicating the abnormal permeability of the round window membrane.