梅尼爾氏病與前庭性偏頭痛病人之內耳功能檢查結果之比較

Comparison of audiometric|caloric|and cervical vestibular evoked myogenic potential test results between patients with Meniere’s disease and vestibular migraine

背景與目的：梅尼爾氏病和前庭性偏頭痛具有重疊的臨床症狀。本研究比較梅尼爾氏病和前庭性偏頭痛病人間，前庭誘發頸肌性電位及溫差眼振測驗的結果，探討內耳功能檢查是否有助於區分這兩種疾病。方法：共11位梅尼爾氏病病人及19位前庭性偏頭痛病人納入研究，我們使用費雪精確概率檢定比較兩組病人的差異。結果：前庭性偏頭痛較梅尼爾氏病病人年輕(P=0.001)，但梅尼爾氏病病人較常見單側感覺神經性聽力損失(P=0.012)，校正年齡後，溫差眼振測驗異常的比例在梅尼爾氏病高於前庭性偏頭痛病人(P=0.030)。結論：在梅尼爾氏病病人中，有較高比例出現溫差眼振測驗異常，可以輔助區別梅尼爾氏病與前庭性偏頭痛。

 

Background and Purpose: Meniere’s disease (MD) and vestibular migraine (VM) have overlapping clinical symptoms. We conducted a single-center observational study to examine the potential role of inner ear test batteries, namely the cervical vestibular–evoked myogenic potential (c-VEMP) and the caloric test, in the differentiation between patients with MD and VM. Methods: A retrospective chart review of patients presenting with dizzi-ness or vertigo symptoms was performed from Feb 2018 to Feb 2019 in the outpatient clin-ic. All patients underwent complete history taking, physical examination, and an inner ear test battery. Eleven MD (9 females, aged 58.1 ± 11.7 years) and 19 VM patients (18 fe-males, aged 42.3 ± 14.7 years) were enrolled for analysis. We examined the differences in clinical characteristics, presenting symptoms, and the presence of abnormal test results in audiometry, c-VEMP, and the caloric test between the two groups using a Fisher’s exact test. Results: Patients with VM were significantly younger than patients with MD (P = 0.001). Patients with MD had a significantly higher incidence of unilateral sensorineural hearing loss than patients with VM (P = 0.012). Caloric test results showed significantly higher abnormal response rates in the MD than in the VM group (72.7% vs. 26.3%, respec-tively, adjusted P = 0.030). In contrast, the c-VEMP test demonstrated no significant differ-ences between the MD and VM groups in interaural difference abnormalities (0% vs. 10.5%, adjusted P = 0.544) and p13 delay or absent responses (36.4% vs. 10.5%, adjusted P = 0.298). Conclusion: The high rates of abnormal responses in caloric tests may facilitate distinguishing MD from VM.