虚拟现实前庭康复治疗突发性聋伴眩晕前后内耳MRI成像变化及治疗效果影响因素分析OA
Changes in inner ear MRI before and after virtual reality vestibular rehabilitation therapy in patients with sudden deafness and vertigo and outcomes influencing factors
目的 探讨突发性聋伴眩晕患者经虚拟现实前庭康复治疗前后内耳MRI变化及治疗效果的影响因素.方法 纳入2022年4月至2024年8月常州市武进中医医院耳鼻喉科收治的突发性聋伴眩晕患者111例为研究对象.根据患者意愿分为对照组59例和观察组52例,倾向性匹配后两组各41例.重复测量方差分析两组治疗前后医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)评分、眩晕障碍量表(dizziness handicap inventory,DHI)评分及耳蜗/延髓(cochlea/medulla oblongata ratio,CM)比值,比较两组治疗效果并采用广义估计方程分析治疗效果的影响因素.结果 治疗7 d,两组HADS评分、焦虑分量表(HADS-anxiety,HADS-A)评分、抑郁分量表(HADS-depression,HADS-D)评分、DHI评分、躯体(DHI-physical,DHI-P)评分、情绪(DHI-emotional,DHI-E)评分、功能(DHI-functional,DHI-F)评分、CM比值均低于本组治疗前,治疗14 d,两组HADS评分、HADS-A评分、HADS-D评分、DHI评分、DHI-P评分、DHI-E评分、DHI-F评分、CM比值均低于治疗前、治疗7d,差异均有统计学意义(P<0.05);治疗7、14 d,观察组HADS评分、HADS-A评分、HADS-D评分、DHI评分、DHI-P评分、DHI-E评分、DHI-F评分、CM比值均低于对照组,差异均有统计学意义(P<0.05).治疗14 d,观察组总有效率高于对照组,差异有统计学意义(P<0.05).年龄、病程、CM比值、听力损失程度(重度、极重度)、听力曲线分型(全聋型)显著影响突发性聋伴眩晕临床疗效,差异有统计学意义(P<0.05).绘制CM比值预测突发性聋伴眩晕治疗效果的受试者工作特征曲线,CM比值为2.20时约登指数最高(0.610),对应灵敏度和特异度分别为0.806、0.804,受试者工作特征曲线下面积为0.848,CM比值对突发性聋伴眩晕治疗效果具有一定预测价值.结论 相较于常规康复治疗,虚拟现实辅助下的前庭康复治疗能够更显著地改善突发性聋伴眩晕患者眩晕症状,临床疗效更佳;虚拟现实前庭康复治疗可显著降低突发性聋伴眩晕患者患耳CM比值,改善血-迷路屏障功能;CM比值对突发性聋伴眩晕临床疗效具有一定预测价值.
Objective To report changes in inner ear MRI before and after virtual reality vestibular rehabilitation therapy in patients with sudden deafness with vertigo,as well as factors that can influence treatment outcomes.Methods Patients with sudden deafness accompanied by dizziness admitted to our hospital from April 2022 to August 2024(n=111)were divided into a control group(routine therapies,n=59)and a study group(virtual reality therapies,n=52)based on the vestibular rehabilitation therapy modality they chose,with 41 patients in each propensity score matching(PSM)group.Hospital Anxiety and Depression Scale(HADS)and Dizziness Handicap Inventory(DHI)scores,and the cochlea/medulla oblongata(CM)ratio on inner ear MRI were compared between the two groups and before and after treatment using ANOVA.Factors influencing treatment efficacy were analyzed using generalized estimation equations.Results After 7 and 14 days of treatment,all HADS scores were lower than before treatment in both groups(P<0.05).Therapy modality and time after treatment were main influencing factors on DHI-F,DHI-E,DHI-P and total DHI scores,and on the CM ratio(P<0.05).After 14 days of treatment,all DHI scores and the CM ratio in the study group were also lower compared with the control group(P<0.05).The CM ratio was correlated to DHI-F,DHI-E,DHI-P and total DHI scores(P<0.05).Age,disease course,CM ratio,severity of hearing loss and hearing loss pattern affected clinical outcomes in these patients(P<0.05).For predicting treatment outcomes,the ROC curve showed the highest Yodene index at 0.610 when the CM ratio was 2.20,with corresponding sensitivity and specificity at 0.806 and 0.804,respectively,and an area under the ROC curve of 0.848,indicating certain values of the CM ratio in predicting treatment efficacy for sudden deafness with vertigo.Conclusions Compared with conventional rehabilitation therapies,vestibular rehabilitation assisted by virtual reality can significantly improve vertigo symptom outcomes with better treatment efficacy in patients with sudden deafness and vertigo.It can significantly reduce the CM ratio,probably by improving function of the blood-labyrinth barrier,which can be used to predict clinical outcomes.
屠勇;陈星;许彩萍
常州市武进中医医院耳鼻喉科,常州 213161常州市武进中医医院耳鼻喉科,常州 213161常州市武进中医医院耳鼻喉科,常州 213161
突发性聋伴眩晕虚拟现实前庭康复治疗磁共振成像
sudden deafness with vertigovirtual realityvestibular rehabilitationmagnetic resonance imaging
《中华耳科学杂志》 2026 (2)
126-132,7
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