中耳压力治疗对难治性梅尼埃病的前庭-自主神经效应：一项回顾性队列研究
Vestibular-autonomic effects of middle ear pressure therapy in refractory Ménière's disease: A retrospective cohort study.
文献信息
| PMID | 42976487 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Toru Miwa |
| 作者单位 | Department of Otolaryngology, Teikyo University Hospital, Mizonokuchi, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa 213-8507, Japan; Department of Otolaryngology-Head and Neck Surgery, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. Electronic address: miwa.tooru.br@teikyo-u.ac.jp. |
| 期刊 | Auris, nasus, larynx |
| SCI 分区 | Q2 |
| IF | 1.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 尽管中耳压力治疗（MEPT）已用于治疗难治性梅尼埃病（MD），但其生理机制仍不明确。本研究旨在评估接受MEPT（使用EFET01®）治疗的4期MD患者与未接受MEPT的对照组相比，前庭和自主神经功能随时间的变化。
方法： 这项回顾性研究纳入了在基线和12个月时接受前庭测试（冷热试验和前庭诱发肌源性电位[VEMP]）和自主神经评估（心率变异性）并完成问卷（如头晕残障量表[DHI]）的患者。
结果： 尽管半规管功能和动态平衡保持不变，但颈性VEMP（cVEMP）不对称比随时间显著下降（p = 0.018），表明整个队列中不对称性呈时间依赖性降低。值得注意的是，自主神经评估显示站立时心率变异性高频成分存在显著的时间依赖性变化（p < 0.001），这可能与自主神经调节改变有关。组别与时间的交互作用未达到统计学显著性（p = 0.050），表明这些变化未被统计学证实为MEPT特异性。两组DHI评分均改善。
结论： 观察到cVEMP不对称性和站立时高频指标的时间依赖性变化，但本队列中未统计学证实MEPT特异性效应。这些发现应谨慎解释为探索性观察，而非因果治疗效应的证据。联合前庭-自主神经评估可作为监测治疗反应的敏感生物标志物。
英文摘要
OBJECTIVE: Although middle ear pressure therapy (MEPT) has been used for treating refractory Ménière's disease (MD), its physiological mechanisms remain unclear. This study aimed to evaluate vestibular and autonomic changes over time in patients with stage 4 MD treated with MEPT (using EFET01®) compared with a non-MEPT control group.
METHODS: This retrospective study included patients who underwent vestibular testing (caloric testing and vestibular evoked myogenic potential [VEMPs]) and autonomic assessment (heart rate variability) and completed questionnaires (e.g., Dizziness Handicap Inventory [DHI]) at baseline and 12 months.
RESULTS: Although canal function and dynamic balance remained unchanged, cervical VEMP (cVEMP) asymmetry ratios significantly decreased over time (p = 0.018), indicating a time-dependent reduction in asymmetry across the cohort. Notably, autonomic evaluation revealed significant time-dependent changes in the high-frequency component of heart rate variability during standing (p < 0.001), which may be associated with altered autonomic regulation. The group-by-time interaction did not reach statistical significance (p = 0.050), indicating that these changes were not statistically confirmed as MEPT-specific. DHI scores improved in both groups.
CONCLUSIONS: Time-dependent changes in cVEMP asymmetry and high-frequency indices during standing were observed, with no statistically confirmed MEPT-specific effects in this cohort. These findings should be interpreted cautiously as exploratory observations rather than evidence of a causal treatment effect. Combined vestibular-autonomic assessment may serve as a sensitive biomarker for monitoring treatment response.