Alerjik Rinit Hastalarında Vestibüler Uyarılmış Miyojenik Potansiyel Yanıtları

Öz

Amaç: Alerjik rinit AR hastalarında servikal vestibüler uyarılmış miyojenik potansiyel cVEMP test yanıtlarını değerlendirmek.Gereç ve Yöntemler: Anamnez, fizik muayene ve deri prick testi sonuçları birleştirilerek AR tanısı konulan 50 hasta hafif ile orta-ağır AR olan hastalar olarak iki gruba ayrıldı. Çalışmaya deri prick testi negatif olan 25 sağlıklı kontrol grubu dahil edildi. Yirmi beş sağlıklı kontrol grubu, 25 hafif AR grubu ve 25 orta-ağır AR grubu vardı. Bilateral cVEMP testi, 500 Hz frekansta 100 dB nHL stimülasyonu ile uygulandı. Kontrol grubu ile hafif AR grubu, kontrol grubu ile orta-ağır AR grubu, hafif AR grubu ile orta-ağır AR grupları arasında latans ve amplitüd değerleri karşılaştırıldı.Bulgular: Sağlıklı kontrol grubunun sağ-sol P13 ve N23 latans değerleri, hafif AR grubu ve ortaağır AR grubuna göre istatistiksel olarak anlamlı derecede düşüktü. Hafif AR grubunun sağ-sol P13 ve N23 latans değerleri orta-ağır AR grubuna göre istatistiksel olarak anlamlı derecede düşüktü. Sağlıklı kontrol grubundaki sağ ve sol P13-N23 amplitüd değerleri, hafif ve orta-ağır AR grubuna göre istatistiksel olarak anlamlı derecede yüksek bulundu. Hafif AR grubunun sağ ve sol P13-N23 amplitüd değerleri orta-ağır AR grubundan istatistiksel olarak anlamlı derecede yüksekti.Sonuç: Alerjik riniti olan ve vestibüler şikayetleri olmayan hastalarda cVEMP testi sakküler disfonksiyonu saptayabilir. Bulgularımızı doğrulamak için daha büyük gruplarla daha fazla çalışmaya ihtiyaç vardır

Anahtar Kelimeler

• Alerjik rinit, Servikal vestibüler uyarılmış miyojenik potansiyel, Endolenfatik Hidrops

Vestibular-Evoked Myogenic Potential Responses in Patients with Allergic Rhinitis

Abstract

Objective: To evaluate cervical vestibular-evoked myogenic potential cVEMP test responses in patients with allergic rhinitis AR .Material and Methods: Fifty patients with an AR diagnosis and anamnesis, physical examination, and skin prick test results were divided into two groups as mild to moderate-severe AR. Twenty-five healthy control subjects with a negative skin prick test were also included in the study. There were 25 subjects each in the healthy control group, mild AR group and moderate-severe AR group. Bilateral cVEMP test was administered using 100 dB nHL stimulation at 500 Hz frequency. The latency and amplitude values were compared between the control group and mild AR group, control group and moderate-severe AR group, and mild AR group and moderate-severe AR group. Results: The right-left P13 and N23 latency values of the healthy control group were statistically significantly lower than those of the mild AR group and moderate-severe AR group. The right-left P13 and N23 latency values of the mild AR group were statistically significantly lower than those of the moderate-severe AR group. The right and left P13-N23 amplitude values in the healthy control group were found to be statistically significantly higher than in the mild and moderate-severe AR group. The right and left P13-N23 amplitude values of the mild AR group were statistically significantly higher than those of the moderate-severe AR group.Conclusion: In patients with allergic rhinitis without vestibular complaints, the cVEMP test may detect saccular dysfunction. Further studies with larger groups are needed to verify our findings

Keywords

• Allergic rhinitis, Cervical vestibular-evoked myogenic potential, Endolymphatic hydrops

Kaynakça

1. Kirtsreesakul V, Somjareonwattana P, Ruttanaphol S. The correlation between nasal symptom and mucociliary clearance in allergic rhinitis. Laryngoscope 2009; 119(8): 1458-62.
2. Sajjadi H, Papparella MM. Meniere’s disease. Lancet 2008;372:406-14.
3. Hughes GB, Kinney SE, Barna BP, Calabrese LM. Autoimmune reactivity in Meniere’s disease: A preliminary report. Laryngoscope 1983;93:410-7.
4. Dagli M, Goksu N, Eryilmaz A, Mocan Kuzey G, Bayazit Y, Gun BD, Gocer C. Expression of histamine receptors (H(1), H(2), and H(3)) in the rabbit endolymphatic sac: An immunohistochemical study. Am J Otolaryngol 2008; 29(1):20-3.
5. Murofushi T, Kaga K. VEMP: Its basics and clinical applications. Tokyo: Springer, 2009.
6. Iseli C, Gibson W. A comparison of three methods of using transtympanic electrocochleography for the diagnosis of Meniere’s disease: Click summating potential measurements, tone burst summating potential amplitude measurements, and biasing of the summating potential using a low-frequency tone. Acta Otolaryngol 2009; 26: 1–8.
7. Lin MY, Timmer FC, Oriel BS, Zhou G, Guinan JJ, Kujawa SG, Herrmann BS, Merchant SN, Rauch SD. Vestibular evoked myogenic potentials (VEMP) can detect asymptomatic saccular hydrops. Laryngoscope 2006;116(6):987-92.
8. de Waele C, Huy PT, Diard JP, Freyss G, Vidal PP. Saccular dysfunction in Meniere ’s disease. Am J Otol 1999; 20: 223–32.

9. Cingi C, Gunhan K, Gage-White L, Unlu H. Efficacy of leukotriene antagonists as concomitant therapy in allergic rhinitis. Laryngoscope 2010; 120(9): 1718-23.
10. Dykewicz MS, Fineman S, Skoner DP, Nicklas R, Lee R, Blessing-Moore J, Li JT, Bernstein IL, Berger W, Spector S, Schuller D. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol 1998;81:478-518.
11. Derebery MJ, Berliner KI. Allergy and Its Relation to Menière’s Disease. Otolaryngol Clin North Am 2010;43: 1047-58.
12. Derebery MJ. Allergic management of Menière’s Disease: an outcome study. Otolaryngol Head Neck Surg 2000; 122:174-82.
13. Rauch SD, Zhou G, Kujawa SG, Guinan JJ, Herrmann BS. Vestibular evoked myogenic potentials show altered tuning in patients with Meniere’s disease. Otol Neurotol 2004;25:333-8.
14. Taylor RL, Wijewardene AA, Gibson WP, Black DA, Halmagyi GM, Welgampola MS. The vestibular evoked- potential profile of Meniere’s disease. Clin Neurophysiol 2011;122:1256-63.
15. Katayama N, Yamamoto M, Teranishi M, Naganawa S, Nakata S, Sone M, Nakashima T. Relationship between endolymphatic hydrops and vestibular-evoked myogenic potential. Acta Otolaryngol 2010;130(8):917-23.
16. Takeda T, Takeda S, Egami N, Kakigi A, Nishioka R, Yamasoba T. Type 1 allergy-induced endolymphatic hydrops and the suppressive effect of leukotriene receptor antagonist. Otol Neurotol 2012;33(5):886-90.
17. Singh S, Nagarkar AN, Bansal S, Vir D, Gupta AK. Audiological manifestations of allergic rhinitis. J Laryngol Otol 2011;125(9):906-10.