Efficacy of Virtual Reality Vestibular Rehabilitation Training in Patients with Sudden Deafness and Vertigo: a Randomized Controlled Trial

doi:10.12114/j.issn.1007-9572.2023.0272

Abstract

Abstract:

Background

Due to its unique advantages, virtual reality rehabilitation (VR) training has been widely used in the field of rehabilitation therapy, but there is a lack of study on its application efficacy in patients with sudden deafness and vertigo.

Objective

To observe the efficacy of coventional vestibular rehabilitation training and vestibular rehabilitation training assisted by VR technology in patients with sudden deafness and vertigo.

Methods

From January 2022 to January 2023, 84 patients with sudden deafness and vertigo were selected from the Department of Otolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University and randomly divided into the two groups, with 42 cases in each group. The control group was given drug therapy combined with coventional vestibular rehabilitation training, while the observation group was given vestibular rehabilitation training assisted by VR technology on the basis of drug therapy. The Dizziness Disorder Scale (DHI) and Hospital Anxiety and Depression Scale (HADS) were respectively used to evaluate the two groups before intervention, 7 and 14 days after the intervention.

Results

Finally 81 patients completed the trial, including 41 patients in the observation group and 40 patients in the control group. Group and time had interaction effects on DHI-Function (F), DHI-Emotion (E) and DHI-Physical (P) scores and total DHI score (P<0.05). The main effects of group and time on DHI sub-scores and total score were significant (P<0.05). There was no significant difference between the two groups in DHI sub-scores and total score before intervention (P>0.05) ; DHI sub-scores and total score in both groups after 7 and 14 days of intervention were lower than those before intervention (P<0.05). DHI sub-scores and total score in the observation group were higher than the control group after 7 and 14 days of intervention (P<0.05). Group and time had interaction effects on HADS-Anxiety Scale (A), HADS-Depression Scale (D) scores and total HADS score (P<0.05). The main effect of group and time on HADS sub-scores and total score was significant (P<0.05). There was no significant difference in HADS sub-scores and total score between the two groups before intervention (P>0.05). HADS sub-scores and total score in both groups after 7 and 14 days of intervention were lower than those before intervention (P<0.05). After 7 and 14 days of intervention, there was no significant difference in HADS sub-scores and total score between the two groups (P>0.05) .

Conclusion

Vestibular rehabilitation training is effective for patients with sudden deafness and vertigo, and the vestibular rehabilitation training assisted by VR technology can obviously improve patients' balance disorders and quality of life.

Key words: Sudden deafness, Vertigo, Hearing loss, sensorineural, Vestibular rehabilitation training, Virtual reality, Treatment outcome

摘要： 背景虚拟现实（VR）康复训练凭借其独特的优势，在康复治疗领域已经被广泛应用，但在突发性聋伴眩晕患者中的应用效果缺乏研究。目的观察常规前庭康复训练、VR技术辅助的前庭康复训练在突发性聋伴眩晕患者中的疗效。方法选取2022年1月—2023年1月山西医科大学第一医院耳鼻咽喉头颈外科收治的突发性聋伴眩晕患者84例，采用随机数字表法将患者分为两组，每组42例。对照组给予药物治疗联合常规前庭康复训练，观察组在药物治疗的基础上予以VR技术辅助的前庭康复训练。干预前及干预后7、14 d，分别使用眩晕残障量表（DHI）和医院焦虑抑郁量表（HADS）对两组进行评估。结果最终81例患者完成试验，其中观察组41例，对照组40例。组别与时间对DHI-功能（F）、DHI-情绪（E）、DHI-躯体（P）评分及DHI总分存在交互作用（P<0.05）；组别及时间分别对DHI各分项评分及其总分主效应显著（P<0.05）。干预前两组患者DHI各分项评分及其总分比较，差异无统计学意义（P>0.05）；干预7、14 d后，两组患者DHI各分项评分及其总分均较组内干预前降低（P<0.05）。干预7、14 d后，观察组患者DHI各项评分及总分低于对照组（P<0.05）。组别与时间对HADS-焦虑量表（A）、HADS-抑郁量表（D）评分及HADS总分存在交互作用（P<0.05）；组别及时间分别对HADS各分项评分及其总分主效应显著（P<0.05）。干预前两组患者HADS各分项评分及其总分比较，差异无统计学意义（P>0.05）；干预7、14 d后，两组患者HADS各分项评分及其总分均较组内干预前降低（P<0.05）。干预7、14 d后，两组患者HADS各分项评分及其总分比较，差异无统计学意义（P>0.05）。结论前庭康复训练对突发性聋伴眩晕患者疗效确切，VR技术辅助下的前庭康复训练可更明显改善患者的平衡障碍，提高患者生活质量。

关键词: 突发性聋, 眩晕, 听力损失, 感音神经性, 前庭康复训练, 虚拟现实, 治疗结果

CLC Number:

R 764.431　R 441.2

ZHAO Yanan,HAN Shifan,LI Ying, et al. Efficacy of Virtual Reality Vestibular Rehabilitation Training in Patients with Sudden Deafness and Vertigo: a Randomized Controlled Trial[J]. Chinese General Practice, 2024, 27(14): 1672-1677. DOI: 10.12114/j.issn.1007-9572.2023.0272.
赵雅楠,韩世范,李莹等. 虚拟现实前庭康复训练对突发性聋伴眩晕患者的治疗效果：一项随机对照试验[J]. 中国全科医学, 2024, 27(14): 1672-1677. DOI: 10.12114/j.issn.1007-9572.2023.0272.

Figures/Tables 6

References 28

[1]	余津颖，陈飞云，赵欢娣，等. 突发性聋伴眩晕患者头脉冲抑制试验特征分析[J]. 听力学及言语疾病杂志，2021，29（4）：434-437. DOI：10.3969/j.issn.1006-7299.2021.04.017.
[2]	中华耳鼻咽喉头颈外科杂志编辑委员会，中华医学会耳鼻咽喉头颈外科学分会. 突发性聋诊断和治疗指南（2015）[J]. 中华耳鼻咽喉头颈外科杂志，2015，50（6）：443-447. DOI：10.3760/cma.j.issn.1673-0860.2015.06.002.
[3]	CHANDRASEKHAR S S，TSAI DO B S，SCHWARTZ S R，et al. Clinical practice guideline：sudden hearing loss （update） executive summary[J]. Otolaryngol Head Neck Surg，2019，161（2）：195-210. DOI：10.1177/0194599819859883.
[4]	LIM K H，JEONG Y J，HAN M S，et al. Comparisons among vestibular examinations and symptoms of vertigo in sudden sensorineural hearing loss patients[J]. Am J Otolaryngol，2020，41（4）：102503. DOI：10.1016/j.amjoto.2020.102503.
[5]	DEVEZE A，BERNARD-DEMANZE L，XAVIER F，et al. Vestibular compensation and vestibular rehabilitation. Current concepts and new trends[J]. Neurophysiol Clin，2014，44（1）：49-57. DOI：10.1016/j.neucli.2013.10.138.
[6]	QUARANTA N，LONGO G，DADDUZIO S，et al. Ocular and cervical vestibular-evoked myogenic potentials in idiopathic sudden sensorineural hearing loss （ISSHL） without vertigo：VEMPs in ISSHL[J]. Eur Arch Otorhinolaryngol，2020，277（2）：409-414. DOI：10.1007/s00405-019-05724-x.
[7]	YU H Q，LI H W. Association of Vertigo with hearing outcomes in patients with sudden sensorineural hearing loss：a systematic review and meta-analysis[J]. JAMA Otolaryngol Head Neck Surg，2018，144（8）：677-683. DOI：10.1001/jamaoto.2018.0648.
[8]	BERGERON M，LORTIE C L，GUITTON M J. Use of virtual reality tools for vestibular disorders rehabilitation：a comprehensive analysis[J]. Adv Med，2015，2015：916735. DOI：10.1155/2015/916735.
[9]	危昔均，韦亦茜，秦萍，等. 虚拟现实技术在国内临床康复治疗中的应用情况调查[J]. 中国康复医学杂志，2021，36（7）：832-837. DOI：10.3969/j.issn.1001-1242.2021.07.012.
[10]	MICARELLI A，VIZIANO A，AUGIMERI I，et al. Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction：a randomized controlled pilot trial[J]. Int J Rehabil Res，2017，40（4）：325-332. DOI：10.1097/MRR.0000000000000244.
[11]	VIZIANO A，MICARELLI A，AUGIMERI I，et al. Long-term effects of vestibular rehabilitation and head-mounted gaming task procedure in unilateral vestibular hypofunction：a 12-month follow-up of a randomized controlled trial[J]. Clin Rehabil，2019，33（1）：24-33. DOI：10.1177/0269215518788598.
[12]	林晨珏，席淑新，王璟. 前庭康复训练对前庭外周性眩晕患者眩晕残障症状的改善作用[J]. 中华医学杂志，2020，100（32）：2503-2506. DOI：10.3760/cma.j.cn112137-20191202-02621.
[13]	刘斌，段作伟，张海峰，等. 前庭康复训练治疗良性发作性位置性眩晕患者残余头晕的疗效观察[J]. 中华物理医学与康复杂志，2017，39（11）：860-862. DOI：10.3760/cma.j.issn.0254-1424.2017.11.016.
[14]	舒福，石磊，张琦，等. 沉浸式前庭功能康复训练系统治疗BPPV复位后的残余症状[J]. 听力学及言语疾病杂志，2021，29（5）：509-513. DOI：10.3969/j.issn.1006-7299.2021.05.008.
[15]	WEI N，HE X，YANG N. Efficacy of vestibular rehabilitation therapy for idiopathic sudden hearing loss with vertigo in vertigo and psychological status[J]. Int J Clin Exp Med，2020，13（4）：2386-2392.
[16]	PEREZ-MARCOS D. Virtual reality experiences，embodiment，videogames and their dimensions in neurorehabilitation[J]. J Neuroeng Rehabil，2018，15（1）：113. DOI：10.1186/s12984-018-0461-0.
[17]	GARCIA A P，GANANÇA M M，CUSIN F S，et al. Vestibular rehabilitation with virtual reality in Ménière's disease[J]. Braz J Otorhinolaryngol，2013，79（3）：366-374. DOI：10.5935/1808-8694.20130064.
[18]	MIZIARA O C，DE OLIVEIRA V R，GASPARINI A L P，et al. Virtual reality in vestibular rehabilitation：a pilot study [J]. International Journal of Therapy and Rehabilitation，2019，26（7）：1-13.
[19]	CAI H H，LIN T，CHEN L N，et al. Evaluating the effect of immersive virtual reality technology on gait rehabilitation in stroke patients：a study protocol for a randomized controlled trial[J]. Trials，2021，22（1）：91. DOI：10.1186/s13063-021-05031-z.
[20]	CABINIO M，ROSSETTO F，ISERNIA S，et al. The use of a virtual reality platform for the assessment of the memory decline and the hippocampal neural injury in subjects with mild cognitive impairment：the validity of smart aging serious game （SASG）[J]. J Clin Med，2020，9（5）：1355. DOI：10.3390/jcm9051355.
[21]	薛静刚，秦金. 轻度认知障碍患者康复训练中虚拟现实技术的应用效果分析[J]. 中国全科医学，2021，24（S1）：110-112.
[22]	焦粤农，林颖，张欣睿，等. 沉浸式虚拟现实系统辅助前庭功能康复的应用[J]. 临床耳鼻咽喉头颈外科杂志，2020，34（5）：447-451. DOI：10.13201/j.issn.2096-7993.2020.05.015.
[23]	文艺，吕萍，丁大雄，等. 突发性聋患者的全身共患病分析[J]. 中华耳科学杂志，2022，20（3）：385-391. DOI：10.3969/j.issn.1672-2922.2022.03.004.
[24]	XIE M，ZHOU K，PATRO N，et al. Virtual reality for vestibular rehabilitation：a systematic review[J]. Otol Neurotol，2021，42（7）：967-977. DOI：10.1097/MAO.0000000000003155.
[25]	邢英姿，裴建军，孙玉涛，等. 突聋伴眩晕患者焦虑和抑郁状态的临床研究[J]. 临床耳鼻咽喉头颈外科杂志，2017，31（24）：1919-1922. DOI：10.13201/j.issn.1001-1781.2017.24.012.
[26]	ALAHMARI K A，SPARTO P J，MARCHETTI G F，et al. Comparison of virtual reality based therapy with customized vestibular physical therapy for the treatment of vestibular disorders[J]. IEEE Trans Neural Syst Rehabil Eng，2014，22（2）：389-399. DOI：10.1109/TNSRE.2013.2294904.
[27]	HSU S Y，FANG T Y，YEH S C，et al. Three-dimensional，virtual reality vestibular rehabilitation for chronic imbalance problem caused by Ménière's disease：a pilot study[J]. Disabil Rehabil，2017，39（16）：1601-1606. DOI：10.1080/09638288.2016.1203027.
[28]	SONG J J. Virtual reality for vestibular rehabilitation[J]. Clin Exp Otorhinolaryngol，2019，12（4）：329-330. DOI：10.21053/ceo.2019.00983.

组别	例数	性别[例（%）]		年龄（±s，岁）
组别	例数	男	女	年龄（±s，岁）
对照组	40	22（55.0）	18（45.0）	47.7±14.9
观察组	41	22（53.7）	19（46.3）	49.0±13.9
χ²（t）值		0.015		-0.413^a
P值		0.904		0.680

组别	例数	性别[例（%）]		年龄（±s，岁）
组别	例数	男	女	年龄（±s，岁）
对照组	40	22（55.0）	18（45.0）	47.7±14.9
观察组	41	22（53.7）	19（46.3）	49.0±13.9
χ²（t）值		0.015		-0.413^a
P值		0.904		0.680

组别	例数	DHI			DHI-F
组别	例数	干预前	干预后7 d	干预后14 d	干预前	干预后7 d	干预后14 d
对照组	40	51.00±9.94	37.10±10.73^a	21.95±5.60^a	21.05±6.01	16.15±4.95^a	9.95±3.99^a
观察组	41	49.51±10.28	24.88±8.97^ab	14.29±6.51^ab	19.95±4.16	12.49±4.79^ab	6.00±3.46^ab
F值		F_时间=669.21，F_组间=13.74，F_交互=12.83			F_时间=269.66，F_组间=12.60，F_交互=4.24
P值		P_时间<0.001，P_组间<0.001，P_交互<0.001			P_时间<0.001，P_组间=0.001，P_交互=0.016
组别	DHI-E			DHI-P
组别	干预前	干预后7 d	干预后14 d	干预前	干预后7 d	干预后14 d
对照组	13.35±3.63	9.95±4.09^a	6.00±2.90^a	16.85±3.89	11.00±3.65^a	6.00±2.90^a
观察组	13.71±4.97	6.20±3.54^ab	4.15±2.25^ab	15.85±5.11	6.20±3.43^ab	4.15±2.30^ab
F值	F_时间=150.30，F_组间=7.41，F_交互=11.23			F_时间=201.39，F_组间=20.51，F_交互=9.42
P值	P_时间<0.001，P_组间=0.008，P_交互<0.001			P_时间<0.001，P_组间<0.001，P_交互<0.001

组别	例数	DHI			DHI-F
组别	例数	干预前	干预后7 d	干预后14 d	干预前	干预后7 d	干预后14 d
对照组	40	51.00±9.94	37.10±10.73^a	21.95±5.60^a	21.05±6.01	16.15±4.95^a	9.95±3.99^a
观察组	41	49.51±10.28	24.88±8.97^ab	14.29±6.51^ab	19.95±4.16	12.49±4.79^ab	6.00±3.46^ab
F值		F_时间=669.21，F_组间=13.74，F_交互=12.83			F_时间=269.66，F_组间=12.60，F_交互=4.24
P值		P_时间<0.001，P_组间<0.001，P_交互<0.001			P_时间<0.001，P_组间=0.001，P_交互=0.016
组别	DHI-E			DHI-P
组别	干预前	干预后7 d	干预后14 d	干预前	干预后7 d	干预后14 d
对照组	13.35±3.63	9.95±4.09^a	6.00±2.90^a	16.85±3.89	11.00±3.65^a	6.00±2.90^a
观察组	13.71±4.97	6.20±3.54^ab	4.15±2.25^ab	15.85±5.11	6.20±3.43^ab	4.15±2.30^ab
F值	F_时间=150.30，F_组间=7.41，F_交互=11.23			F_时间=201.39，F_组间=20.51，F_交互=9.42
P值	P_时间<0.001，P_组间=0.008，P_交互<0.001			P_时间<0.001，P_组间<0.001，P_交互<0.001

组别	例数	HADS-A			HADS-D			HADS
组别	例数	干预前	干预后7 d	干预后14 d	干预前	干预后7 d	干预后14 d	干预前	干预后7 d	干预后14 d
对照组	40	6.30±2.38	4.23±1.66^a	2.70±1.44^a	5.40±2.48	4.00±2.04^a	3.20±1.79^a	11.68±4.26	8.23±3.03^a	5.83±2.55^a
观察组	41	6.51±2.10	3.63±1.97^a	2.68±1.68^a	5.12±2.28	3.54±1.86^a	2.59±1.61^a	11.63±3.50	7.17±3.41^a	5.27±2.86^a
F值		F_时间=107.49，F_组间=0.16，F_交互=2.49			F_时间=63.63，F_组间=1.43，F_交互=0.35			F_时间=179.66，F_组间=0.74，F_交互=1.11
P值		P_时间<0.001，P_组间=0.695，P_交互=0.090			P_时间<0.001，P_组间=0.235，P_交互=0.708			P_时间<0.001，P_组间=0.391，P_交互=0.335