돌발성 난청 및 급성 말초성 안면마비 환자에서 진단 초기 바이러스 항체 혈청검사의 한계
Viral Serologic Test in Sudden Sensorineural Hearing Loss and Acute Peripheral Facial Paralysis：Is It Always Necessary
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Sudden sensorineural hearing loss (SSNHL) and acute peripheral facial paralysis (APFP) are common otologic diseases related to viral infections. In this study, we investigated the clinical necessity of viral serologic tests in the diagnosis of SSNHL and APFP. Subjects and Method：A retrospective study was carried out for 348 patients with SSNHL, 121 patients of Bell’s palsy (BP) and 37 patients of Ramsay Hunt syndrome (RHS). The serologic tests for IgM and IgG titers of herpes simplex virus (HSV) and varicella zoster virus (VZV) using enzyme-linked immunosorbent assay were performed within 10 days after onset in all patients. Clinical manifestations, abnormalities on MRI and prognosis were compared in relation to the results of viral serologic tests. Mean duration between the onset and the serologic tests was 4.6±2.9 days. The prognosis was determined using pure tone audiometry and House-Brackmann grading system after 6 months. Results：The positivity of VZV IgM and titer of VZV IgG in RHS were significantly higher than those in the others (p<.001). Patients with RHS showed a tendency of higher VZV IgG titer irrespective of the sampling time. There was no significant correlation between the serologic status of HSV or VZV and prognosis both in SSNHL and APFP (p>.05). Conclusion：The serologic tests for IgM and IgG titers of HSV and VZV performed once in the acute stage are unlikely to provide additional information for the prognosis of SSNHL or APFP, but they might be helpful in the differential diagnosis process of APFP. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:1088-92)
Abstract
Sudden sensorineural hearing loss (SSNHL) and acute peripheral facial paralysis (APFP) are common otologic diseases related to viral infections. In this study, we investigated the clinical necessity of viral serologic tests in the diagnosis of SSNHL and APFP. Subjects and Method：A retrospective study was carried out for 348 patients with SSNHL, 121 patients of Bell’s palsy (BP) and 37 patients of Ramsay Hunt syndrome (RHS). The serologic tests for IgM and IgG titers of herpes simplex virus (HSV) and varicella zoster virus (VZV) using enzyme-linked immunosorbent assay were performed within 10 days after onset in all patients. Clinical manifestations, abnormalities on MRI and prognosis were compared in relation to the results of viral serologic tests. Mean duration between the onset and the serologic tests was 4.6±2.9 days. The prognosis was determined using pure tone audiometry and House-Brackmann grading system after 6 months. Results：The positivity of VZV IgM and titer of VZV IgG in RHS were significantly higher than those in the others (p<.001). Patients with RHS showed a tendency of higher VZV IgG titer irrespective of the sampling time. There was no significant correlation between the serologic status of HSV or VZV and prognosis both in SSNHL and APFP (p>.05). Conclusion：The serologic tests for IgM and IgG titers of HSV and VZV performed once in the acute stage are unlikely to provide additional information for the prognosis of SSNHL or APFP, but they might be helpful in the differential diagnosis process of APFP. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:1088-92)
참고문헌 (8)
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