- 353 - KISEP 한이인지: 한이인지: 한이인지: 한이인지:제 40 권 제 3 호 1997 신경전도 검사시 기록전극의 위치에 따른 의의 국립경찰병원 이비인후과 홍정훈·임주영·조영호·최혜진·조태권 = Abstract = The Significance of Recording Electrode Placement in ENoG Measurement Jong Hun Hong, M.D., Joo Young Lim, M.D., Young Ho Jo, M.D., Hye Jin Choi, M.D., Tai Kwon Cho, M.D. Department of Otolaryngology, National Police Hospital, Seoul, Korea ENoG is the objective electrophysiologic measurement of the muscle compound action potential( CAP) to assess the rate of degenerated nerve fibers. However, occasional discorrelation with clinical findings may diminish the utility of the ENoG. So, we studied the significance of recording electrode placement, which is considered to affect the result of the ENoG. We performed the interside variance in 20 healthy adults( 20 males) volunteers and retest was performed in 6 adults of 20 volunteers. The recording electrode was placed at 3 positions.( whole nasolabial fold( A) , 2 / 3 of the nasolabial fold( B) , 1 / 2 of the nasolabial fold( C)) And then we compared the results: 1) In the first measurement, the mean CAP was 3.02± 0.98mV( A) , 2.80± 0.75mV( B) , 2.56± 0.57mV( C) on the right side, 2.70± 1.02mV( A) , 2.50± 0.90mV( B) , 2.33± 0.86mV( C) on the left side, and there was no significant difference between right and left inter-side amplitude( p≥ 0.05) . 2) In the first measurement, the mean interside variance( ISV) was 32.7%( 37.55± 16.32%( A) , 29.88± 17.15%( B) , and 30.67± 18.56( C)) and there was no significant difference among them( A, B, C)( p≥ 0.05) . The minimal individual ISV was 20.35± 12.44%. There was significant difference between it and the other individual 3 positions( p< 0.05) . 3) In the second measurement, the mean test-retest variability was 17.78%( A:18.62± 3.70%, B:18.50± 3.10%, C:16.22± 4.95%) . There was no significant difference among them( p≥ 0.05) . The minimal individual ISV was varied in each testing at 3 positions. And the value was 14.32± 2.69%. There was no significant difference between it and other 3 postions( p≥ 0.05) . So we recommand that the recording electrode may be fixed at the bilateral same position of the nasolabial fold. But if there is any indication of facial nerve decompression, you must find the best recording electrode position to get the minimal ISV before operation. ( Korean J Otolaryngol 40:3, 1997) KEY WORDS:ENoG·Interside variance·Test-retest variability·Electrode position. 논문접수일:1996년 8월 28일 심사통과일:1997년 1월 8일
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The Significance of Recording Electrode Placement in ENoG Measurement
Jong Hun Hong, M.D., Joo Young Lim, M.D., Young Ho Jo, M.D., Hye Jin Choi, M.D., Tai Kwon Cho, M.D.
Department of Otolaryngology, National Police Hospital, Seoul, Korea
ENoG is the objective electrophysiologic measurement of the muscle compound action potential(CAP) to assess the rate of degenerated nerve fibers. However, occasional discorrelation with clinical findings may diminish the utility of the ENoG. So, we studied the significance of recording electrode placement, which is considered to affect the result of the ENoG.
We performed the interside variance in 20 healthy adults(20 males) volunteers and retest was performed in 6 adults of 20 volunteers.
The recording electrode was placed at 3 positions.(whole nasolabial fold(A), 2 / 3 of the nasolabial fold(B), 1 / 2 of the nasolabial fold(C)) And then we compared the results:
1) In the first measurement, the mean CAP was 3.02±0.98mV(A), 2.80±0.75mV(B), 2.56±0.57mV(C) on the right side, 2.70±1.02mV(A), 2.50±0.90mV(B), 2.33±0.86mV(C) on the left side, and there was no significant difference between right and left inter-side amplitude(p≥0.05).
2) In the first measurement, the mean interside variance(ISV) was 32.7%(37.55±16.32%(A), 29.88±17.15%(B), and 30.67±18.56(C)) and there was no significant difference among them(A, B, C)(p≥0.05). The minimal individual ISV was 20.35±12.44%. There was significant difference between it and the other individual 3 positions(p<0.05).
3) In the second measurement, the mean test-retest variability was 17.78%(A:18.62±3.70%, B:18.50±3.10%, C:16.22±4.95%). There was no significant difference among them(p≥0.05). The minimal individual ISV was varied in each testing at 3 positions. And the value was 14.32±2.69%. There was no significant difference between it and other 3 postions(p≥0.05).
So we recommand that the recording electrode may be fixed at the bilateral same position of the nasolabial fold. But if there is any indication of facial nerve decompression, you must find the best recording electrode position to get the minimal ISV before operation. ((((Korean J Otolaryngol 40::::3, 1997))))
Fig. 2. Placement of the recording, ground, andreference electrodes. A:recording electrode placed along the na-solabial fold. D:reference electrode placed on the initial point of the nasolabial fold. E:ground electrode placed on the midlineof the forehead.
Fig. 1. Electrodes used in this study. A:stimulating bip-olar electrode. B, C, D, E:ground, recording, and reference electrodes.
Korean J Otolaryngol 40:3, March 1997
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감고 온몸의 긴장을 풀도록 했으며, 입을 힘없이 약간
벌리고 있도록 하여 삼차신경자극에 의한 저작근의
수축을 알 수 있도록 하였다. 자극강도는 0mA에서부
터 서서히 1mA씩 증가시키면서 안면근의 수축이 일
어나는 시점을 관찰하였다. 안면근의 수축이 시작되면
자극강도의 증가정도를 더욱 천천히 하여 환자로 하
여금 불편함을 최대로 적게 느끼도록 하였으며, 총합
활동전위의 급상승이 관찰될때에는 자극강도의 상승
을 멈추고 총합활동전위가 안정화 될때까지 기다렸다.
자극강도는 총합활동전위가 더이상 상승하지 않는 강
도에서 10∼20%의 자극을 더 주어 역치상자극(sup-
ramaximal stimulation)을 가하였으며, 이때 역치상
자극이 저작근의 수축을 유도할 때에는[치아가 부딛
히거나, ENoG의 총합활동전위 곡선이 이상(biphas-
ic)이 아닌 다상(multiphasic)으로 나올 경우] 자극강
도를 낮추었으며, 이때 총합활동전위가 낮아지면 다시
자극 강도를 올려 총합활동전위가 더이상 상승하지
않는 강도에서 기록하였다.
측정하기전 최소한 20회 정도의 자극을 주었는데,
이는 초발자극은 피부의 반응성 충혈(reactive hyp-
eremia)을 유도할 수 있으며, 또한 신경내의 firing
synchronization을 증진시켜 총합활동전위를 상승시키
기 때문이다.
이차 측정군에서는 6명중 1명은 검사도중 탈락하였
으며, 나머지 5명에서 검사-재검사변이를 구하기 위
하여 10일이내 5회에 걸쳐 A, B, C세 지점에서 좌우측
을 측정하였으며, 검사결과는 Interside Varience(ISV)
50% 미만의 것과 Smirnov의 지각 검정에 어긋나는 것
은 제외시켰다.
결 과
1) 일차 측정군에서, 평균총합활동전위(mean CAP)
는 우측 A지점이 3.02±0.98mV, B지점이 2.80±
0.75 mV, C지점이 2.56±0.57mV였고, 좌측 A지점
이 2.70±1.02mV, B지점이 2.50±0.90mV, C지점
이 2.33±0.86mV였으며, 좌측과 우측간에는 같은 지
점에서 전위간의 통계학적으로 유의한 차이는 없었다
(p≥0.05)(Table 1).
2) 일차 측정군에서, 전위는 A 지점에서 C 지점으
로 갈수록 감소하는 경향을 보였으며, 여기에서는 A
지점과 C 지점간에는 통계학적으로 유의한 차이가 있
었으나(p<0.05), A 지점과 B 지점, B 지점과 C 지점
간에는 유의한 차이가 없었다(p≥0.05)(Table 1).
3) 일차 측정군에서, 평균 ISV는 32.7%(A지점이
37.55±16.32%, B지점이 29.88±17.15%, C지점이
30.67±18.56%)로 이들 세 지점간에는 통계학적으
로 유의한 차이는 없었다(p≥0.05)(Table 1).
4) 일차 측정군에서, 각각의 세지점중 최소 ISV들
의 평균값은 20.35±12.44%이고, 이값은 각각의 세
Fig. 3. The stimulating electrode was located at thestylomastoid foramen of the initial point of thefacial nerve. It should be located at the areashowing maximal amplitude.
Fig. 4. Recording electrode placement. A. was loca-ted at the whole nasolabial fold.B. was locatedat the 2/3 of the nasolabial fold. C. waslocated at the 1/2 of the nasolabial fold.
한이인지:제 4 0권 제 3호 1997
- 356 -
지점들과는 통계학적으로 유의한 차이가 있었다
(p<0.05)(Table 1).
5) 이차 측정군에서, 각각의 ISV는(mean±SD) 2
번의 경우는 A지점이 20.77±13.16, B지점이 20.23
±18.45, C지점이 21.08±6.81, 최소 ISV는 12.90±
9.74였고, 6번의 경우는 A지점이 22.41±14.92, B지
점이 26.42±14.08, C지점이 21.22±15.03, 최소 IS
V는 14.58±12.43였고, 10번의 경우는 A지점이 25.3
5±14.76, B지점이 19.18±13.65, C지점이 15.4 0±
11.69, 최소 ISV는 13.09±10.95였고, 12번의 경우는
A지점이 29.14±9.78, B지점이 21.53±14.70, C지점
이 18.98±15.70, 최소 ISV는 17.25±15.11였고, 13
번의 경우는 A지점이 31.28±16.32, B지점이 1 8.93
±11.94, C지점이 21.74±15.77, 최소 ISV는 15.11
±12.65였다(Table 2).
6) 이차 측정군에서, 평균 검사–재검사 변이는 17.7
8%(5명의 피검자에서, 5회에 걸쳐 세지점에서 측정하였
으며, A지점이 18.62±3.70%, B지점이 18.50±3.10%,
C지점이 16.22±4.95%)로 세지점간에는 통계학적으로
유의한 차이는 없었다(p≥0.05)(Table 3).
7) 이차 측정군에서, 각각의 세지점중 최소 ISV의
Table 1. The 1st measurement results of compound action potentials(N=20) (unit:mV)
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