突发性聋与微循环障碍关系的临床研究

目的 探讨突发性聋患者的发病诱因，从而分析突聋与微循环障碍的关系。方法 采集86例突发性聋患者的详细病史资料，进行血流变和血脂检测。结果 突聋患者的工作性质，及其发病前在行为、心理上的改变与突聋的发生有一定的联系。突聋组血脂、血流变检测结果与正常组比较，多项指标差异均有显著性。结论 心理和行为有异常改变的脑力劳动者，及血流变和血脂检测指标异常者，其突聋的发生和微循环障碍存在一定的联系。     

突发性耳聋患者的局部脑血流断层显像研究

本研究旨在探讨局部脑血流断层显像与突发生感音神经性耳聋的关系和临床价值。方法;对１０例正常志愿者,１９例传导性耳聋及３１例突聋患者在治疗前行ｒＣＢＦ显像并对比分析其显像特点,与同期ＣＴ对照,随访ｒＣＢＦ显像阳性的突聋患者６－１２月并再次行ｒＣＢＦ显像。结果：（１）突聋组ｒＣＢＦ显像阳性率明显高于传导性聋组和正常组,其突聋组病灶与正常组织的放射性比值明显低于传导性聋和正常组;     

双耳先后发病突发性聋患者的临床特点分析

目的分析双耳先后发病突发性聋(突聋)患者的临床特点,提出可能的针对性预防措施。方法回顾性分析2015年12月至2018年3月收治的19例双耳先后发病(间隔时间>3 d)突聋患者的临床资料,包括性别、年龄、既往史、患耳侧别、听阈曲线类型、听力损失程度、发病时间、双耳发病的间隔时间及治疗效果,总结其临床特点,并与同期收治的单侧突聋患者比较。结果 19例双耳先后发病的突聋患者中,先发耳听阈曲线为全聋型10例(52.6%)、平坦型8例(42.1%)、高频下降型1例(5.3%),听力下降以重度和极重度聋为主;后发耳听阈曲线为平坦型15例(78.9%)、全聋型3例(15.8%)、低频下降型1例(5.3%),听力下降以中度和重度聋为主。双耳先后发病组平均年龄高于单侧发病组,治疗后有效率低于单侧发病组(P<0.05)。有高血压、糖尿病等慢性病史组出现对侧突聋的比例(56.5%,13/23)高于无慢性病史组(2.8%,6/214)(P<0.05)。结论先发耳听阈曲线为平坦型或全聋型者、听力损失程度为重度或极重度者,且有高脂血症、高血压、糖尿病等影响血流动力学的慢性疾病史的高龄单侧突聋患者,对侧耳再发突聋的可能性较大;降脂、降压、控制血糖等治疗可能有利于预防对侧耳再发突聋。     

特发性突聋患者GJB2 235delC突变分析

目的：分析GJB2 235delC突变在特发性突聋患者中的发生频率,探寻其与特发性突聋发病的可能相关性。方法：收集234例特发性突聋患者,以同期听力正常的80例体检人员为对照组。分别采外周静脉血,提取基因组DNA,经聚合酶链反应扩增GJB2基因编码区后,用限制性内切酶酶切的方法筛查235delC位点突变,同时对特发性突聋患者的临床资料汇总分析。结果：234例特发性突聋患者中,5例检测出GJB2 235delC杂合突变,突变检出率为2.1%,未检测出235delC纯合突变;对照组中未检出GJB2 235delC突变。2组人群235delC突变检出率差异无统计学意义（P〉0.05）。结论：特发性突聋患者中GJB2 235delC突变检出率低,提示该突变位点可能与特发性突聋的发病无相关性。     

突发性聋伴发眩晕的初步探讨

目的:探讨突发性聋(突聋)伴发眩晕的病变类型及发病机制.方法:详细记录住院治疗的121例突聋患者性别、年龄、就诊时病程、听力损失情况、听力图类型、发病前后的眩晕情况及预后.按照中华医学会突聋多中心研究突聋分类,依照纯音测听图将突聋分为低频型、高频型、中频型、平坦型、全聋型5种类型,分别计算眩晕在不同类型突聋中的比例,并将各组的眩晕比例进行统计学分析.结果:121例患者中,伴发真性及假性眩晕的患者有45例(37.2%);高频型突聋、低频型突聋、平坦型突聋及全聋型突聋患者中眩晕的发生率分别为42.9%,47.1%,23.6%和51.4%;不同突聋类型眩晕的发生率采用卡方检验,分别两组进行卡方检验,低频组、高频组及全聋组眩晕的发生率没有差别,平坦组眩晕发生率较其他3组低(P<0.05).121例患者中,伴发真性眩晕的患者有23例(19.0%);不同类型突聋之间眩晕的发生率没有差别.结论:通过对不同眩晕类型及不同听力学类型的突聋患者的病情分析,进一步验证了血管因素和病毒感染因素在不同突聋类型患者中的作用.通过对突聋伴眩晕患者眩晕情况的探讨,加深了对突聋的发病机制的认识,改进了耳源性眩晕的诊断治疗.     

突发性聋发病与天气和天体变化的关系

目的 研究分析突发性聋(突聋)发病与季节、月份、月亮盈亏、太阳黑子以及大气温度变化的关系方法 回顾性分析我科2000年-2006年住院治疗的突聋患者发病的具体时间,并对近30年我院突聋住院人数占耳鼻喉科总住院人数的平均构成比与近56年西安市年平均气温进行对比分析.结果 332例突聋中,春季发病66例,夏季发病94例,秋季发病86例,冬季发病87例;9月和8月突聋发病人数最多,5月和10月突聋发病人数最少.农历初一与农历15日突聋发病人数明显多于农历28日和29日的发病人数.农历初一至十五突聋发病185例,农历十六至三十日发病147例,即月亮由新月到满月的突聋发病人数构成比多于月亮由满月到残月的突聋发病人数构成比.近30年太阳黑子爆发高发年是1989年和2000年,太阳黑子爆发低谷年为1996年,这3年我院突聋住院人数占耳鼻喉科总住院人数的构成比分别为1.99%、5.01%和4.23%.与所在年代的我院突聋住院人数占耳鼻喉科总住院人数的平均构成比无显著性差异(P>0.05).研究发现近30年突聋住院病人占我院耳鼻喉科住院人数构成比有逐渐增多趋势,其中上世纪80年代构成比为1.69%、90年代为3.31%、2000年-2009年为4.38%,不同时期突聋住院人数的构成比在统计学上有显著性差异(P<0.01).而近30年西安市的年平均气温明显升高,突聋发病与平均气温升高可能存在一定关系.结论 突聋发病在一年四季中以夏季发病人数最多,9月和8月是突聋发病高发期.月亮圆缺变化可能对突聋发病有一定影响,太阳黑子爆发与突聋发病无明显相关.近30年突聋发病有逐渐增多趋势,可能与CO2排放增加和温室效应导致的大气平均温度升高有关.     

突发性聋患者血脂分析

目的 研究血脂与突发性聋(突聋)发病的相关性,为血脂某些指标较高的人群提供预防措施,降低突聋发病率。 方法 检测68例突聋患者(突聋组)及同期住院的80例非突聋患者(对照组)血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、载脂蛋白a(Apo-A)和载脂蛋白β(Apo-β)的水平,统计分析两组间各血脂指标的差异。 结果 突聋组与对照组间甘油三酯(TG)差异有统计学意义(P<0.05),其余各指标差异无统计学意义(P>0.05);不同听力学曲线及不同听力下降程度的患者之间血脂各指标差异无统计学意义(P>0.05)。 结论 血脂中TG升高与突发性聋的发病有一定的关系,控制TG对预防突聋的发生可能有一定的意义。     

突发性聋与颈静脉球高位扩大

目的 在３例突发性聋（突聋）合并明显颈静脉球（ＪＢ）扩大的临床现象启示下，研究ＪＢ直径和高度与突聋的关系。方法 报告３例突聋合并ＪＢ高度扩大，其中１例手术探查２次，排除ＪＢ肿瘤。进一步探索聋与ＪＢ扩大的相关性：选择诊治３月以上无效的１５例突聋与３５例耳部正常者（对照组）行ＪＢ磁共振血管造影（ＭＲＡ），测量ＪＢ直径和高主度行对比分析。结果 突聋组聋耳侧与对侧ＪＢ大小不对称性较对照组两则ＪＢ不对称性明     

突发性聋的血液流变学检测及中药治疗

突发性聋，中医学称之为“暴聋”，是一种发病急骤，原因不明的感音神经性耳聋。由于其确切病因及发病机理尚不完全清楚，给治疗带来了一定的困难。近年来，我们通过检测突发性聋患者血液流变学的多项指标，同时应用中药进行治疗，以冀为临床治疗本病提供用药依据及施治方向。1资料与方法1．１ 正常对照组：选取３０例，其中男、女各１５例，平均年龄4４．５岁。全部经心电图、胸透、血常规检查正常，并无出、凝血疾病者。（本组资料由我院血液病中心实验室提供）1．２ 突发性聋组ｌ．２．１ 样本例数：共随机选取５２例，其中男性２７例，…     

彩色多普勒血流仪对突聋患者的眼动脉血流观察

目的 :探讨突聋发病与微循环障碍的关系。方法 :采用 Acuson 12 8XP/ 10彩色多普勒血流仪检测34例突聋患者及 15例正常人的眼动脉血流参数。结果 :突聋患者 2 8例 (82 .4% )患侧眼动脉的血流速度低于健侧眼动脉和对照组 ,血管阻力高于对照组 ,两组间差异有显著性意义 (P <0 .0 5 )。结论 :提示突聋患者患侧眼动脉的低流速、低灌注、高阻力型血流状态改变 ,可能与突聋发病有关。     

Prevalence of obstructive sleep apnea syndrome (OSA) in patients with sudden hearing loss. A pilot study

BACKGROUND: It is estimated that in patients with sleep-related breathing disorders the probability of a cerebral vascular infarction (CVI) is 3.1 times that in patients without sleep apnea and that 25-50% of all patients who have a stroke suffer from sleep apnea (OSA) and have a respiratory disturbance index (RDI) higher than 10. CVI may be caused by variations in intracranial pressure or in intracranial hemodynamics owing to decreasing pO(2) and increasing pCO(2) during cessation of airflow. It is suspected that the most common causes of sudden deafness are vasospasm, thrombosis, embolism, hypercoagulation and sludging. The present study analyzed the prevalence of sleep apnea in patients with sudden hearing loss. PATIENTS AND METHODS: A 7-channel polygraph was used to test 33 subjects with normal hearing and 27 patients suffering from sudden hearing loss. Statistical analyses were performed with a Chi-square test and the Mann-Whitney test. RESULTS: We found that 29.6% of the patient group and 21.2% of those in the study control group were suffering from OSA and had RDI >10; this difference was not significant ( p=0.554). Sudden hearing loss may also be an indicator of arteriosclerosis secondary to such risk factors as hypertension ( p=0.005), diabetes ( p=0.003), and hyperlipidemia ( p=0.004), which were highly significant for the patient group. CONCLUSION: Patients who develop sudden hearing loss tend to have OSA more frequently than those in the control group owing to the similar risk factors for cerebral infarction and sudden hearing loss.     

Inner ear hearing loss--predisposing factor in acute disorders of inner ear function (sudden deafness and vestibular loss)?

49% of 111 patients with sudden hearing loss had pre-existing inner ear damage to a greater extent than would be expected in a population of the same age. The same age-independent hearing loss of inner ear type was seen in 44% of 72 patients with a sudden unilateral isolated vestibular loss. The accumulated occurrence of diseases of the cardial-vascular system, metabolism, and cervical spine is suggested as the reason for the greater extent of inner ear damage with respect of age and the acute disorders in this area. The high proportion of a pre-existing noise deafness in patients (in 38% of men) with sudden hearing loss suggests an increased vulnerability of the inner ear in pre-existing hearing loss.     

脂质代谢、尿酸与突发性聋的关系

目的探讨突发性聋与血清脂质代谢、血尿酸之间的关系。方法回顾性分析突发性聋住院患者100例的病史特点、血液学检查和影像学检查结果,检测其血清中甘油三酯、胆固醇、高密度胆固醇、低密度胆固醇、载脂蛋白ＡＩ、载脂蛋白Ｂ、血尿酸的含量。结果突发性聋组高密度胆固醇低于对照组,血尿酸值高于对照组,且差异有统计学意义（Ｐ<0.05）,各年龄组之间的高密度胆固醇、尿酸值差异无统计学意义（Ｐ>0.05）。两组之间的甘油三酯、胆固醇、低密度胆固醇、载脂蛋白ＡＩ、载脂蛋白Ｂ值均差异无统计学意义。结论高密度胆固醇下降、 尿酸代谢紊乱是突发性聋发生的危险因素。     

Zur Ätiologie des Hörsturzes

Summary In a prospective study of 70 patients with sudden hearing loss there was found no evidence of basilar impression using six different radiological guide lines. Many serological reactions were due to normal grade of contamination of an average population, definite viral infections were diagnosed in 11 cases only. Metabolic disorders such as hypercholesterolaemia and hypertriglyceridaemia were found in a high percentage of patients with sudden hearing loss, treatment is necessary.     

Red cell basic ferritin concentration in sensorineural hearing loss.

Red cell basic ferritin (RCBF) was measured in 62 healthy subjects with normal hearing and 224 patients with different kinds of sensorineural hearing loss, compared with serum ferritin, haemoglobin, serum iron and circadian variation in the serum iron levels. The results showed that the RCBF concentrations in most kinds of sensorineural hearing loss were significantly lower than those in normal hearing status. It is conceivable that the RCBF assay can be used to evaluate the adequacy of iron stores that are useful in times of urgent iron needs and to diagnose relative iron deficiency in those patients with some other normal laboratory assays related to iron metabolism.     

突发性聋患者外周血白细胞水平与预后的关系

目的：分析突发性聋患者外周血白细胞水平与预后的关系。方法:按白细胞水平对突发性聋135例分组分析，并探讨其发生机制。结果:（1）白细胞升高组与正常组突发性聋患者的听阈水平无统计学差异（P＞0.05）；（2）白细胞与中性粒细胞计数均高的突发性聋组的有效率明显低于白细胞正常组（P＜0.05）。结论:突发性聋患者外周血中白细胞明显增高,提示其疗效明显低于白细胞数正常者。     

Idiopathic sudden hearing loss and disturbance of iron metabolism. A clinical survey of 426 cases.

The role of disturbances of the iron metabolism (DIM) in idiopathic sudden hearing loss (ISHL) was investigated in 426 patients with ISHL who received iron therapy, anti-DIM medication, vitamins, and a combined regimen in a randomized study which was stratified by stages and groups. Low concentrations of haemoglobin, serum iron, serum ferritin, and red cell basic ferritin as well as abnormal circadian variations in the serum iron level were observed. The results were significantly better in patients receiving iron therapy than in those receiving anti-DIM medication, vitamins, and the combined regimen. Hearing improvement was achieved in 53.26% of the patients whose treatment started later than 3 months after the onset of the disease. The clinical association of DIM and ISHL is discussed.     

突发性聋患者的人格特征分析

目的　探讨突发性聋患者的人格特征及发病的人群分布,了解该患病群体的心理健康情况。方法　采用明尼苏达多项人格测量表（Minnesota multiphasic personality inventory,MMPI）,对118例突发性聋患者及100例健康志愿者测试并进行对照性研究。结果　突发性聋患者在疑病（Hs）、抑郁（D）、情绪不稳定（Pd）、精神衰弱（Pt）及社会内向（Si）等方面MMPI量表因子分高于健康对照组,差异具有统计学意义,伴有耳鸣患者焦虑情绪更重,31～50岁是突发性聋发病的高发年龄。结论　突发性聋患者有情绪不稳定和较多的心理健康问题。     

Extent of lesions in idiopathic sudden hearing loss with vertigo: study using click and galvanic vestibular evoked myogenic potentials

OBJECTIVE: To clarify the extent of the vestibular lesions in idiopathic sudden hearing loss with vertigo using vestibular evoked myogenic potentials (VEMPs) in response to click (click-VEMP) and galvanic (galvanic-VEMP) stimulation, as well as caloric tests. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: We enrolled 22 patients with idiopathic sudden hearing loss with vertigo in this study. All patients underwent audiometry and click-VEMP and caloric tests. Eight patients underwent a galvanic-VEMP test. RESULTS: Among the 22 patients, 17 (77%) showed an absence of click-VEMPs on the affected side. In response to caloric testing, 10 patients (45%) showed a decreased response on the affected side. All 8 patients who underwent galvanic-VEMP testing showed normal responses. Most patients with decreased caloric responses (9 [90%] of 10 patients) showed an absence of click-VEMPs, whereas 9 (53%) of the 17 patients who showed abnormal click-VEMPs showed decreased caloric responses. Initial hearing level and hearing outcome significantly correlated with abnormalities on the vestibular test results. CONCLUSIONS: The lesion site of vestibular disorders in idiopathic sudden hearing loss with vertigo appeared to be within the labyrinth on the basis of galvanic-VEMP findings. Results of the click-VEMP and caloric tests suggested that the saccule could be involved more frequently than the semicircular canals. The combined use of click-VEMP and caloric tests is useful for evaluating vestibular functions in idiopathic sudden hearing loss with vertigo because the extent of vestibular abnormalities correlated well with hearing outcome.     

Does pure-tone audiometry provide inferences for a vascular cause of sudden deafness?

The theory that sudden hearing loss is caused by some form of vascular catastrophe has not been confirmed by pathological evidence, but it agrees with a number of clinical observations. But there are several pieces of experimental and clinical evidence that cast serious doubt upon a vascular hypothesis, especially the considerable variability in site and degree of cochlear and vestibular impairment. A review of the vascular anatomy of the inner ear makes it clear that many clinically observed audiometric patterns and associated partial vestibular deficits in idiopathic sudden hearing loss cannot be explained by assigning a site of presumed vascular occlusion. We investigated 166 pure tone audiograms of patients with idiopathic sudden hearing loss by using the statistical method of cluster analysis, which allow an explanation based on the vascular anatomy. Three types of audiograms could be found which differed not in shape but in the degree of hearing loss. None of them can be explained by the vascular anatomy. The three groups of audiograms with different degrees of hearing loss allowed investigations of the influence of age, sex, vestibular disturbance and vascular disease. Men are more often affected, the degree of the hearing loss is not dependent on age, vestibular disturbance, vascular disease, diabetes or smoking. The prognosis for sudden hearing loss is independent of all the investigated parameters. Our findings support the conclusion that a vascular hypothesis cannot adequately explain the clinical findings in idiopathic sudden hearing loss.