急性低频下降型感音神经性听力损失的临床研究

目的：研究急性低频下降型感音神经性听力损失（ALHL）的病因、诊断和治疗方法。方法：选择55例ALHL患者为研究对象，经详细询问病史和耳专科检查后，行纯音测听，声导抗测听和听性脑干反应（ABR），随机分为泼尼松组和对照组治疗，疗程结束后随访6个月。结果：两组患者多以青年为主，主要症状为耳闷，低音调耳鸣和听力减退，耳科检查无殊。所有患者（55例58耳）纯音听阈示轻到中度低频感音神经性聋，鼓室导抗图“A”型，49耳镫骨肌反射引出，其中40耳Metz试验阳性。受检的45耳中ABR均正常。治疗后泼尼松组效果优于对照组（P〈O．05）。结论：ALHL以突发的低音调耳鸣，听力减退和耳闷为主要表现，常单耳发病，听力学定位诊断提示为蜗性病变，仅累及低频区。本病对皮质类固醇激素有一定的治疗效果。     

急性内耳疾病后精神性聋伴惊恐性焦虑症

突发性聋或内耳性聋合并非器质性聋罕见。本文报道一例 5 0岁患者突发性聋后发生精神性聋伴惊恐性焦虑症。因左耳突发性聋和自听增强一天就诊。纯音测听提示左耳感音神经性聋 ,右耳听力正常 (见附图 ) ,言语测听提示内耳疾病。言语识别阈和纯音测听一致。鼓室图表明双耳呈 A型 ,110 d B声刺激均未引出镫骨肌反射 ,诊断为内耳疾病引起的急性感音神经性聋 ,给予静滴 6 0 mg强的松龙 / d。在发病第 5天患者听力突然恶化 ,平均气导听力降至 87.5 d B,脑干诱发电位(ABR) 70 d B声刺激时出现 波 ,MRI检查排除颅内病变。在发病第 6天 ,患者突…     

感音神经性聋听力图分型

目的对感音神经性聋不同听力图进行分型,为感音神经性聋提供病因学方面的诊断依据。方法对一年内解放军总医院耳鼻咽喉科门诊就诊的2428耳感音神经聋进行纯音听力检测并进行听力图分型。结果将感音神经性聋听力图分为:缓降型816耳,陡降型627耳,低频型152耳,平坦型404耳,岛状为284耳,钟型73耳,V型20耳,蝶型33耳,峰型19耳。结论对感音神经性聋纯音听力图分型,可加深对各型感音神经性聋病因的认识,以利于探索针对性的防治措施。     

慢性鼻窦炎对中耳功能的影响

目的：研究慢性鼻窦炎的病变范围、病程长短对中耳功能的影响。方法：利用纯音测听及声阻抗检测５６例慢性鼻窦炎患者的纯音听力,鼓室导抗图和咽鼓管功能。结果：慢性鼻窦炎虱咽鼓管功能异常４８．３％,鼓室导抗图异常４２．０％,气导听阈提高３３．９％,前组鼻窦炎和中耳功能比较有级性差异（Ｐ〈０．０１）,病程〉５年和≤５年比较,有极显著性差异（Ｐ〈０．０１）。结论：慢性鼻窦炎对中耳功能的影响,随着病变范围的扩大,     

听神经病

目的介绍一种特殊的感音神经性听力疾患-听神经病,探讨其临床特征及听力学特点.方法报道5例听神经病患者,2例为成人;3例为儿童.记录患者的临床资料,并对患者进行纯音测听、脑干电反应测听、耳声发射、耳蜗电图及语言辨别率等听力学检查.结果5例均主诉听力下降,听力学检查纯音听阈为轻、中度感音神经性聋,与纯音测听不相符的语言辨别率明显下降,不能引出脑干诱发电位(ABR),耳蜗电图基本正常,畸变产物耳声发射(DPOAE)基本正常.提示外毛细胞功能正常,病变可能在听神经.结论听神经病是一种主诉听力下降,纯音听阈为轻、中度感音神经性聋,不能引出脑干诱发电位(ABR),畸变产物耳声发射正常的听力疾患,临床上应与其他感音神经性聋区别.     

150耳胆脂瘤型中耳炎的听力分析

采用Madsen TBN-85型纯音测听仪，在隔音室内对148例（150耳）胆脂瘤型中耳炎患者的听力进行了测定。男85例，女63例，年龄5－66岁，其中50岁以上仅有4例。感音神经性聋、混合性聋53耳，占35％，其中有8耳全聋；传导性聋97耳。前者平均病程为14.2年，后者为13.1年，两者之间没有明显差异，提示感音神经性聋的发生率与病程关系不大。感音神经性和混合性聋对侧有中耳感染性病变者占28％，传导性聋对侧耳有病变者占19％，说明双侧中耳炎较单侧中耳炎易发生感音神经性聋。对比感音神经性聋和混合性聋与传导性聋鼓膜穿孔类型，发现边缘性穿孔的病例，前者明显多于后者，其余的穿孔类型则均无明显差异。     

单纯感音神经性聋和耳硬化症

单纯感音神经性聋在耳科临床并不少见。然而 ,耳硬化症 ( OS)引起的单纯感音神经性聋却非常罕见。该作者报道一例由耳硬化症引起的单纯感音神经性聋。男性 ,30岁。六年来双耳进行性听力减退。无特殊就医史 ,无家族耳硬化症史。言语和耳部检查正常。无前庭异常发现。纯音听力检查发现双侧感音神经性聋 ,左耳更明显。鼓室图 A型 ,声反射 (机器限定范围内 )双耳消失。ABR右耳听阈 30 d B,左耳听阈 70 d B。潜伏期无延迟。高清晰度 CT扫描见双侧耳蜗囊内多发的大片密度减低的融合硬化灶。囊内融合的透明区是环状。耳囊内矿物质脱失带几乎表…     

急性低频感音神经性听力损失的临床研究

目的　探讨急性低频感音神经性听力损失(acutelow tonesensorineuralhearingloss,ALHL)的病因病理、临床特点和诊治方法。方法　选择30例ALHL患者为研究对象,在详细采集病史和耳科检查的基础上,行系统的听力学检测,包括纯音测听、声导抗测试、听性脑干反应(auditorybrainstemresponse, ABR)和耳声发射(otoacousticemissions,OAE)。所有患者接受为期15天的皮质类固醇激素试验性治疗,疗程结束后随访6~14个月(平均10 2个月)。结果　本组患者以青年为主,临床主诉多为低音调耳鸣、耳闷和听力下降,耳科检查未见异常。所有患者(30例31耳)纯音测听显示轻到中度的低频感音神经性听力损失;鼓室图呈“A”型, 26耳引出镫骨肌声反射,其中14耳Metz试验阳性。受检的20耳中,ABR均正常;初诊时14耳瞬态诱发性耳声发射未通过,畸变产物耳声发射听力图表现为0 .5及0 .75kHz两个频率点上异常。经激素治疗后, 24耳听力完全恢复, 4耳部分恢复, 3耳无变化,总有效率90. 3%。结论　ALHL以突发的低音调耳鸣、听力下降和耳闷为主要表现,常单耳发病,听力学定位诊断提示为蜗性病变,仅累及低频区。本病尚无特效疗法,皮质类固醇激素可能是一种有希望的治疗药物。     

单侧听神经病附三例报告

目的　探讨单侧听神经病的听功能特征及病损部位。方法　报告及分析 3例患者的临床资料、纯音测听、声导抗测试、畸变产物耳声发射 (DPOAE)、听性脑干反应 (ABR)检测结果。结果　 3例单侧患耳纯音听力图分别为上升型、平坦型及下降型 ,听力损失 1例为中度 ,2例为重度 ,另侧听力图正常 ;3例患者双侧DPOAE正常引出 ,而ABR患侧未能引出 ,健侧正常引出。颞骨HRCT未见异常。结论　单侧听神经病的听功能特征与双侧听神经病的听功能特征相同。诱发性耳声发射及ABR对鉴别一般感音神经性聋与中枢性聋有重要意义。病损部位可能在内毛细胞至听神经的传入通路     

声反射增长函数对感音神经性聋的诊断

鉴别感音性聋和神经性聋的测听法有很多种 ,现利用声导抗仪对感音神经性聋患者进行声反射增长函数测试 ,以期寻找感音性聋和神经性聋的函数曲线特征 ,现报告如下 :1　资料与方法1.1　临床资料　 6 2例感音神经性聋患者均为 1999～ 2 0 0 0年间在我院就诊的 ,其中男 37例、女 2 5例 ,年龄 17～ 4 5岁 ,平均 33.5± 4 .7岁 ,这些病例纯音测听结果均为单耳感音神经性聋 ,言语频率的平均听阈为 35～ 5 0ｄＢＨＬ ,后经ＣＴ或磁共振及手术后病检证实有 9例 ( 9耳 )为神经性聋。另外以 15例 ( 30耳 )无耳疾史且纯音测听结果正常的受试者作对照组 ,…     

Physiotherapy of Eustachian tube dysfunction in adults--preliminary report

The paper presents preliminary results of Eustachian tube dysfunction treatment with the use of vibroaerosols in adult patients. 21 patients aged 16-73 y.o. (mean age 49 y.o) have been included in the study. The treatment included inhalation of medicines individually selected for the patient, based on the results of the physical examination. The patients have been divided into 2 groups, depending on the type of tympanogram. Group I included patients with type A tympanogram and abnormal Eustachian tube patency test result. Group II comprised of patients with type B or C tympanogram and abnormal Eustachian tube patency test result. After treatment, subjective improvement has been observed in 88.9% of the ears, objective improvement in 61.5% of the ears. In group II, objective improvement observed by the change of tympanogram has been observed in 85% of ears. Lack of correlation between objective and subjective improvement have been observed in 26% of the ears. In 11.1% of the ears no benefit from treatment has been observed. The correlation between subjective and objective improvement has been observed in 74% of ears. It appears that treatment with the use of vibroaerosols is beneficial for patients with Eustachian tube dysfunction.     

Abnormal middle ear pressures during experimental influenza A virus infection--role of Eustachian tube function

Introduction: Experimental infection of adults with influenza A virus, rhinovirus or RSV causes abnormal ME pressure in some, but not all subjects. The hypothesis tested in this study is that the response variability is caused by constitutional differences in the functioning of the Eustachian tube. Methods: 18 adult subjects were experimentally infected with influenza A virus. On five occasions before virus exposure, middle ear pressure (by tympanometry) and Eustachian tube function (by sonotubometry) were recorded bilaterally. Tests were repeated on days 1 through 8 and 10 after infection. Individual ears were classified with respect to the number of pre-exposure, positive sonotubometric testings and the middle ear pressure response to infection was compared between ears with Eustachian tube openings at all pre-infection test sessions (GR-A) and those with at least one negative test (GR-B). Results: Pre-exposure, 19, six, four, four, one and two ears had tubal openings on five, four, three, two, one and zero sessions, respectively. For that period, GR-A had significantly lesser average intra-ear and intra-group middle ear pressure variances compared to GR-B, but there were no between-group differences in the average middle ear pressure or in the number of observations of abnormal middle ear pressure. After virus exposure, middle ear pressure variances and the number of abnormal observations increased and the average pressure decreased in both groups, but the effects were more pronounced for GR-B ears. Conclusions: These results support the hypothesis that pre-existing good Eustachian tube function reduces the otological complications of viral upper respiratory tract infection.     

鼻咽癌放疗后分泌性中耳炎的治疗探索

目的探索鼻咽癌（nasopharyngeal carcinoma,NPC）放射治疗后分泌性中耳炎（secretory otitis media,SOM）的治疗方法。方法对63例（72耳）NPC放疗后SOM患者,采用综合治疗措施：全身和局部抗炎,神经营养,扩张血管,激素治疗;加强鼻腔、鼻咽局部清理,治疗鼻腔鼻窦疾病;咽鼓管置管、冲洗并向鼓室注入麻黄碱、氧氟沙星、地塞米松和α-糜蛋白酶混合药液。结果所有患者治疗前均有耳鸣、耳闷塞感、听力下降等症状,鼓室导抗图均为“B”型。经综合治疗后,耳鸣消失45耳（62.50％）,好转17耳（23.61％）,无效10耳（13.89％）,总有效率86.11％;耳闷塞感消失57耳（79.17％）,好转11耳（15.28％）,无效4耳（5.55％）,总有效率94.45％;声阻抗检查鼓室曲线“A”型38耳（52.78％）,“As”型25耳（34.72％）,“B”型4耳（5.56％）,“C”型5耳（6.94％）;0.5、1.0、2.0kHz气导听阈均值从治疗前的（46.0±5.0）dBHL提高到治疗后的（25.8±3.5）dBHL,差异具有显著性（P〈0.001）。结论分析NPC放疗后SOM的发病机理,有针对性地采取对因治疗,是非常有效和切实可行的,对提高NPC患者的生存质量具有重要意义,可以在临床实践中加以应用和推广。     

声导抗测试与咽鼓管开放类型的判别

分析了近１０年来作者采用的声导测试法诊断咽鼓管开放症的４８例６３耳临床资料，发现咽鼓管开放有主观症状而无客观体，有主观症状又有客观体症，无主观症状而有客观体征三种情况。认为咽鼓管在生理性开放和病理性异常开放之分。     

Eustachian tube closing failure in children with persistent middle ear effusion

One important role of the Eustachian tube is to protect the middle ear from the extensive physiological pressure variations that take place in the nasopharynx, for example on sniffing. In a previous investigation in 50 children with persistent middle ear effusion a surprisingly high percentage of ears were evacuated by sniffing. The present study was undertaken in a second series of children, and results were found to be reproducible. In total 156 ears in 100 children have been investigated. In 63% of ears (73% of subjects) evacuation of the middle ear took place on sniffing. Results show that Eustachian tube malfunction in these subjects is characterized by a reduced protective function; a condition denoted "Eustachian tube closing failure".     

Seasonal allergic rhinitis and its effects on Eustachian tube function and middle ear pressure

Middle ear pressure was recorded from 396 ears and aural symptoms enquired of 198 adult subjects with seasonal allergic rhinitis. Evidence of Eustachian tube dysfunction was found in 24% of subjects. Increased duration of exposure to pollen over a further 2 weeks increased the incidence of Eustachian tube dysfunction to 48%. The development of Eustachian tube dysfunction did not correlate with the severity of nasal symptoms.     

慢性鼻-鼻窦炎对中耳功能的影响

目的探讨慢性鼻-鼻窦炎对中耳功能的影响。方法前瞻性研究218例慢性鼻窦炎和慢性肥厚性鼻炎患者的中耳功能,中耳功能异常的患者经鼻内镜鼻腔、鼻窦手术后复查鼓室导抗图和纯音测听。结果218例患者中28例(36耳)中耳功能异常,慢性鼻窦炎Ⅲ型患者中耳功能异常发生率显著高于慢性鼻窦炎Ⅰ型和慢性肥厚性鼻炎患者(P<0.05,P<0.01),慢性鼻窦炎Ⅱ型患者中耳功能异常发生率显著高于慢性肥厚性鼻炎患者(P<0.05)。经鼻内镜鼻腔、鼻窦手术后随访6.5月,36耳中治愈19耳,好转15耳,无效2耳。结论慢性鼻-鼻窦炎可能影响中耳功能,治疗慢性鼻-鼻窦炎有利于中耳功能恢复。