鼻咽癌放射治疗后感音神经性耳聋的临床分析

目的观察鼻咽癌患者放射治疗后感音神经性耳聋的发生率及探讨影响其发生的因素。方法对放射治疗后随访期满1年以上的25例鼻咽癌患者分别进行纯音听阈和声阻抗一导纳测试，并且收集相关的临床资料予以回顾性分析。结果所有患者随访期为12—94月(中位53月)。低频段和高频段感音神经性耳聋的发生率分别为8％和42％。对影响高频段感音神经性耳聋的单因素分析后发现，患者确诊时的年龄和随访时间有统计学意义(t=2．051，P=0．0458；t=2．978，P=0．0045)；而性别、确诊时是否主诉有听力下降和(或)耳鸣、鼻咽部照射剂量和是否联合应用含顺铂的化疗则均无统计学意义。采用Binary Logistic回归法多因素分析显示，患者确诊时的年龄和随访时间有统计学意义(P=0．02；P=0．009)。结论鼻咽癌放射治疗后高频段感音神经性耳聋的发生率明显高于低频段，影响高频段感音神经性耳聋发生的主要因素是患者确诊时的年龄和随访时间，而治疗前的听力水平、放疗剂量与是否联合应用含顺铂的化疗对其发生率的影响尚不明确。

Clinical analysis of post-irradiation sensorineural hearing loss in patients suffering from nasopharyngeal carcinoma

Objective To investigate the incidence of post-irradiation sensorineural hearing loss(SNHL) in patients suffering from nasopharyngeal carcinoma and to evaluate its potentially contributing factors. Methods(Pure tone )test and impedance audiography were carried out in patients suffering from nasopharyngeal carcinoma with a post-irradiation follow-up time over 1 year.Additionally,the test results were combined with clinical data and analyzed retrospectively. Results The follow-up time of all patients ranged from 12 to 94 months(median 53 months).The incidences of SNHL at low and high frequencies were 8% and 42% respectively.Univariate analysis showed that patient's age and follow-up time affected the incidence of SNHL at high frequencies(t=2.051,P=0.0269;t=2.978,P=0.0011),but sex,preirradiation subjective hearing loss,irradiation dose and chemotherapy including cisplatin had no significance.Multivariate analysis by Binary Logistic Regression revealed that the risk of SNHL was correlated with patient's age and follow-up time (P=0.02;P=0.009). Conclusion Post-irradiation SNHL at high frequencies in patients suffering from nasopharyngeal carcinoma is more common than that at low frequencies.The independent prognostic factors for development of SNHL at high frequencies are patient's age and follow-up time.But the role of preirradiation hearing level,irradiation dose and chemotherapy including cisplatin are not conclusive and further research is needed.;