以耳鸣耳聋为首发症状的慢性粒细胞白血病一例

患者 :男 ,2 5岁。因耳鸣耳聋 1d于 2 0 0 2年 8月 19日来我院就诊。患者 1d前无诱因出现双侧听力骤然下降 ,以左侧为著 ,呈持续性 ,伴高调耳鸣 ,恶心 ,非旋转性头晕 ,无耳廓溢液 ,听神经诱发电位示双侧感音神经性耳聋 (左侧听阈 70 d B,右侧听阈 4 0 d B)。予以胞二磷胆碱、天麻素静脉滴注治疗 ,同时予以大剂量 B族维生素、能量合剂、眩晕停等治疗 1周 ,无好转 ,发现白细胞增多达 2 4 8× 10 9/ L ,遂转入血液科。查体 :皮肤黏膜无出血点 ,浅表淋巴结无肿大 ,胸骨无压痛 ,心肺 (- ) ,肝肋下 4 cm ,脾肋下 14 cm ,质韧 ,轻度触痛。血象示 …     

银杏叶片联合地塞米松治疗神经性耳鸣的临床研究

目的 评估银杏叶片联合地塞米松治疗神经性耳鸣患者的临床疗效。方法 选取2019年6月—2020年6月在遂宁市中心医院耳鼻咽喉科住院的120例神经性耳鸣患者,随机分为对照组和治疗组,每组各60例。对照组鼓室内灌注地塞米松磷酸钠注射液,0.6 mL/次,首周治疗2次,然后1次/周。治疗组在对照组基础上口服银杏叶片,2片/次,3次/d。两组均持续治疗4周。观察两组患者临床疗效,比较治疗前后两组患者耳鸣致残量表（THI）评分、耳鸣响度和中枢神经递质水平。结果 治疗后,治疗组神经性耳鸣的临床症状改善的有效率（93.33%）显著高于对照组（68.33%）(P<0.05)。治疗后,两组患者THI评分、耳鸣响度评分均较治疗前显著降低（P<0.05）,治疗后治疗组THI评分、耳鸣响度评分低于对照组（P<0.05）。治疗后,两组患者血清5-羟色胺（5-HT）的水平显著降低,γ-氨基丁酸（GABA）的含量显著升高（P<0.05）;且治疗组5-HT和GABA的变化比对照组更明显（P<0.05）。结论 银杏叶片联合地塞米松治疗可显著改善神经性耳鸣患者的临床症状,降低患者的耳鸣响度,...     

特发性耳鸣严重程度的临床评估和影响因素分析

目的分析特发性耳鸣严重程度的评估和相关因素。方法对不明原因、伴或不伴有感音神经性耳聋、病程≥6个月的特发性耳鸣患者236例,采用耳鸣残疾量表(THI)、国内耳鸣评价量表及视觉模拟量表(VAS)等进行特发性耳鸣评估和相关因素分析。结果耳鸣响度VAS评分与特发性耳鸣严重程度密切相关(t=2.826,P=0.007),耳鸣THI的亚量表功能性量表得分次之(t=2.169,P=0.035);患者的耳鸣部位、耳鸣响度及听力与耳鸣严重程度无明显相关性(P>0.05)。结论耳鸣响度VAS评分与特发性耳鸣严重程度密切相关,可以满足临床医生对耳鸣严重程度的初步评估。     

不同年龄突发性耳聋的近期疗效观察

目的分析不同年龄突发性耳聋患者药物治疗的近期疗效。方法240例突发性耳聋患者,根据年龄不同分为A组(年龄30~40岁)、B组(年龄41~50岁)、C组(年龄51~60岁)、D组(年龄61~70岁),每组60例。四组患者均给予丹参川芎嗪注射液、甲钴胺注射液、前列地尔注射液、糖皮质激素、高压氧治疗。比较四组治疗前后言语频率平均听阈及不同发病时间患者疗效、不同听阈患者疗效、耳鸣患者疗效。结果治疗后,四组患者患耳言语频率平均听阈均低于本组治疗前,差异具有统计学意义(P<0.05);A组、B组患者治疗总有效率分别为73.33%、71.67%,均高于C组的53.33%、D组的50.00%,差异具有统计学意义(P<0.05)。以50岁为界,预后呈明显不良。四组发病时间≤7 d患者的治疗总有效率高于同组发病时间>7 d患者,差异具有统计学意义(P<0.05)。四组不同听阈患者总有效率组内比较差异具有统计学意义(P<0.05),听力损失越重,听阈越高,预后越差。四组耳鸣患者治疗总有效率比较差异无统计学意义(P>0.05)。结论病程对突发性耳聋的治疗效果有重要的影响,尽早治疗可以明显改善预后,随着年龄的增长,预后逐渐变差。听阈亦是影响预后的因素,听阈越高,预后越差。耳鸣的治疗效果与年龄无关。     

声信息治疗神经性耳聋耳鸣的体会

耳聋耳鸣是耳科临床中最常见的症状,除了部分具有明显器质性病变诱因外,大部分耳聋耳鸣的发病机制尚不完全明了,现有的治疗技术其疗效均不理想。美国自70年代以来,利用白噪声掩敝耳鸣,取得了减轻病人痛苦的效果,受到同行瞩目。我科自1996年10月引进一台S9818声信息治疗仪应用于临床,取得了一定的疗效。1 临床资料1.1 一般资料 声信息治疗组,男179例,女197例;年龄15～78岁;病程2d至30余年。感音神经性耳聋260例,388只耳;混合性耳聋30只耳;神经性耳鸣348例,486只耳。其中只聋不鸣的27例,39只耳。听阈正常的耳鸣115只耳。以上病例均采用过不同的治疗方法,其疗效欠佳。药物治疗组,男16例,女15例;年龄6～73岁;感音神经性聋43只耳,神经性耳鸣48只耳,均为随机抽取。1.2 治疗方法 治疗前需对病人进行常规检查,如:听阈、血压、心率、脑血流图,必要时做经颅多普勒、脑干诱发电位、     

银杏叶片联合地塞米松治疗神经性耳鸣的临床疗效研究

目的 探究银杏叶片联合地塞米松治疗神经性耳鸣的临床疗效。方法 70例神经性耳鸣患者,按照随机数字表法分为对照组和观察组,各35例。对照组采取地塞米松治疗,观察组采取银杏叶片联合地塞米松治疗。比较两组患者临床疗效、不良反应发生率及治疗前后耳鸣情况(耳鸣致残量表评分、响度评分)、中枢神经递质[血清5-羟色胺(5-HT)和γ-氨基丁酸(GABA)]水平。结果 观察组的治疗总有效率91.43%高于对照组的71.43%,差异有统计学意义(P<0.05)。治疗前,两组患者的耳鸣致残量表评分和响度评分比较,差异无统计学意义(P>0.05);治疗后,两组患者的耳鸣致残量表评分和响度评分均低于本组治疗前,且观察组患者的耳鸣致残量表评分(26.38±3.41)分和响度评分(5.24±1.26)分均低于对照组的(32.54±4.19)、(7.07±1.42)分,差异有统计学意义(P<0.05)。治疗前,两组患者的血清5-HT和GABA水平比较,差异无统计学意义(P>0.05);治疗后,两组患者的血清5-HT水平低于本组治疗前, GABA水平高于本组治疗前,且观察组患者的血清5-HT(...     

颈上神经封闭治疗神经性耳鸣

神经性耳鸣为耳鼻喉科难治疾病。自 2 0 0 0年来 ,我科采用颈上神经节封闭治疗本病 40例共 46耳 ,疗效较为满意 ,现报告如下。1　资料与方法1.1　一般资料　本组 40例 46耳 ,男 2 5耳 ,女 2 1耳 ;年龄 2 0～62岁 ;病程 2ｄ～ 2月 ,单纯耳鸣 2 0例 2 0耳 ,耳鸣伴耳聋 2 2耳伴眩晕 ,恶心 4耳 ,耳鸣均为突发性、高音调、持续性 ,耳聋为感音神经性。1.2　方法　采用 2 %利多卡因 2ｍｌ加维生素Ｂ1 、Ｂ1 2 各 1ｍｌ,患者侧卧位 ,头下加枕高 5ｃｍ ,后仰 30度 ,下颌角上 1ｃｍ胸锁乳突肌前缘 ,针头垂直皮肤穿刺进针 5～ 6ｃｍ ,回抽无血或脑脊液 …     

健脾益气止鸣汤联合西药治疗神经性耳鸣40例疗效观察

目的 探讨健脾益气止鸣汤联合西药治疗神经性耳鸣的临床疗效。方法 80例神经性耳鸣患者,按照入院治疗先后顺序分为对照组和观察组,各40例。其中对照组选择西药治疗方案,观察组在对照组基础上联合健脾益气止鸣汤行中医辨证治疗。比较两组治疗效果;中医证候积分;最大及最小耳鸣响度;治疗前后耳鸣严重程度评分;耳鸣残疾评分;左耳和右耳听阈值和生活质量评分。结果 观察组治疗总有效率为97.5%,显著高于对照组的77.5%,差异具有统计学意义(P<0.05)。观察组中医症候积分、最大耳鸣响度、最小耳鸣响度分别为(11.29±4.12)分、(23.00±2.80)dB、(0.04±0.01)dB,均显著低于对照组的(16.33±3.27)分、(65.10±6.10)dB、(13.40±1.80)dB,差异均有统计学意义(P<0.05)。治疗后,观察组耳鸣严重程度评分、耳鸣残疾评分、左耳和右耳听阈值分别为(4.34±1.56)分、(37.47±9.45)分、(27.93±4.24)dB,均显著低于对照组的(8.13±1.52)分、(44.28±8.37)分、(29.41±1.84)dB,生活质量评分(60.56±10.63)分高于对照组的(51.34±10.11)分,差异均有统计学意义(P<0.05)。结论 健脾益气止鸣汤联合西药治疗方案应用于神经性耳鸣患者中临床疗效更理想,可改善患者的疗效,并降低最大耳鸣响度、最小耳鸣响度,是一种值得推荐的中西医治疗方案。     

微波治疗耳鸣临床疗效观察

微波技术是八十年代初医学领域兴起的一项技术 ,微波辐射天线 (即治疗电极 )的研制更进一步拓宽了微波在临床的应用范围。近三年来我科使用ＥＢＨ Ⅳ型耳鼻喉微波综合治疗仪理疗耳鸣 32例 4 0耳 ,经随访 2个月～ 2年 ,疗效较为满意 ,现报告如下。对象与方法一、对象本组 34例 4 0耳 ,男 2 9耳 ,女 11耳 ;年龄 16～5 7岁 ;病程 2天～ 8个月 ,以耳鸣为主诉。耳鸣均为特发性、高音调、持续性。 11耳伴有感音神经性耳聋 ,平均听力降低约 6 0～ 80ｄＢ。本组患者多曾有药物治疗症状未改善史。患者均无心血管疾病及糖尿病等病史。二、方法耳鼻喉微…     

甲钴胺对64例突发性耳聋患者耳鸣症状的疗效观察

目的探索甲钴胺对突发性耳聋患者耳鸣症状的临床疗效。方法 64例突发性耳聋且伴有耳鸣症状的患者,按照就诊先后顺序分为观察组和对照组,各32例。对照组均予常规药物治疗,观察组在对照组基础上加用甲钴胺治疗,比较两组患者耳鸣症状的改善情况。结果观察组患者经治疗后纯音听阈值为(22.76±4.12)d B,与治疗前的(83.93±8.23)d B和对照组的(43.09±5.32)d B比较均有明显减少(P<0.05)。观察组经治疗耳鸣症状改善总有效率为90.63%,显著高于对照组的68.75%(P<0.05)。结论甲钴胺用于改善突发性耳聋患者的耳鸣症状能取得显著效果,可进行临床推广应用。     

鼓室成形术治疗慢性化脓性中耳炎的疗效分析

目的探讨慢性化脓性中耳炎鼓室成形术的可行性和疗效。方法对33例单侧慢性化脓性中耳炎患者在恢复咽鼓管功能、清除病变的同时行鼓室成形术,随访观察近期及远期疗效。结果33例患者中,3例术腔填塞时有耳鸣,取出填塞物后即恢复正常。术后2周去除外耳道填塞物后,27例移植片色泽正常,生长好,4例血液供应稍差,2例移植片下缘有裂隙,经对症处理后,移植物全部存活。随访至术后1年,鼓膜生长良好28例,占85％;2例半年后再发生鼓膜穿孔,但鼓室内干燥;1例移植的鼓膜穿孔后再流脓;1例移植物内陷,经咽鼓管吹张后好转;1例鼓膜内陷较明显,听力无改善。术后1年纯音测听语频区气骨导差较术前平均缩小10dB者9例,占27％;缩小15—20dB者14例,占42％;缩小25～30dB者6例,占18％;无变化4例,占12％。结论慢性化脓性中耳炎可行鼓室成形术。彻底清除病变,恢复中耳通气功能,加强抗感染,正确放置移植物并防止其感染;避免不愈合及胆脂瘤形成,是手术成功的关键。     

Application of a response duration schedule in rats to evaluate visual and/or auditory threshold

Determination of visual and auditory thresholds was carried out under a response duration schedule of tone and/or light-dipper presentation. This schedule enabled an exact assessment of visual and auditory sensitivities, since the direction and distance from the rat to the sound or light sources were constant, and the rat could thus acquire the conditioned behavior in a short time. The rat has to put its nose into the hole and hold it there until a conditioned stimulus (tone and/or light) was presented. The animal could get water-reinforcement by taking its nose out from the hole during the period of conditioned stimulus. To determine the visual threshold, the intensity of light was reduced, from 100 Lx (starting point) by 10 Lx steps in each trial, until the subject made 10 non-response trials (i.e., no dipper approach within 1.0 sec after the light onset) among 10 trials. In terms of auditory threshold, the intensity of 3, 7 and 10 KHz pure tone was reduced, from 90 dB by 10 or 2 dB steps in each trial, until the subject made 10 non-response trials among 10 trials. The light or tone intensity that prolonged the response latency 2 times compared to normal rats was taken as the threshold. The visual sensitivity in the rats suffering from alkaline-burn on its corneas decreased about 14 Lx. The auditory thresholds in rats were 19.5 +/- 1.3, 37.5 +/- 1.8 and 54.6 +/- 1.3 dB at 10, 7 and 3 KHz, respectively. The auditory sensitivity in the rats with cotton-stuffed ears and pierced eardrums decreased about 6 and 12 dB, respectively.     

软腭拉钩协助下经口咽鼓管注药治疗分泌性及单纯型化脓性中耳炎

目的：总结在软腭拉钩协助下用咽鼓管导管治疗分泌性及单纯型化脓性中耳炎的疗效。方法：用软腭拉钩协助下经口咽鼓管注药治疗分泌性中耳炎192例（236只耳）,单纯型化脓性中耳炎168例（204只耳）。结果：分泌性中耳炎治疗前听阈（HL）平均为（51．2±7．1）dB,治疗后平均为（36．2±7．1）dB,两者比较,差异有统计学意义（P〈0．001）。鼓室功能曲线治疗前B型140只耳,C型80只耳,治疗后该两型减少,出现新增As型94只耳。单纯型化脓性中耳炎组治疗前听力丧失（HL）平均（49．5±7．1）dB,治疗后平均为（34-3±7．1）dB,两者比较,差异有统计学意义（P〈0．001）。结论：此法能改善分泌性中耳炎患者咽鼓管功能,提高听力,并能改善单纯型化脓性中耳炎的中耳腔引流问题。     

自体颞肌筋膜移植在听力重建手术中的应用

目的:探讨自体颞肌筋膜移植在慢性化脓性中耳炎行听力重建手术中的应用效果.方法:我科自2006年1月～2008年1月对63例中耳炎进行了开放式乳突根治+鼓室成形术,应用自体颞肌筋膜移植重建鼓膜.结果:随访6～12个月,除2例患者术后复发外,其余病例均获干耳,无面瘫、眩晕发生.鼓膜成形良好,术后听力提高30 dB者10耳,20～29 dB者30耳,10～19 dB者23耳.结论:自体颞肌筋膜移植在听力重建手术中发挥了重要作用.     

偏头痛患者听功能及前庭功能状态的临床研究

目的:探讨偏头痛患者听功能及前庭功能表现与原发病的关系。方法:随机选择31例偏头痛患者及31例对照组患者,收集详细病史,并测定其纯音听阈和声导抗以及视频眼震图。结果:偏头痛患者中有2例(3耳)出现听阈上升,均为感音神经性耳聋,声导抗无明显异常。偏头痛患者中有10例出现眩晕症状(对照组无明显眩晕症状)。偏头痛组视频眼震图各参数与对照组相比有不同程度的差异。结论:偏头痛患者有听功能的下降,无中耳传音功能的异常。一部分偏头痛患者出现眩晕,与偏头痛发作有密切关系。偏头痛患者不仅有周围性前庭功能的异常,也可以有中枢性前庭功能的异常。偏头痛患者进行前庭功能的检查,有助于该病的诊断和治疗。     

The clinical free radical scavenger, edaravone, protects cochlear hair cells from acoustic trauma

It is known that reactive oxygen species have toxicity to the cochlea. We investigated the effect of edaravone, a free radical scavenger for clinical use, on the cochleae of guinea pigs subjected to acoustic trauma. We assessed auditory brainstem response (ABR) thresholds to evaluate cochlear function and observed the sensory epithelium. After noise exposure (130 dB SPL, 3 h), we observed that the auditory brainstem response threshold shift in edaravone-treated ears was significantly less than that in untreated ears. This result suggests that edaravone protected the cochleae from acoustic trauma.     

Auditory effects of chronic alcoholism

Clinical reports of hearing loss, tinnitus, and auditory hallucinations, as well as empirical studies of auditory phenomena, have sparked interest in the auditory effects of chronic alcoholism. The auditory system, owing to its multi-synaptic course through the central nervous system and to the many techniques available for diagnostic evaluation, affords a special opportunity for examination of transmission breakdown in alcoholics. The present paper reviews several different approaches to the study of disrupted hearing: histologic evidence; threshold measurement, evoked potential data; acoustic reflex studies; and behavioral central auditory evaluation. The review explores effects attributed to both peripheral and central loci, and outlines the ramifications for research and treatment.     

Evaluating children's hearing by DPOAEs at 1-10 kHz

The efficacy of application of DPOAE (distortion product otoacoustic emission) in the evaluation of hearing in children was assessed. 106 children were checked by both DPOAE and ABR. The results show that DPOAE is highly effective in discriminating between hearing disorders and normal hearing. The correct classification rate of normal ears varied between 86.8-96.8% and ears with hearing loss (ABR threshold equal or above 20 dB HL) 87-100%. At the lower frequencies (1-2 kHz) the hit rate was lower. The results of this study suggest that the DPOAE can be used as a rapid hearing screening test for infants and children providing frequency specific information, mostly in the 3-10 kHz frequency range. The effectiveness of DPOAE at 1-10 kHz was evident in children with middle ear dysfunction and in detecting infants with possible high frequency hearing loss. In addition, high frequency DPOAE broadens the range typically available from click-evoked ABR measurements. This information is of increased clinical value not only in terms of speech and language development but also for detecting children who are at high-risk for possible hearing deterioration and who require early intervention.     

Sudden hearing loss associated with tacrolimus in a kidney-pancreas allograft recipient.

A 38-year-old woman with type 1 diabetes underwent kidney-pancreas transplantation. Her postoperative course was complicated due to recurrent acute graft rejections and pancreatitis. After initial immunosuppression with microemulsion cyclosporine, mycophenolate mofetil, and prednisone with muromonab-CD3 induction, cyclosporine was switched to tacrolimus on day 44. The initial dosage was 5 mg twice/day, but it was gradually increased to 10 mg twice/day, aiming at 15-20 ng/ml. On day 17 of tacrolimus therapy the woman developed sudden hearing loss with tinnitus. The serum tacrolimus level was 28.3 ng/ml (therapeutic range 10-20 ng/ml) on day 20 of tacrolimus therapy, and peaked at 34.9 ng/ml on day 28. Two audiograms performed on days 28 and 29 confirmed bilateral hearing loss of 80% for speech perception, characterized as mild to moderate sensorineural hearing loss with speech reception threshold of 35 dB (normal < 20 dB) in both ears. The tacrolimus dosage was gradually reduced to 6 mg twice/day by day 36, with drug level 9.7 ng/ml, after which her hearing gradually recovered.     

腭裂患儿听力检查的临床研究

目的分析腭裂患儿鼓室图、镫骨肌声反射和听性脑干反应（auditory brainstem besponse,ABR）检查的特点,探讨听力学检查对腭裂患儿的临床应用价值。方法采用中耳分析仪和听觉诱发电位仪测试,对40例（80耳）腭裂患儿进行听力学检查。结果鼓室图：B型37耳（46.25%）,C型10耳（12.5%）,A型22耳（27.5%）,As型11耳（13.75%）。镫骨肌声反射：64耳（80%）消失,16耳（20%）存在。ABR结果：听力损失41耳（51.25%）,均伴有V波潜伏期延长,其中鼓室图呈B型25耳（60.98%）,C型9耳（21.95%）。此41耳中轻度听力损失21耳（51.22%）,中度听力损失20耳（48.78%）,无重度和极重度听力损失。80耳中V波潜伏期延长58耳（72.5%）。结论腭裂的解剖生理特点决定了患儿中耳炎的发病率较高。当鼓室图呈B型或C型曲线,同时出现ABR中V波听阈呈轻中度下降且V波潜伏期延长时,应高度警惕发生分泌性中耳炎,否则会严重影响患儿生活和学习。