感音神经性聋的诊断和治疗

感音神经性聋概述 由于耳蜗毛细胞、听神经、听觉通路或各级听中枢神经元受损害,致声音的感受与神经冲动传递障碍者,称感音性聋或神经性聋.其中毛细胞病变引起者称感音性聋(耳蜗性聋或终器性聋),病变位于听神经及听觉通路者称神经性聋(蜗后性聋),病变发生于听觉中枢核团或大脑皮层听中枢者称中枢性聋.     

感音神经性聋高频听力易损机制

感音神经性聋是临床常见的疾病,包括噪声性聋、老年性聋、药物性聋、突发性聋等。感音神经性聋多以高频听力损失为主要表现,或由高频听力下降开始（Cole,1988;Mur-phy,1991）。以往人们对高频听力损失的认识比较局限,为何感音神经性聋高频听力比低频更容易受损,并没有明确的结论,本文就感音神经性聋高频听力损失的原因和机理做一综述,以期为采取合适的预防和治疗方案提供依据。     

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。     

显性遗传性感音神经性聋24家系调查报告

文中对24个显性遗传性感音神经性聋家系进行了调查.24个家族共有聋人156人,对其中50人作了纯音测听和声导抗测试,对10名幼儿作了听性脑干反应测试.常染色体显性遗传性聋表现为连续3代以上相传,子代两性均有发病,听力测试为双耳感音神经性聋.应劝阻有遗传性聋者间通婚.对迟发型常染色体显性遗传性聋家族中年幼者应注意听力监测,以便早期发现听觉障碍.早期进行干预.     

多频稳态诱发电位评估中度感音神经性聋儿童的应用

目的探讨多频稳态听觉诱发电位评估儿童中度感音神经性聋的可靠性。方法所有患者经纯音测听（PTA）检查筛选出中度感音神经性聋30例5～6岁儿童（共40耳），然后口服10％水合氯醛镇静睡眠后，行多频稳态听觉诱发电位（ASSR）检测，其阈值与纯音听阂阈值进行比较，分析不同频率处听力阈值分布情况及其相关性。结果分别比较语言频率ASSR阂值与纯音听闽阈值，结果显示，0．5kHz处相关性较差，其差值为2-18dB，而在4kHz处相关性最好。结论可以应用多频稳态听觉诱发电位评估中度感音神经性聋儿童的听力阈值，但需要注意0．5kHz处的相关性差异。     

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。     

既往存在感音神经性听力损失突发性聋患者临床特征与疗效分析

目的探讨既往存在感音神经性听力损失突发性聋患者临床特征与疗效。方法对61例(63耳)既往存在感音神经性听力损失突发性聋患者的临床资料进行系统性分析,包括临床表现、疗效评估等,与同期收入院的既往不存在感音神经性听力损失突发性聋患者资料对比,分析发病和影响疗效的高危因素,总结该病发生、发展及预后的特点。结果既往存在和不存在感音神经性听力损失突聋患者的性别、现患耳侧别、病程差异无统计学意义(P值均>0.05),发病年龄差异具有统计学意义(P<0.05)。既往存在和不存在感音神经性听力损失突聋患者的听力曲线类型、听力损失程度差异无统计学意义(P值均>0.05),既往存在感音神经性听力损失突聋患者总有效率低于既往不存在感音神经性听力损失突聋患者总有效率,差异有显著统计学意义(χ²=6.915,P=0.009),既往存在感音神经性听力损失突聋患者痊愈率低于既往不存在感音神经性听力损失突聋患者痊愈率,差异无统计学意义(χ²=0.221,P=0.638)。结论既往存在感音神经性听力损失突聋患者病因复杂,疗效较差,应加大研究制定个性化的诊疗方案。     

单侧低频感音神经性聋：附40例分析

文中对40例单侧低频感音神经性聋患者进行分析,发现患者主诉中有耳鸣的最多(87.5%)、耳聋次(75%)、眩晕和耳闷者各为35%及25%.纯音测听均为低频感音神经性聋,其低频与高频听阈均值之差为26.32 dB.40例中36例听性脑干反应正常.并讨论了产生低频感音神经性聋可能的原因,耳鸣、低频听力损害与内淋巴积水的关系,并提出对低频感音神经性自应有统一的划定标准.     

氧化应激在感音神经性耳聋中的作用机制

感音神经性耳聋是由于内耳与听觉皮层之间的听觉通路中一个或多个部分发生功能障碍导致的常见疾病,其病因复杂,除遗传因素外,还包括耳毒性药物、噪声暴露以及年龄老化等。全世界有4.66亿人患有中度至重度双耳听力损失,约占世界人口总数的6.1%,听力受损人群逐年增长并呈现年轻化趋势。大量研究证据表明,氧化应激产生过量的活性氧自由基参与包括噪声性聋、年龄相关性聋、药物性聋和突发性感音神经性聋等在内的感音神经性听力损伤过程,是可能的共同性病理环节。本文就氧化应激在上述疾病中的损伤机制进行综述。     

分泌性中耳炎骨导听力下降的临床观察

目的 分泌性中耳炎导致骨导听力下降的比例比人们认识的要高。方法:收集分泌性中耳炎患者33例(36耳),传导性聋16例(16耳);感音神经性聋11例(12耳),混合性聋6例(8耳),鼓室图为B或C,声反射消失。结果 经过4—12周治疗后,传导性聋患者听力改善或恢复12耳,无效4耳;感音神经性聋听力改善7耳,无效5耳,混合性聋听力改善2耳,无效6耳;结论 分泌性中耳炎可导致感音神经性聋。病程的长短是影响治疗效果的主要因素,鼓室图能否转为A型是判断疗效的客观指标指标。     

HPV and head and neck cancer

Head and neck cancer is frequent worldwide and oropharyngeal locations are presently sharply on the increase, in relation with an increasing incidence of oropharyngeal infection by oncogenic type-16 human papillomavirus (HPV). The clinical and biologic profile of these patients is distinct from that of other oropharyngeal carcinoma patients, with earlier onset, cystic cervical nodes and basaloid carcinoma histopathology. Detection of intratumoral viral DNA is essential to confirm the role of HPV, and E6/E7 mRNA expression is the most relevant indicator for stratification. Several methods can reveal intratumoral oncogenic HPV DNA, but PCR with hybridization is the most sensitive and most widely used. According to several reports, prognosis in terms of survival and locoregional control is better in HPV-positive oropharyngeal carcinoma than in oropharyngeal carcinoma associated with smoking and alcohol consumption. The future lies in vaccination, but further studies will determine whether the rate of oropharyngeal carcinoma falls in women vaccinated against cervical cancer.     

Papillomavirus and head and neck cancer

Tobacco and alcohol consumption are the main risk factors for head and neck cancers. Papillomavirus (HPV) infection was recently associated with the development of malignant tumors of the oropharynx, according to molecular and biological arguments. We describe the oncogenic mechanisms of HPV infections, the epidemiological and clinical aspects of associated head and neck cancers, their prognosis, and issues of specific therapeutic strategies.     

紫杉醇与头颈部肿瘤

为了解紫杉醇治疗鼻咽癌、喉癌及其他头颈部肿瘤的疗效及作用机理，本文分析了近年来的文献27篇。紫杉醇通过稳定微管、阻断细胞的有丝分裂和增殖，从而显著地抑制肿瘤细胞的生长并促进细胞调亡，在头颈部肿瘤同期放化疗中能起到放疗增敏作用，单独或联合其他抗癌药物治疗亦有较佳的疗效。紫杉酵是一种具有良好抗癌活性的药物，随着研究的深入，将会在头颈部肿瘤的治疗中发挥更大的作用。     

Aging and olfactory and taste function

This article focuses on the change in olfaction and taste with aging. It discusses histopathology with an emphasis on age-related changes, causes of chemosensory dysfunction in the elderly, how to evaluate a patient with dysfunction, useful tests and imaging, clinical consequences of chemosensory impairments, and available treatment options.     

Nutrition and taste and smell dysfunction

Food selection plays a pivotal role in maintaining adequate nutrient intake, thus elucidating drivers of food choice is a meaningful strategy to maintain health and manage disease. Taste and smell are key determinants of food choice and warrant careful consideration. In this review, we first discuss how sensory stimulation influences food selection and metabolism. We then review the evidence regarding the relationship between taste and smell dysfunction and food preferences and selection, with attention given to contexts of certain chronic diseases. We conclude with brief recommendations for the management of chemosensory disorders. While sensory abilities influence food selection, the effect of taste and smell dysfunction on long-term consumption patterns and health status must be considered in light of environment, exposure, and culture.     

Pepsin and Laryngeal and Hypopharyngeal Carcinomas

Laryngeal and hypopharyngeal carcinomas are common malignant tumors of the head and neck, and the incidence of both is increasing. Laryngopharyngeal reflux refers to the retrograde flow of gastric contents into the larynx, oropharynx, and/or nasopharynx. It remains controversial whether laryngopharyngeal reflux is a risk factor for laryngeal and hypopharyngeal cancers. The refluxing substances mainly include hydrochloric acid, pepsin, and occasionally bile acids and bile salts, as well as bacteria that colonize the gastrointestinal tract. Loss of epithelium in the mucous membrane of the larynx and hypopharynx is thought to be caused by pepsin. Here, we review the relationships between laryngopharyngeal reflux and both laryngeal and hypopharyngeal carcinomas, as well as the significance of pepsin, methods of clinical detection, and the mechanism of carcinogenesis.