突发性极重度聋与全聋的预后特点及差异

目的 研究突发性极重度聋和全聋的预后特点及差异.方法 回顾性研究复旦大学附属眼耳鼻喉科医院2007年6月至2008年9月收治的初始平均纯音听阈(pure tone average,PTA)>90 dB、随访完整的204例患者,分为全聋和极重度聋两组,对两组的预后进行比较,并对预后与年龄、并发症、发病-就诊时间进行相关性分析.结果 全聋组57例,极重度聋组147例,耳鸣、眩晕、耳闷三大伴随症状中,耳鸣的伴随率最高,两组均达90%以上,眩晕的伴随率全聋组为64.9%(37/57),极重度聋组为45.6%(67/147),两组间差异有统计学意义(x2=5.72,P=0.017).治疗后全聋组PTA下降(36.4±19.3)dB,极重度聋组下降(40.2±21. 3)dB,差异无统计学意义(t=1.165,P=0.245).两组痊愈者均为1周内接受治疗者,全聋组痊愈率为2.6%(1/38),极重度聋组为14.3%(14/98),两组间差异有统计学意义(Fisher确切概率法,P=0.045).全聋组治疗后PTA≤50 dB的患者占3.5%(2/57),极重度聋组达29.9%(44/147),两组间差异有统计学意义(x2=15.92,P=0.001).两组的预后与发病-就诊的时间有关(P值均为0.01),与年龄无关.结论 初始PTA>90 dB的突发性聋可分为极重度聋与全聋,两者预后有差异,需分开进行研究.     

突发性极重度聋与全聋的预后特点及差异

Objective To clarify the different prognostic characteristics between profound sudden sensorineural hearing loss (SSNHL) and total SSNHL. Methods The patients with SSNHL who visited Eye Ear Nose and Throat Hospital from June 2007 to September 2008 were reviewed retrospectively. All the 204 patients, with pure tone average (PTA) threshold more than 90 dB, were enrolled and divided into two groups, including total SSNHL and profound SSNHL groups. The relationship between recovery rate and prognostic factors including the age, complications, time period between onset and therapy was analyzed.Results There were 57 cases of total SSNHL and 147 cases of profound SSNHL in this series. Tinnitus was complained in more than 90% of the patients in both groups, which was higher than that of dizziness and ear fullness. Dizziness was present in 64. 9% (37/57) patient with total SSNHL group and 45.6% (67/147)patients with profound SSNHL, which had significant difference between the two groups (x2 = 5.72,P =0. 017). The PTA threshold improvement in total SSNHL group and profound SSNHL group was (36. 4 ±19.3) dB and (40. 2 ±21.3) dB respectively, which was no significant difference between the two groups (t = 1. 165 ,P =0. 245). The cured patients were all those received therapy within 1 week following the onset of SSNHL, which was of 2. 6% (1/38) patients in the total SSNHL group and 14. 3% (14/98) patients in the profound SSNHL group(P =0. 045). Furthermore, 3.5% (2/57) patients in total SSNHL group as well as 29. 9% (44/147) patients in profound SSNHL group obtained a good result with PTA threshold ≤50 dB after therapy(x2 = 15.92,P = 0. 001 ). In addition, the favorable prognosis was related with the onsettherapy time point( P = 0. 001 ), but not related to the patients' age. Conclusion Profound SSNHL and total SSNHL though both with PTA threshold > 90 dB had significant differences recovery rate and need to be studied separately.     

治疗前听力图形状与突发性聋预后关系分析

目的探讨突发性聋患者治疗前听力图形状与预后的关系。方法回顾性分析我科收治的339例突发性聋患者的临床资料。按患者治疗前听力图形状,分为上坡型,下坡型,凹陷型,平坦型,极重度聋型,全聋型六组。对突发性聋患者的治疗前听力图形状和预后的关系进行秩和检验分析,检验方法有Kruskal-Wallis Test和Mann-Whitney Test。结果经秩和检验分析,治疗前六组听力图形状和预后的差异有统计学意义。突发性聋患者听力图形状呈凹陷型和上坡型的预后较好,总有效率分别为83.8%和78.2%;听力图形状呈下坡型,平坦型,极重度聋型预后较差,总有效率分别为46.2%,64.8%和57.1%;全聋型预后最差,总有效率仅为30.6%。结论突发性聋患者治疗前听力图形状为全聋型的预后最差,听力图形状为凹陷型和上坡型的预后较好。     

鼓室内注射地塞米松治疗极重度以上突发性聋的临床研究

目的 评估鼓室内注射地塞米松在极重度以上突发性聋仞始治疗中的作用.方法 以发病2周内,未接受任何治疗,初始听力损失(250～4000 Hz均值)>90 dB的突发性聋患者78例作为研究对象,根据患者意愿分为全身激素+局部激素组(22例)、全身激素组(44例)和局部激素组(12例),各组均同时给予扩血管、营养神经的药物治疗和高压氧治疗.全身激素治疗采用地塞米松15 mg/d连用3 d,随后10 mg/d用3 d,最后5 mg/d用3 d.局部激素治疗采用鼓窜内注射5 mg/ml地塞米松0.8 ml,隔日1次,共5次.获取治疗后第10、20、30天的纯音测听结果并进行疗效评估.结果 治疗前影响预后的因素三组间基本匹配.治疗后纯音听阈均值(pure tone average,PTA)改善≥30 dB者所占比例,全身+局部激素组81.82%、局部激素组83.33%、全身激素组88.64%,三组间差异无统计学意义(P=0.726);治疗30 d后PTA改善值分别为:全身+局部激素组41.36 dB、局部激素组43.08 dB、全身激素组51.70 dB,三组间差异无统计学意义(F=1.58,P=0.2133).各组患者治疗后10 d听力改善最为显著,20 d听力基本稳定.纯音测听各频率听阈的改善程度由低频向高频逐渐递减.结论 局部激素治疗作为极重度以上突发性聋的初始治疗与全身激素治疗相比并无优越性.     

双侧与单侧突发性聋的临床特点及疗效分析

目的：分析与比较双侧与单侧突发性聋的临床特点与疗效。方法：对333例突发性聋患者（单侧315例，双侧18例）资料进行回顾性研究。结果：双侧突发性聋占突发性聋患者的5．4％，单侧和双侧突发性聋的发病年龄、性别比例、就诊时间、伴随症状差异无统计学意义。5例（27．8％）双侧突发性聋患者并发有糖尿病，概率高于单侧的9．8％（P〈0．05）。单侧者突发性聋的听力损失程度比双侧者严重，但它的疗效较好（二者总有效率分别为58．4％和13．9％）。就诊越早，越早使用激素，突发性聋的疗效越好。结论：单侧突发性聋更常见，双侧突发性聋并发糖尿病者更多。双侧突发性聋预后比单侧差。越早激素治疗疗效越好。     

听力损失程度和听阈图型与突发性聋预后关系探讨

目的：探讨听力损失程度和听阈图型与突发性聋预后关系。方法：回顾性分析我科收治的92例（97耳）突发性聋患者的临床资料。结果：上升型和反盔型听力损失预后最好,总有效率均为100．0％;缓降型其次,总有效率70．0％（7／10）;全聋型总有效率为66．7％（14／21）,陡降型较差,有效率为50．0％（4／8）。虽然全聋治疗总有效率高于陡降型,但无一耳痊愈,而陡降型有1耳痊愈。另全聋治疗后有6耳仍为全聋,1例提高65dBHL,1例提高50dBHL。耳聋程度中,轻、中度各1耳,虽然总有效率最高,但均未痊愈,经治疗后,听力各提高17dBHL和19dBHL,中重度、重度、极重至全聋总有效率差异无统计学意义（P〉0．05）,但是痊愈率均差异有统计学意义（均Pd0．01）,中重度组痊愈率最高38．5％（10／26耳）,其次重度组,痊愈率为33．3％（12／36耳）,极重至全聋最差为6．0％（2／33）。结论：耳聋的程度与总有效率无明显关系,但与痊愈率差异有统计学意义,突发性聋的不同听阈图型与听力的预后极为相关。     

影响极重度突发性聋疗效的因素分析

目的探讨影响极重度突发性聋疗效的因素。方法总结武警浙江总队嘉兴医院2010-2013年135例有完整资料极重度突发性耳聋患者的临床资料,分析影响其疗效的因素。结果 1135例患者中治愈、显效和有效分别为14例（10.37%）、35例（25.93%）和19例（14.07%）,治疗有效率为50.37%（68/135）,无效率为49.63%（67/135）。2男女性有效率分别为51.43%（36/70）、49.23%（32/65）,两者比较差异无统计学意义（χ^2=0.07,P〉0.05）;左右侧患耳有效率分别为52.31%（34/65）、48.57（34/70）,两者比较差异无统计学意义（χ^2=0.19,P〉0.05）;伴眩晕与不伴眩晕有效率分别为36.54%（19/52）、59.04%（49/83）,两者比较差异有统计学意义（χ^2=6.47,P〈0.05）;加用东菱迪芙与未加用东菱迪芙有效率分别为53.73%（36/67）、47.06%（32/68）,两者比较差异无统计学意义（χ^2=0.60,P〉0.05）;病程3天以下、4-7天、8-14天、和14天以上有效率分别为58.01%（36/62）、51.92%（27/52）、50.00%（3/6）、13.33%（2/15）,各阶段比较差异有统计学意义（χ^2=9.75,P〈0.05）;20岁以下、21-40岁、41-60岁和60岁以上有效率分别为25.00%（2/8）、50.00%（15/30）、52.00%（39/75）、54.55%（12/22）,各阶段比较差异无统计学意义（χ^2=2.29,P〉0.05）;治疗7-14天、15-21天、22-28天和28天以上有效率分别为51.50%（33/64）、48.72%（19/39）、57.14%（12/21）、36.36%（4/11）,各阶段比较差异无统计学意义（χ^2=1.33,P〉0.05）。结论极重度突发性聋的治疗有效率较低,伴有眩晕和病程超过14天是影响疗效的不利因素。     

突发性聋预后影响因素

目的对影响突发性聋的预后因素进行分析讨论。方法回顾分析249例突发性聋患者临床资料,包括年龄、初诊时间,初诊时听力损失程度,听力曲线类型,是否伴有眩晕和耳鸣,进行畸变产物耳声发射(distortion product otoacoustic emissions,DPOAE)检查结果。结果初诊时间为发病后1～23天,患侧耳初诊时250 Hz～4000 Hz平均听力损失40dB以下31例(12.45%),41 dB～70 dB 80例(32.13%);71 dB～90 dB 74例(29.72%),91 dB以上64例(25.70%)。听力曲线上升型72例,下降型81例,平坦型96例。伴有眩晕96例,伴耳鸣174例。治疗药物包括血管扩张剂、皮质类固醇激素、神经营养剂、抗病毒及能量合剂,疗程2～4周。81例进行畸变耳声发射检查,45例在不同频率被引出,经治疗最终被引出DPOAE的频率听力恢复达痊愈水平。结论高龄患者和年龄小的患者预后不良;初诊时间越早听力恢复越好;听力曲线上升型预后好;伴有眩晕者预后不好;能引出DPOAE者听力恢复好。     

影响突发性聋预后因素的临床研究

目的 研究影响突发性聋预后的相关因素,提高突发性聋预后的判断.方法 回顾性分析2006年1月至2007年3月复旦大学附属眼耳鼻喉科医院收治的突发性聋患者,首先去除初始听阈≤40 dB的低频聋患者,得到882例进行疗效分析.初始听阈＞40 dB的患者按不同的初始听阈形态与严重程度分为下坡型组(69例)、上坡型组(24例)、平坦型组(139例)、凹陷型组(44例)、极重度聋(126例)和全聋(86例)6组.结果 病程3 d内疗效最佳,其次是1、2周内,超过2周疗效差,3周内和1个月内、1个月后差异无统计学意义.病程2周内患者初始听阈＞40 dB组中凹陷型组与其他组相比预后最佳,恢复率达97.7%.极重度聋组和其他组(除全聋组)相比,治愈率(23.8%)及恢复率(57.9%)低,但好于全聋组.全聋组的预后最差,无效率达67.4%.合并有糖尿病、高血压患者的预后与其他不伴此病的患者相比差异具有统计学意义(H=4.455,P=0.0348).年龄与预后有关,年龄越大,预后也越差,以50岁为界,＜50岁的患者的预后要好于≥50岁的患者,差异有统计学意义(H=7.739,P=0.0054).结论 病程大于2周的患者疗效差,不同的初始听阈形态与听力损失程度是影响突发性聋预后的重要因素.年龄越大预后越差.合并有高血压、糖尿病的患者,其预后比无任何合并症的患者差.     

突发性聋预后因素分析

目的 探讨突发性聋的预后因素.方法 对456例(484耳)突发性聋患者采用糖皮质激素,神经营养药和改善内耳微循环药物为主的综合治疗,并进行回顾性分析.结果 突发性聋的疗效与发病年龄、发病到诊治的时间、是否合并眩晕、听力损失的程度、是否伴有高血压或糖尿病、是否双耳发病有显著的相关性.结论 年龄介于20～60岁、发病后7天内诊治,不伴眩晕者、听力损失程度较轻、不伴高血压或糖尿病、单耳发病的突聋患者,其疗效较好;反之,疗效较差.     

Different prognoses in patients with profound sudden sensorineural hearing loss

Background: Inner ear hemorrhage is increasingly recognized as a cochlear lesion that can cause profound sudden sensorineural hearing loss (SSNHL).

Objectives: To investigate changes of cochlear and vestibular function and to compare therapeutic recovery from profound SSNHL induced by different etiologies.

Material and methods: Eighty patients with profound SSNHL (≥90?dB) were divided into an inner ear hemorrhage group and a non-inner ear hemorrhage group by MRI. Statistical analysis was performed to compare the therapeutic effects from vertigo and hearing loss and the outcomes of follow-up in the two groups.

Results: There were significant differences between the two groups in terms of the overall 14-day therapeutic response rate (20 vs. 48%), the incidence of imbalance (26.7 vs. 6%), the incidence of semicircular canal dysfunction on the affected side (60 vs. 20%), the incidence of abnormal C-VEMP and O-VEMP on the affected side (63.3 vs. 38%; and 60 vs. 30%, respectively), the average hearing threshold (74.2?±?10.7 vs. 53.6?±?11.4?dB), and the word recognition score (65.5?±?21.7 vs. 83.5?±?24.5%) at a 12-month follow-up.

Conclusions and significance: A higher percentage of patients with profound SSNHL induced by inner ear hemorrhage were associated with vertigo and had a poor prognosis.     

Comparison of hearing recovery criteria in sudden sensorineural hearing loss

The countless methods available to analyze hearing recovery in idiopathic sudden sensorineural hearing loss (ISSHL) cases hinder the comparison of the various treatments found in the literature.ObjectiveThis paper aims to compare the different criteria for hearing recovery in ISSHL found in the literature.Materials and MethodsThis is an observational clinical cohort study from a prospective protocol in patients with ISSHL, treated between 2000 and 2010. Five criteria were considered for significant hearing recovery and four for complete recovery by pure tone audiometry, using non-parametric tests and multiple comparisons at a significance level of 5%. After determining the stricter criteria for hearing recovery, vocal audiometry parameters were added.ResultsThere was a significant difference between the criteria (p < 0.001) as they were analyzed together. Mild auditory recovery occurred in only 35 (27.6%) patients. When speech audiometry was added, only 34 patients (26.8%) showed significant improvement.ConclusionsThere is a lack of consistency among the criteria used for hearing recovery. The criterion of change of functional category by one degree into at least mild hearing recovery was the stricter. Speech audiometry did not prove essential to define significant hearing recovery.     

纤维蛋白原水平与突发性聋发病的关联性研究

目的:研究纤维蛋白原水平与突发性聋(SSHL)发病之间的关系.方法:选择50例(55耳)诊断明确、发病在7 d以内的SSHL患者(SSHL组)为研究对象,另选择50例在性别和年龄上与SSHL组患者匹配并相同的听力正常人作为对照组,分别对其血液流变学、血生化、血常规和凝血功能进行检测.结果:SSHL组纤维蛋白原水平、全血低切还原黏度、全血高切还原黏度、血浆黏度明显高于对照组,差异均有统计学意义(均P＜0.05);血浆凝血酶原时间、活化部分凝血活酶时间明显短于对照组,差异也均有统计学意义(均P＜0.05);而血生化、全血细胞计数、血小板黏附率两组比较差异无统计学意义(P＞0.05).结论:血浆纤维蛋白原水平升高可能是SSHL血管性病因中的主要因素,其发病原因可能是血浆纤维蛋白原水平提高导致血液流变学改变,血黏度增加,形成血液高凝状态或血栓形成状态,导致内耳血管微血栓,损伤耳蜗微循环.     

影响突发性聋疗效的相关因素研究

目的探讨突发性聋预后的相关因素,指导其预后判断。方法回顾性分析2007年10月-2012年7月710例（748耳）突发性聋患者,应用有序Logistic回归分析,筛选与突发性聋预后相关的因素,对于有统计学意义的因素用非参数检验再次验证,以指导预后分析。结果年龄、病程、伴眩晕症状、治疗前耳聋程度、伴糖尿病与疗效有相关性;性别、耳聋侧别、伴高血压与疗效无相关性,病程长短与疗效有统计学意义（P〉0．05）;不伴眩晕的患者治疗有效率要明显高于伴眩晕的患者（P〈0．05）;糖尿病患者与非糖尿病患者的有效率比较有统计学意义（P〈0．05）;初诊听阈程度与疗效差异有统计学意义（P〈0．05）。结论影响突发性聋预后的因素有年龄、病程、伴发症状、伴糖尿病、治疗前耳聋稃彦．     

突发性聋预后因素分析

目的:探讨突发性聋预后的相关因素,指导其预后判断.方法:回顾性分析256例(280耳)突发性聋患者应用有序Logistic回归分析,筛选与突发性聋预后相关的因素,同一影响因素采用χ2检验,进一步量化指标,以指导预后分析.结果:年龄、病程、伴发症状、治疗前耳聋程度、听力曲线类型均与疗效有相关性;性别、耳聋侧别与疗效无相关...