突聋患者的心理因素

突聋患者的心理因素卢洁贞１赖荷１突发性聋是指听力急剧明显下降，不明原因的感音神经性聋，是耳鼻咽喉科的常见病之一。尽管不少学者对其病因进行着一系列的探讨，但仍不够明确。本文就我科从１９９４年１月～１９９６年５月间诊断的２１例２２耳突发性聋患者的心理及社...     

突聋与微循环障碍的关系

目的：探讨血管病变引起的微循环障碍与突发性聋的关系。方法：对３８例未经治疗突聋患者检测其血液凝固、血液脂质、血浆纤维蛋白原和血小板聚集功能。结果：突聋患者血液凝固和血浆纤维蛋白原含量正常,但呈相对高凝状态;高密度脂蛋白ＨＤＬ３－ｃｈ升高,血小板最大聚集率增高,与对照组比较,有统计学差异（Ｐ＜０．０５）。结论：血小板聚集功能改变、血脂代谢异常和相对高凝状态等引起的微循环障碍,可能在突聋的发病机理中起重要作用。     

以耳闷为首发症状的突发性聋15例诊治分析

目的：探讨以耳闷为首发症状的突发性聋患者的临床表现和诊断要点。方法：回顾性分析15例以单侧耳闷为主诉的突发性聋患者的临床表现和听功能检查情况。结果：以耳闷为首发症状的突发性聋患者可伴耳鸣，多无眩晕、恶心、呕吐；听力图为低音型，中高频基本正常，听力损失程度多为轻度；治疗效果好，易恢复。结论：对以单侧耳闷为主诉者，应考虑突发性聋的可能，早期进行听力检查，及时采取有效的治疗方法，提高治愈率。     

伴或不伴眩晕的突聋疗效的分析

突发性聋 (突聋 )是否伴眩晕 ,对其预后的影响文献中报道不一。本文报告 1986年 7月～ 1997年 7月我科收治的发病 2周内的突聋患者 92例 ,分析伴或不伴眩晕的两类突聋患者经高压氧加常规药物综合治疗的疗效。1　资料与方法1 1　临床资料　 92例突聋患者中男性 6 4例 ,女性 2 8例。男性中伴眩晕 2 1例 ,女性中伴眩晕 12例。发病 1周内入院5 8例 ,伴眩晕 2 5例 ,无眩晕 33例。发病第 2周人院 34例 ,伴眩晕 8例 ,无眩晕 2 6例。 92例患者均符合 1996年上海会议制定的突发性聋的诊断标准。92例均经颅神经检查及头颅内听道影像检查无异常 ,纯音听…     

突聋患者听觉恢复的评估

报告同时采用听力改善、相对听力改善及听力恢复率三个指标，对６２例突聋患者听力恢复情况进行评估。结果表明，治疗起始时听力对估计患者预后有重要意义；治疗第１周为获得最侍效果或听力自然恢复的关键时间；听力恢复率箐可能是评估突聋听觉恢复及预后的最适当指标。     

迷路内出血相关突聋伴眩晕患者临床特点及治疗效果分析

目的探讨迷路内出血相关突聋伴眩晕患者的临床特点及治疗效果。方法回顾我科2016年9月至2018年4月总计110份诊断为单耳突发性耳聋伴眩晕患者的病例资料,17例经头部磁共振检查提示内耳出血,将其中病例资料完整的13例患者与55例病例资料完整、磁共振检查正常的突发性耳聋伴眩晕患者进行比较,观察其治疗结果的差异有无统计学意义。结果迷路内出血在MRI T2 FLAIR及T1WI序列中均表现为高信号,部位多位于半规管(13例),其次是前庭(7例)和耳蜗(5例)。阳性组治疗总有效率46.2%,阴性组为52.7%,两组间差异无统计学意义(χ2=0.182,n=1,P=0.670);两组间受损频率提升绝对值的差异无统计学意义(t=-0.348,P=0.729)。结论迷路内出血相关突聋伴眩晕患者多为全频受累的中度至极重度听力损失,可由头部MRI T1WI及T2 FLAIR序列检出,提示预后不良。     

有眩晕及无眩晕突聋的纯音听力表现

本文分析病程２周内的特发性突聋１０９例的有眩晕及无眩晕两组病人的听力损失类型及预后。发现；女性合并眩晕多于男性，有眩晕病人平均年龄高于无眩晕病人。１０９例中深度耳聋型占４１例，平坦听力损失型３１例，高频听力损失型２５例，低频听力损失型９例，中应听力损失碟型３例。１０９例中突聋有眩晕者占４５％。     

降纤酶及高压氧治疗突聋的疗效

突发性耳聋简称突聋,指突然发生的原因不明的感音神经性聋,表现为急性耳蜗性聋的一组原因不明的症状,一般在48h内达到耳聋最高峰。突聋发病原因不明,一般认为与病毒感染、内耳血流障碍、圆窗膜破裂等有关。     

纯音听阈正常的耳闷患者诱发性耳声发射分析

目的:对纯音听阈正常的耳闷患者进行诱发性耳声发射分析,以早期发现这些患者的耳蜗损害.方法:采用丹麦Madsen公司Capella耳声发射仪对纯音听阈正常的耳闷患者43例(72耳,耳闷组)及正常人30例(60耳,对照组)分别进行TEOAE及DPOAE检测,记录和分析各频率DPOAE的检出率、幅值,TEOAE的通过率、反应波信噪比、波形重复性及各频带反应波信噪比和重复性.结果:①DPOAE检出率仅在0.50、0.75 kHz两频点上耳闷组明显低于对照组(P＜0.05),其余各频率点差异均无统计学意义(P＞0.05);②TEOAE通过率对照组为100%,耳闷组为90.28%,2组比较差异有统计学意义(X2=6.16,P＜0.05);③与对照组相比,纯音听阈正常的耳闷患者各频率DPOAE的幅值、TEOAE的反应波信噪比、波形重复性及各频带反应波信噪比和重复性均降低,差异有统计学意义(P＜0.05或P＜0.01).结论:部分纯音听阈正常的耳闷患者已存在耳蜗外毛细胞的损害,利用诱发性耳声发射的方法可在其听力损失出现之前早期发现此类病变.     

突聋治疗无效与痊愈的临床对比分析

1989年以来我院收治的172例突发性费病人，其中经各种治疗疗效不住，平均听间改善≤15dB的计24例。本文将其资料与同期住院的已痊愈的30例就各种因素进行对比分析．以期探讨影响本清转归的有关因素。资料与方法1989年以来我院住院，诊断明确、资料完整的突发性聋172例中，选择经治疗后平均听阈改善≤15dB的24例作为无效组；另选择经治疗后听力恢复至20dB以内或病前相同水平的30例作为痊愈组对照。两组男女比例接近，均为单耳发病，全部患者入院后均详细询问病史，体位及血液生化指标检查，抬疗前后用PertersAP41型时力计记录对比，部分患…     

Otoacoustic emissions, ear fullness and tinnitus in the recovery course of sudden deafness

OBJECTIVE: This study aimed to investigate how the symptoms of ear fullness, tinnitus and otoacoustic emissions (OAE) change in relation to the recovery course of pure tone audiometry thresholds (PTA) in sudden deafness (SD). METHODS: This study analyzed follow-up data on ear fullness, tinnitus and otoacoustic emissions of eight SD patients with good hearing improvement (Group A) and eight SD patients with poor hearing improvement (Group B) in an attempt to elucidate the behavior of these symptoms in their recovery course. This study was done until there was no change in the PTA for more than 1 week and hearing recovery was no longer expected. RESULTS: All patients from both groups had ear fullness and tinnitus in association with the onset of SD. However, these symptoms improved only in Group A. showing a significant relationship between PTA recovery and the improvement of ear fullness annoyance (P<0.05), presence of tinnitus (P<0.01), improvement in tinnitus loudness (P<0.01) and in tinnitus annoyance (P<0.01). No patients (Group A or B) had OAE responses at their first examination. In Group A, OAE responses appeared simultaneously with improvement of hearing levels in five patients (63%) and it appeared later than hearing levels improvement in the other three patients (37%) from Group A. No patient from Group B showed OAE response on follow-up. CONCLUSION: SD patients with good hearing improvement (Group A) tended to have OAE responses and the sensations of the ear fullness and tinnitus improved almost simultaneously with hearing level improvement. Their PTA improvement occurred primarily in the low to mid frequencies, with high frequencies showing less recovery. When hearing recovery was not full, OAEs did not reappear for these frequencies. Patients with poor hearing improvement tended to have absent OAEs and persistent ear fullness and tinnitus.     

突发性聋患者血白细胞水平与疗效的关系探讨

突发性聋是指突然发生的原因不明的感音神经性听力损失。病人的听力一般在数分钟或数小时内（少数病人可在三天以内）下降至最低点；可伴有耳鸣及眩晕；除第Ⅷ颅神经外，无其他颅神经症状。该病是耳科临床中的一种常见病．近年来有增加趋势。本文通过检测突发性聋患者外周血中自细胞（WhiteBloodCells．WBC）水平和中性粒细胞（Neutrophile，NEUT）百分数，探讨外周血白细胞水平与疗效的关系。     

突发性聋患者血液易栓症结果分析

目的通过分析突发性聋(sudden deafness,SD)患者血液中各项易栓症(thrombophlilia)的发生率,进一步明确突聋的发病原因及指导临床诊疗。方法选择我科2009年11月～2010年7月期间诊断明确的突聋患者43例(43耳)为突聋组,另选30例健康体检者为对照组,对所有受试者的遗传性易栓症指标包括抗凝血酶Ⅲ(AT-Ⅲ)活性、蛋白C(PC)活性、蛋白S(PS)活性、血清同型半胱氨酸(Hcy)及获得性易栓症指标D-二聚体(D-D)的阳性率进行分析。结果 43例突聋患者遗传性易栓症的总发生率为46.5%,其中Hcy的阳性率为44.1%,PS阳性率为23.3%;获得性易栓症D-D的阳性率为67.4%,与对照组比较,差异有统计学意义(P<0.05),AT-Ⅲ、PC两组比较差异无统计学意义(P>0.05)。结论突聋患者易栓症发病率高,尤其是获得性易栓症,其血液高凝状态可能是由遗传性和获得性易栓症共同作用的结果。     

突发性聋住院患者焦虑抑郁状况分析

目的对突发性聋患者焦虑抑郁状况及影响因素进行分析。方法收集突聋患者93例,采用焦虑(SAS)和抑郁(SDS)自评量表对突聋患者进行评价,并应用THI耳鸣残疾评估量表和耳鸣评估量表进行耳鸣评估,分析突聋患者患病后焦虑抑郁状态和造成这种心理状态的原因及对疗效的影响。结果 1.焦虑抑郁和性别、年龄、城乡差异、发病天数、听力损失程度无关,P>0.05,无统计学意义。2.突聋组SAS评分(47.07±9.64),正常组评分(37.70±9.21)相比较,P=0.00<0.05,差异有统计学意义,和中耳炎组评分(40.70±9.18)比较,P=0.00<0.05,差异有统计学意义;突聋组SDS评分(51.92±11.22),正常组评分(41.82±8.26)相比较,P=0.00<0.05差异有统计学意义,和中耳炎组评分(42.14±8.02)比较,P=0.00<0.05,差异有统计学意义。耳鸣和焦虑抑郁之间存在相关性,P=0.00<0.05差异有统计学意义。3.焦虑抑郁和眩晕、耳闷无关,P>0.05,无统计学意义。4.突聋患者中有焦虑抑郁组耳鸣量表和THI各维度评分均高于无焦虑抑郁组P<0.05,差异有统计学意义。5.治疗后的总有效率有焦虑组为16.1%,无焦虑组为31.2%,P>0.05,无统计学差异;总有效率有抑郁组为15.0%,无抑郁组为32.3%,P<0.05,有统计学差异。结论突聋患者心理健康状况较差,主要原因是耳鸣,并且抑郁的心理状态会影响疗效,需要对患者进行及时心理疏导。     

类固醇激素鼓室内注射治疗突发性聋

目的：对类固醇等药物综合治疗突发性聋的疗效进行临床观察。方法：对照组采用银杏达莫、辅酶A、 肌苷、维生素B常规药物治疗,治疗组在对照组药物治疗基础上加用地塞米松鼓室内注射。结果：治疗组的治疗有效率(77.78%)高于对照组(46.66%)。结论：地塞米松鼓室内注射治疗突发耳聋临床上有很好的疗效。     

Labyrinthine lesions in presumed inner ear hemorrhage-related sudden deafness

PurposeInner ear hemorrhage (IEH) is a rare cause of sudden sensorineural hearing loss (SSNHL). This study aimed to evaluate the lesional patterns in patients with presumed IEH from morphological and functional aspects.MethodsSeventeen patients with SSNHL and presumed IEH who completed audio-vestibular tests were included. The main outcome measures included clinical characteristics, radiology, and functional test results.ResultsThe morphological findings and functional tests revealed differences in locations and lesional spectrums. The magnetic resonance imaging (MRI) hyperintensity was likely to involve the vestibule (88.2%), the cochlea (76.5%), and the posterior and lateral semicircular canals (76.5% and 70.6%, respectively). Furthermore, 70.6% of cases showed abnormality in the entire labyrinth, and abnormalities in the vestibule/semicircular canals were observed in 17.6% of cases. Meanwhile, dysfunction was sequentially detected in the cochlea (100%), semicircular canals (94.1%), and vestibule (70.6%); 64.7% of cases showed combined deficit in the entire labyrinth, and 29.4% of cases showed combined deficit in the cochlea/semicircular canals. Although lesions in the labyrinth were frequently detected, the results of the radiological and functional tests did not always match and significantly differed in either cochlear or superior semicircular canal damage detection (p < 0.05 each).ConclusionsIn this cohort, IEH preferentially caused sudden audio-vestibular impairment, which was well demonstrated by a combination of MRI and functional tests. The specific lesional configurations revealed in this study may suggest a possible pathomechanism that could be further explored as a therapeutic target.     

Prognosis of inner ear periphery and central vestibular plasticity in sudden deafness with vertigo

OBJECTIVES: We sought to elucidate the clinical problems and otopathology of patients with sudden deafness with vertigo (SDV). METHODS: In 24 patients with SDV who had significant canal paresis (CP) at their first visit to our hospital between 1997 and 2001, we examined pure tone audiograms, caloric tests, and several questionnaires twice, at the first visit within 5 days after the onset and around 2 years after steroid therapy. RESULTS: These examinations revealed that improvements of auditory and vestibular function in patients with SDV tended to be correlated with one another. Sixteen of the 24 patients (66.7%) still had CP. This rate in SDV was significantly worse than that reported previously for vestibular neuritis (VN). On the other hand, patients with SDV with long-lasting CP had a faster reduction of head-shaking afternystagmus and of handicaps in their everyday life due to dizziness than did patients with VN and CP. CONCLUSIONS: These findings suggest that SDV may deteriorate the inner ear function more severely but accelerate the central vestibular compensation more effectively than VN after the lesion. It is well known that vestibular neurectomy causes much more severe motion-induced dizziness after surgery than does labyrinthectomy. Taken together, these findings suggest different regions of damage in SDV (mainly the labyrinth, as in labyrinthectomy) and VN (mainly the ganglion, as in vestibular neurectomy).     

突发性聋患者的状态-特质焦虑与行为状况的相关性分析

目的　探讨突发性聋患者的状态-特质焦虑与行为状况的相关性。方法　2015年4月～2016年6月选择在我院耳鼻咽喉科住院治疗的突发性聋患者140例为观察组,同期选择在我院进行体检的健康志愿者140例为对照组,两组都进行一般资料、状态-特质焦虑、生活质量和行为状况调查,同时进行相关性分析。结果　观察组状态-特质焦虑评分（51.20±4.19）分,对照组（34.40±3.49）分,两组比较差异有统计学意义,观察组明显高于对照组（t =12.949,P＜0.05）。观察组的躯体化、强迫、人际关系敏感、敌对、抑郁评分显著高于对照组（P＜0.05）。观察组解决问题与求助评分明显低于对照组,而幻想与自责评分明显高于对照组,两组比较差异均有统计学意义（P＜0.05）。Person相关分析显示观察组状态-特质焦虑评分与生活质量各维度、幻想、自责评分呈明显正相关性（P <0.05）,而与解决问题、求助评分呈明显负相关性（P＜0.05）。结论　突发性聋患者多伴有状态-特质焦虑状况与幻想、自责等不良行为,严重影响患者生活质量,且能形成恶性循环,在临床上要加强针对性护理干预。     

心理因素对突发性聋发病的影响

突发性聋，即突然发生的原因不明的感音神经性聋。询问病史可发现多数患者发病与身心过度疲劳、焦虑抑郁等情绪波动有关。通过对就诊于我科的46例突发性聋患者的研究，从发病前负性生活事件调查、发病后心理量表评分和血浆5-羟色胺浓度测定的关系着手，来揭示突发性聋的发病与心理因素的相关性。