急性低频感音神经性听力损失的听力学检查特征及意义

目的明确各项听力学检查在急性低频感音神经性听力损失诊断及研究中的意义,以指导该病的诊断和治疗。方法对2008年7月至2010年5月在本科就诊的急性低频感音神经性听力损失患者的临床听力学检查进行了回顾性分析。结果在所有15例患者中有9人(60.0%)有明显诱发因素。在随访期间,有8例(53.3%)出现复发。男女两性无诱发因素和复发率差异。8例患者进行了耳蜗电图的检查,有5例(62.5%)-SP/AP(总合电位/动作电位)检查异常。结论纯音测听、耳蜗电图、DPOAE(畸变产物耳声发射)、ABR(听性脑干电位)在急性低频感音神经性听力损失诊断及研究中意义较大。其发病很可能与生活压力事件相关,病因可能是膜迷路积水、自身免疫性机制和自主神经功能紊乱等因素的综合作用。     

急性低频感音神经性聋的临床分析

目的:评估急性低频感音神经性聋的临床疗效以及相关因素对预后的影响.方法:从398例突发性聋患者中筛选出41例急性低频听力下降者,分析经糖皮质激素等综合治疗后的效果,探讨患者的性别、病程和发病年龄与疗效的相关性.结果:急性低频感音神经性聋占突发性聋的10.30%,其中女性患者占70.73%,明显高于男性.初诊时3个低频和...     

Epidemiological survey of acute low-tone sensorineural hearing loss

Abstract

Objectives: A nationwide epidemiological survey involving 23 hospitals in Japan was conducted and the predictive values of demographic data were examined statistically.

Methods: A total of 642 patients from 23 hospitals, including 20 university hospitals, in Japan were enrolled in the study. Age ranged from 8 to 87 years, and all were diagnosed with acute low-tone sensorineural hearing loss (ALHL) between 1994 and 2016. Demographic data for the patients, such as symptoms, gender, mean age, and distribution of ALHL grading, were collected and analyzed in relation to prognosis using Student’s t-test, χ² test and logistic regression.

Results: Female gender (p?<?.013), younger age (p?<?.001), low-grade hearing loss (p?<?.001), and shorter interval between onset and initial visit (p?<?.004) were significantly predictive of a good prognosis. The prognosis for definite ALHL was significantly better than that for probable ALHL (p?<?.007).

Conclusions: The severity of initial hearing loss, interval between onset and initial visit and age were important prognostic indicators for ALHL, while female gender was an important prognostic indicator peculiar to ALHL.     

Idiopathic sudden sensorineural hearing loss and acute low-tone sensorineural hearing loss: a comparison of the results of a nationwide epidemiological survey in Japan

Abstract

Objectives: The aim of this study was to investigate the differences between idiopathic sudden sensorineural hearing loss (SSNHL), and acute low-tone sensorineural hearing loss (ALHL) using the results of a nationwide survey database in Japan and to analyze the variables associated with their clinical features and the severity of hearing impairment, treatment, and prognosis.

Methods: Participants were patients registered between April 2014 and March 2016 in a multicenter epidemiological survey database involving 30 university hospitals and medical centers across Japan. Statistical analysis was performed to clarify the factors associated with their clinical characteristics and the severity of hearing impairment, treatment, and prognosis.

Results: Idiopathic SSNHL and ALHL differed significantly in terms of male-to-female ratio, age distribution, and time from onset to start of treatment. The treatment methods and hearing prognosis also differed markedly between the two diseases. A majority (92%) of idiopathic SSNHL patients were administered some type of corticosteroid, while half of the ALHL patients received corticosteroids and a diuretic agent.

Conclusion: The results suggested that idiopathic SSNHL and ALHL belonged to different categories of inner ear disease.     

急性低频感音神经性聋的短期临床疗效分析

目的探讨小剂量、短疗程皮质类固醇激素对急性低频感音神经性聋的疗效。方法选取28例(30耳)急性低频感音神经性聋患者作为研究对象,随机分为强的松治疗组16例(耳)与对照组12例(14耳),两组患者在口服等剂量强的松基础上,对照组加用血管扩张剂和神经营养剂治疗,1周后观察疗效。结果两组患者总有效率(完全恢复和部分恢复)为83.3%(25/30),总治愈率(完全恢复)46.7%(14/30);激素治疗组的有效率87.5%(14/16),治愈率50.0%(8/16),对照组有效率78.6%(11/14),治愈率42.9%(6/14),两组间的疗效比较,差异无统计学意义(P>0.05)。结论急性低频感音神经性聋的治疗有别于突发性耳聋,治疗上无需使用血管扩张剂及神经营养剂等,初始小剂量皮质类固醇激素治疗本病有效。     

Magnetic resonance imaging of the endolymphatic space in patients with acute low-tone sensorineural hearing loss

ObjectiveThe aim of this study was to measure the volume of the endolymphatic space (ELS) and to investigate prognosis in patients with acute low-tone sensorineural hearing loss (ALHL).MethodsA total of 61 ALHL patients participated; 47 were definite while 14 were probable ALHL cases. The definite ALHL patients were classified into three groups: A, “Cure”; B, “No cure”; and C, “Recurrence.” Also, nine patients for whom diagnosis changed from ALHL to cochlear Meniere’s disease (cMD) without vertigo (ALHL-cMD group). Images of the inner ear fluid space, positive perilymph, and positive endolymph were acquired using a 3T magnetic resonance scanner. Three-dimensional (3D) images were semi-automatically reconstructed using anatomical and tissue information to fuse the 3D images of the inner ear fluid space with the 3D ELS images.ResultsPatients in the no cure group showed a significantly higher ELS/total fluid space (TFS) volume ratio in the affected cochlear region than the patients of the other groups. Additionally, the affected vestibular ELS/TFS volume ratio in the cure group was significantly lower than that in the recurrence group. There were significantly higher cochlear and vestibular ELS/TFS ratios in ALHL-cMD patients than in control subjects.ConclusionsThese results indicate that the cochlear ELS/TFS volume ratio should be considered when investigating the extent of recovery, while the extended ELS in the vestibule should be considered when investigating cases of recurrence. Thus, our study suggests that the severe extended ELS appeared likely to change to cMD and that the prognostic determination of ALHL is possible.     

An electrocochleographic study of acute low-tone sensorineural hearing loss

Summary Twenty-four patients with acute low-tone sensorineural hearing loss (ALHL) were examined using electrocochleography. The negative summating potential (SP) amplitude and the summating potential/action potential (AP) ratio were significantly greater in the ALHL patients than in normals. The SP/AP ratio was smaller in the ALHL patients than in patients with known Meniere's disease and moderate hearing loss, although the SP amplitude was somewhat greater in the former. An abnormal increase in the SP amplitude following click stimuli was found in 54% of the ALHL patients, while the SP/AP ratio was increased abnormally in 63% of these patients. These findings suggest that the pathophysiology of ALHL may be similar to that for endolymphatic hydrops.     

Vestibular evoked myogenic potentials in acute low-tone sensorineural hearing loss

OBJECTIVE/HYPOTHESIS: It was the authors' premise that the vestibular evoked myogenic potential (VEMP) test may be used to differentiate acute low-tone hearing loss (ALHL) from Meniere's disease with low-tone HL. STUDY DESIGN: Prospective study. METHODS: From January 2000 to December 2002, consecutive 12 patients with ALHL and another 12 patients with definite Meniere's disease with low-tone HL were enrolled in this study. All patients underwent audiometry and VEMP test, before and after treatment with isosorbide for 3 consecutive months. RESULTS: Before treatment, 12 patients with ALHL revealed normal VEMPs (11, 92%) and augmented VEMPs (1). After treatment, 11 (92%) patients had resolved to normal hearing within 3 days. One year later, two (17%) patients progressed to Meniere's disease. In comparison with Meniere's disease, 6 (50%) of 12 patients showed normal VEMPs before treatment, and 7 (58%) patients had their hearing improved 3 months after treatment. Comparison of VEMP responses or hearing outcome between both groups exhibited significant differences. CONCLUSION: Most patients with ALHL reveal normal VEMPs throughout the episode, indicating that the saccule is spared. In contrast, 50% of Meniere's disease patients with low-tone HL demonstrate abnormal VEMPs, showing a significant difference. Therefore, the VEMP test can be used to differentiate ALHL from Meniere's disease with low-tone HL.     

Magnetic resonance imaging of endolymphatic space in patients with sensorineural hearing loss: comparison between fluctuating and idiopathic sudden sensorineural hearing loss

Abstract

Background: Recently, 3-Tesla magnetic resonance imaging (MRI) after an intravenous gadolinium injection has been used to describe the endolymphatic space (ELS).

Objectives: This study described the histopathological differences between idiopathic sudden sensorineural hearing loss (ISSNHL) and fluctuating sensorineural hearing loss (FSNHL) by examining the ELS. Additionally, the relationship between the affected cochlear and vestibular ELS/total fluid space (TFS) volume ratio and the duration from the onset to MRI in patients with FSNHL were evaluated.

Material and methods: This study included 205 individuals without vertigo: 47 controls, 94 with ISSNHL, and 64 with FSNHL. The TFS and ELS volumes were measured and the ELS/TFS volume ratios (%) were evaluated.

Results: The cochlear and vestibular ELS/TFS volume ratios of the affected ear in patients with FSNHL were significantly higher than that in those with ISSNHL. There was no correlation between the duration from FSNHL onset to the MRI scan in the affected cochlea and vestibule.

Conclusion and significance: There were differences in the form of hearing fluctuation and the extended ELS volume between ISSNHL and FSNHL. ISSNHL cases with severe ELS extension were likely to change to FSNHL.     

Magnetic resonance-based volumetric measurement of the endolymphatic space in patients with Meniere’s disease and other endolymphatic hydrops-related diseases

ObjectiveTo employ magnetic resonance imaging (MRI) to measure the volume of the inner ear endolymphatic space (ELS) in patients with acute low-tone sensorineural hearing loss (ALHL), sudden deafness (SD), cochlear Meniere’s disease (cMD), and unilateral MD (uMD) compared with control subjects (CS) with chronic rhinosinusitis.MethodsForty-one patients with ALHL, 82 with SD, 48 with cMD, 72 with uMD, and 47 CS participated in the study. With the exception of all uMD patients, none of the subjects had vertigo. Images of the inner ear fluid space, positive perilymph signal, and positive endolymph signal were acquired using a 3-T MRI scanner. Three-dimensional images were reconstructed semi-automatically by using anatomical and tissue information to fuse the inner ear fluid space images and the ELS images.ResultsThe cochlear ELS/total fluid space (TFS) volume ratio was 10.2 ± 6.7% (mean ± standard deviation) in the CS group, 12.1 ± 5.7% in ALHL patients, 15.2 ± 8.7% in SD patients, 18.1 ± 8.2% in cMD patients, and 21.9 ± 16.4% in uMD patients. The vestibular ELS/TFS volume ratio was 17.7 ± 10.2% in the CS group, 18.9 ± 8.3% in ALHL patients, 19.9 ± 11.3% in SD patients, 22.5 ± 13.7% in cMD patients, and 35.7 ± 24.1% in uMD patients. The cochlear ELS/TFS volume ratio in patients with uMD was similar to that in the cMD group and significantly higher than that in the CS, ALHL, and SD groups (CS = ALHL < SD < cMD = uMD: p < 0.05 for CS vs. SD and p < 0.01 for CS vs. cMD). The vestibular ELS/TFS volume ratio in patients with uMD was significantly higher than that in the CS and all other patient groups (CS = ALHL = SD = cMD < uMD: p < 0.01 for uMD vs. all other groups).ConclusionThe cochlear ELS volume of patients with MD and other endolymphatic hydrops-related diseases differed from that of CS. Our results suggest that ALHL may not be caused by endolymphatic hydrops. We confirmed the presence of extended ELS in patients with SD.     

不同剂量糖皮质激素在急性低频下降型感音神经性聋治疗中的疗效差异

目的:探讨不同剂量糖皮质激素在治疗急性低频下降型感音神经性聋(ALHL)中的疗效差异。方法:选取54例(54耳)ALHL患者,随机分为无泼尼松组(10例)、低剂量泼尼松组(22例)和高剂量泼尼松组(22例),治疗10d,并随访6个月。结果:无泼尼松组、低剂量泼尼松组和高剂量泼尼松组痊愈率分别为30.0%、59.1%、90.9%,高、低剂量组比较差异有统计学意义(P<0.05);改善率分别为40.0%、86.4%、95.5%,低剂量、高剂量泼尼松组与无泼尼松组比较均差异有统计学意义(均P<0.05)。结论:用糖皮质激素治疗ALHL疗效显著,高剂量优于低剂量,提示该病与内淋巴水肿和患者自身免疫机制可能相关。     

急性低频下降型感音神经性听力损失的临床研究

目的：研究急性低频下降型感音神经性听力损失（ALHL）的病因、诊断和治疗方法。方法：选择55例ALHL患者为研究对象,经详细询问病史和耳专科检查后,行纯音测听,声导抗测听和听性脑干反应（ABR）,随机分为泼尼松组和对照组治疗,疗程结束后随访6个月。结果：两组患者多以青年为主,主要症状为耳闷,低音调耳鸣和听力减退,耳科检查无殊。所有患者（55例58耳）纯音听阈示轻到中度低频感音神经性聋,鼓室导抗图“A”型,49耳镫骨肌反射引出,其中40耳Metz试验阳性。受检的45耳中ABR均正常。治疗后泼尼松组效果优于对照组（P〈O．05）。结论：ALHL以突发的低音调耳鸣,听力减退和耳闷为主要表现,常单耳发病,听力学定位诊断提示为蜗性病变,仅累及低频区。本病对皮质类固醇激素有一定的治疗效果。     

Acute sensorineural hearing loss in hemodialysis patients

Abstract

Background: Approximately, 30–40% of patients experienced hearing loss under regular hemodialysis.

Objective: This study reviewed our experience on treating acute hearing loss in patients under regular hemodialysis over the past two decades.

Methods: Twenty-six patients having acute hearing loss under hemodialysis were divided into two groups based on their etiologies. Sixteen patients (16 ears) with sudden sensorineural hearing loss (SSHL) were assigned to Group A and 10 patients (13 ears) with endolymphatic hydrops (EH) were assigned to Group B.

Results: No significant difference was noted between Groups A and B, regardless of hemodialysis duration, clinical manifestation, underlying systemic diseases, blood examination, and vestibular test battery. In contrast, serum osmolality was significantly lower in Group B (292?±?11 mOsm/kg) than in Group A (310?±?11 mOsm/kg). Furthermore, Group B (40?±?14?dB) had better mean hearing level than Group A (87?±?21?dB) in the initial audiogram, and a higher hearing improvement rate (69%) than Group A (19%).

Conclusions and significance: Both SSHL and EH are major causes for precipitating acute hearing loss in hemodialysis patients. Compared to SSHL, the less deteriorated MHL and lower serum osmolality in EH provide two clues for differentiating acute hearing loss in hemodialysis patients.     

Feeling of ear fullness in acute sensorineural hearing loss

Conclusions. This study revealed two characteristic findings of the feeling of ear fullness (FEF) in acute sensorineural hearing loss (ASNHL). First, that the appearance of FEF was not associated with the auditory function on audiograms; and second, that the disappearance of FEF is clearly associated with the hearing prognosis. Objective. FEF appears frequently in patients with ASNHL. However, there are few reports on this symptom and its mechanism has yet to be clarified. So we tried to investigate the character of FEF in ASNHL. Patients and methods. In this study, observations were made during the period from the first medical examination to 2 months after obtaining a steady audiogram on 227 ears from unilateral ASNHL cases, and the relationship between FEF and the audiograms was analyzed. Results. The FEF prevalence at the first medical examination was about 80% for any audiogram shape or hearing threshold. Moreover, the better the hearing prognosis, the higher the improvement rate of FEF.     

Relationship between changes in hearing function and volumes of endolymphatic hydrops after endolymphatic sac drainage

Abstract

Background: Endolymphatic sac drainage (ELSD) may have a positive effect on endolymphatic hydrops (EH) and may help to preserve inner ear function. However, the relationship between changes in EH volumes and hearing function after ELSD has not been described.

Objectives: We aimed to reveal the factors related to changes in hearing and EH following ELSD.

Material and Methods: Twenty-one patients who received ELSD were enrolled. Pure tone audiometry and 3-T magnetic resonance imaging (MRI) 4?h after intravenous injection of gadolinium enhancement were performed just before surgery and 2 years later. To characterize the endolymphatic space (ELS), we measured the volume of the total fluid (TFS) and ELS and calculated the ratio of ELS to TFS (ELS ratio).

Results: The ELS ratio of the patients who showed hearing improvement was 18.5?±?11.4% before surgery and 23.9?±?14.3% after. For those with no change, it was 29.7?±?10.8% before and 29.4?±?9.5% after, and in patients with worsened hearing function it was 22.7?±?7.5% before and 27.2?±?13.4% after.

Conclusion: We found no correlation between the changes in hearing function and the volume of EH after ELSD.     

Acute sensorineural hearing loss immediately following a local anaesthetic dental procedure

Acute sensorineural hearing loss is an uncommon phenomenon. We describe the first case of a 42-year-old lady who presented with acute sensorineural hearing loss occurring immediately after a dental procedure. Possible mechanisms are discussed. She was treated with high dose oral steroids, low molecular weight dextran and vasodilators with benefit.     

Aspirin-induced hearing loss as a model of sensorineural hearing loss

Performance in forward-masking, temporal-integration, and gap-detection tasks was measured in five normal-hearing subjects before and during a five-day period of aspirin use. The drug regimen was 3.9 g per day, taken in four equal doses at 6-h intervals. In the subjects showing substantial temporary hearing loss induced by the aspirin. (1) forward masking declined at about a normal rate as the masker-to-signal interval was increased. (2) the temporal-integration functions were flatter than normal, and (3) detection of a temporal gap was worse than normal at low sound-pressure levels (SPLs) but was essentially normal at levels above about 60 dB SPL. These aspirin-induced changes in performance are similar to the differences observed between normal listeners and listeners with mild sensorineural hearing loss. Thus, temporary, aspirin-induced hearing loss offers promise as a model condition for sensorineural hearing loss. The advantages offered by this model include all those typically attributed to within-subjects experimental designs, as well as the ability to manipulate the amount of hearing loss. Its primary disadvantages are that the hearing loss is not asymmetrically distributed toward the high-frequency region, as it typically is with sensorineural deafness, and there are large individual differences in the amount of temporary hearing loss induced by fixed doses of aspirin.     

Differences between acoustic trauma and other types of acute noise-induced hearing loss in terms of treatment and hearing prognosis

Abstract

Objectives: To evaluate the differences between acoustic trauma (AT) and other types of acute noise-induced hearing loss (ANIHL), we performed a literature search and case reviews.

Methods: The literature search based on online databases was completed in September 2016. Articles on ANIHL and steroid treatment for human subjects were reviewed. The source sounds and treatment sequelae of our accumulated cases were also reviewed. Hearing loss caused by gun-shots and explosions was categorized into the AT group, while hearing loss caused by concerts and other noises was categorized into the ANIHL group.

Results: Systemic steroid treatment did not appear to be effective, at least in the AT group, based on both the literature and our case reviews. However, effective recovery after treatment including steroids was observed in the ANIHL group. The difference in hearing recovery between the AT and ANIHL groups was statistically significant (p?=?.030), although differences in age, days from the onset to treatment and pretreatment hearing levels were not significant.

Conclusions: Hearing recovery from AT is very poor, whereas, ANIHL is recoverable to some extent. Therefore, it is essential to differentiate between these two groups for accurate prediction of the hearing prognosis and evaluation of treatment effects.     

Sudden sensorineural hearing loss (SSHL) following a local anesthetic dental procedure

Acute sensorineural hearing loss is an uncommon phenomenon in dentistry. We describe the case of a 79-year-old male who presented with acute sensorineural hearing loss occurring 2 days after a tooth extraction procedure under local anesthesia. Possible mechanisms are discussed. He was treated with vasodilators (Ginaton and Alprostadil Injection) and Mecobalamin injection with benefit. High dose oral steroids (1 mg/kg) and low molecular weight dextran were used.