地塞米松麻黄素混合液滴鼻预防高压氧治疗突发性聋继发的中耳气压伤

目的探讨地塞米松麻黄素混合液滴鼻预防高压氧治疗突发性聋继发中耳气压伤的应用价值。方法回顾性分析2016年1月~2019年12月确诊为突发性聋并接受高压氧治疗的368例(392耳)患者的临床资料,其中190例(204耳)为观察组,高压氧治疗前给予地塞米松麻黄素混合液滴鼻联合山楂、陈皮咀嚼;178例(188耳)为对照组,治疗前不给予地塞米松麻黄素滴鼻,比较两组患者治疗效果、继发中耳气压伤情况。结果治疗后两组纯音听阈均较治疗前改善,差异有统计学意义(均为P<0.05),但观察组与对照组间总有效率(分别为91.18%和88.30%)差异无统计学意义(P>0.05)。两组共38例(42耳)发生中耳气压伤,观察组中耳气压伤发生率(6.8%,14/204)和损伤程度均低于对照组(14.8%,28/188),差异有统计学意义(P<0.05)。38例继发中耳气伤病例中,32例(84.21%,32/38)存在鼻腔鼻咽部或/和咽后壁不同程度病变(下鼻甲肥大、鼻息肉、鼻咽部淋巴组织增生等),28例(73.68%,28/38)(30耳)有中耳功能异常(鼓室导抗图As型8耳,Ad型6耳,B型6耳,C型10耳)。结论地塞米松麻黄素混合液滴鼻联合山楂陈皮咀嚼可有效降低突发性聋患者高压氧治疗继发中耳气压伤的发生率及损伤程度。     

高压氧耳部并发症人工气道的影响

高压氧治疗（HBOT）可并发鼓膜和中耳气压伤，人工气道（气管内插管或气管切开戴套管）可危及正常咽鼓管功能和中耳气压平衡。复习5年中HBOT267例，依有无人工气道分组，对中耳并发症发生率作比较研究。HBOT267例发生鼓膜和中耳并发症（耳痛、分泌性中耳炎、血鼓室和鼓膜破裂）共131例，占49％，有65例并发症展鼓膜切开后鼓室量管治疗。作人工气道者28例，治疗中已施行鼓室量管10例未发生中耳并发症；未置管18彻中，17例（94％）有并发症，需量管治疗者11例（61％）。气管内插管辅助呼吸14例中8例（57％）置管，而气管切开戴管自主呼吸…     

儿童鼻窦炎对咽鼓管与中耳传音功能的影响

目的：探讨儿童鼻窦炎对咽鼓管与中耳传音功能的影响及程度,观察治疗鼻窦炎后,中耳传音功能障碍的恢复情况。方法：对儿童鼻窦炎100例和正常儿童50例行耳科检查、咽鼓管咽口观察、声阻抗检查、纯音测听,对比结果;对鼻窦炎合并耳病变的68例患者（128耳）行有针对性的治疗。结果：鼻窦炎患者中鼓膜异常率为64%、咽鼓管咽口异常率为62%、咽鼓管功能异常率为63.5%、鼓室导抗图异常率为62.5%,听力减退47.5%,与正常儿童组相比,差异有统计学意义（P＜0.01）。急性鼻窦炎、亚急性鼻窦炎与慢性鼻窦炎中耳病变的发生率和程度相比,差异有统计学意义（P＜0.05）。治疗鼻窦炎后,中耳传音功能障碍有明显改善。结论：儿童鼻窦炎引起咽鼓管功能的改变,中耳病变发生率较正常儿童显著增高;随病程的延长,发病率增高且程度加重。     

不同体位麻黄碱滴鼻对高压氧治疗所致中耳气压伤的预防效果及患者耐受性

目的探讨不同体位麻黄碱滴鼻对高压氧治疗所致中耳气压伤的预防效果及患者耐受性的影响。方法选取我院2014年1月~2015年12月收治的首次行高压氧治疗的260例患者作为研究对象,采取随机数字表将其分成两组,每组130例。两组患者均于治疗第1~3d进舱前采用麻黄碱滴鼻,观察组滴鼻时采取的体位是平卧位头部后仰侧转45°,对照组则采取平卧位头部后仰,比较两组患者用药3d后中耳气压伤发生情况以及高压氧治疗过程中患者的耐受性。结果观察组中耳气压伤发生率为5.38%,相对于对照组的15.38%有明显下降(P0.01);观察组鼓膜损伤程度明显轻于对照组(P0.01);观察组高压氧治疗耐受率为93.85%,相对于对照组的86.15%有明显上升(P0.05)。结论平卧位头部后仰并侧转45°给予1%盐酸麻黄碱滴鼻液滴鼻可有效预防中耳气压伤的产生,提高患者对高压氧治疗的耐受性。     

高压氧治疗并发中耳气压伤22例

中耳气压伤是高压氧治疗中常见并发症，1998年3月～2001年2月，在我院作高压氧治疗者824例，治疗中经我科会诊有38例患者并发中耳气压伤，占4．61％，其中22例资料完整，报告如下。     

经面罩不同途径加压鼻咽部预防耳气压性损伤

气压损伤性中耳炎（barotitis media，BM）是航空医学、潜水医学和高压氧治疗中的常见病之一，迄今还没有有效的预防耳气压伤的方法。只要咽鼓管（ET）咽口的压力大于ET通气阻力（ventilative resistance of the eustachian tube，VRET），ET将被动开放。笔者在高压舱增压的过程中，对舱内的被试者在中耳产生负压时提供大于VRET的面罩压力，经面罩分3种途径分别对包括ET咽口在内的鼻腔加压，鼻及鼻咽部加压，以及全呼吸道加压，观察是否可以平衡鼓室压，预防耳气压伤。     

鼻-耳窘迫综合征的中耳功能测试

鼻-耳窘迫综合征的定义是中隔畸形合并咽鼓管功能失常而无其他病变的患者。本文观察了102名瓦氏、汤氏和波氏法鼓膜不活动的潜艇、潜水和空勤支队的新兵。其中87人双侧鼓膜不活动,15人为单侧。中耳功能测试包括在加压舱中进行增压的试验。凡能对外界压力在10米水柱时进行气压平衡的可以排除鼻-耳窘迫综合征。结果单耳瓦氏法阴性(鼓膜不活动)者53.3%可以平衡外界增压。而双侧瓦氏阴性者80.4%不能平衡外界增压。77人患鼻-耳窘迫综合征。他们的中耳压力多在正常范围,但都有咽鼓管功能失常。中隔矫正术后73人(94.8%)可以平衡中耳压力。增加外界压力的咽鼓管功能试验决定于乳突     

咽鼓管周围病变与耳气压伤

环境气压的迅速改变可造成耳气压伤，是飞行人员（包括乘客）和潜水人员（包括潜水爱好者）在飞行和潜水过程中必须随时面对的问题。其中咽鼓管的结构和功能与其关系密切，咽鼓管周围病变与耳气压伤的关系也密不可分。本文就笔者在此方面所做的工作，结合国内外的研究现状，介绍咽鼓管周围病变（本文特指咽鼓管咽口周围如鼻咽部、鼻中隔、下鼻甲、鼻窦的病变及咽鼓管鼓室口周围如中耳腔、鼓膜、乳突的病变）与耳气压伤的相关知识。     

咽鼓管功能状况对根治术后疗效的影响

在促使慢性化脓性中耳乳突炎患者行根治术后仍有继续流脓的诸多因素中,咽鼓管功能紊乱占主导地位,会妨碍术腔的愈合过程,尤以肉芽型咽鼓管炎为甚,作者对这类患者40例(男35、女5,16～64岁,90%有长期耳溢)进行了观察,用间接鼓室镜检查鼓口,以后孔镜检查其咽口,行碘油咽鼓管造影,咽鼓管通畅度和引流检查。患者均有传音聋,29例尚伴有感音聋;19例造影见咽鼓管扭曲、不光滑,15例造影剂停滞干管峡部;咽鼓管引流功能良好者4例,Ⅱ度5例,完全不通者31例;27例伴有鼻及鼻窦病,须给予相应治疗。肉芽性咽鼓管炎患者的鼓室内有大量肉芽,管的咽口及圆枕处有颗粒状     

高压氧治疗突聋诱发急性中耳积液一例

高压氧治疗突聋诱发急性中耳积液一例张志钢，李德坚，刘水莲患者，女，５０岁。因双耳听力突然下降伴头晕、耳鸣１周入院。专科检查：双侧鼓膜完整，不充血，活动度良好。纯音测听：双耳气骨导均降至７０ｄＢＨＬ左右，为重度感音性聋。双乳突及内听道Ｘ片示正常。入院后...     

Hyperbaric oxygenation in early treatment of sudden deafness

BACKGROUND: The treatment of sudden deafness with hyperbaric oxygenation (HBO) is a new method, which is a routine application in some German centers and subject to contraindications can be assessed as relatively reliable. PATIENTS AND METHODS: In a retrospective study, data were analyzed from 49 patients who had received primary HBO therapy because of sudden deafness (up to 3 weeks old). In comparison to the standard infusion therapy according to Michel, the primary HBO therapy led to inferior results (no change in hearing: right ear 63.88%, left ear 60.98%; improvement in hearing: right ear 22.49%, left ear 21.71%; decrease in hearing: right ear 13.64%, left ear 17.32%). RESULTS: Considering the spontaneous remission of sudden deafness, neither the results of the infusion therapy nor those of the hyperbaric oxygenation surpass the rate of complete spontaneous remission. On the basis of our research, primary treatment of "fresh" sudden deafness with hyperbaric oxygenation cannot be recommended. CONCLUSIONS: The question remains open whether HBO as a secondary treatment for sudden deafness leads to improvements for the patient after unsuccessful standard therapy.     

Combination steroid and hyperbaric oxygenation therapy for sudden idiopathic sensorineural hearing loss

We retrospectively evaluated the efficacy of combination therapy with steroid and hyperbaric oxygenation for sudden idiopathic sensorineural hearing loss (SISNHL). Patients (n: 109; 111 ears) visited our clinic within 14 days from onset before receiving treatment between January 1999 and March 2003. Hearing loss was assessed based on criteria prepared by the Ministry of Health and Welfare Acute Severe Hearing Loss Study Group. Patients were distributed into Group I-95 patients who started treatment within 7 days from onset-, and Group II-14 patients who started treatment within 8-14 days from onset. We evaluated the outcome of therapy using grading established by The Research Committee on Acute Profound Deafness, Ministry of Health and Welfare, Japan. The complete recovery of hearing was worse in patients with severe hearing loss. It was 4.8% in grade 4a, 18.2% in grade 3a, 25% in grade 2a, 20.0% in grade 4b, 38.5% in grade 3b, and 66.7% in grade 2b. We studied the relationship between type of hearing loss and recovery after treatment. The complete recovery of hearing was most favorable in patients with low tone hearing loss, followed by those with middle tone hearing loss and those with horizontal hearing loss. These findings indicate that the type of hearing loss was the most significant determinant of SISNHL prognosis and course. Twenty patients with acute stage SISNHL had diabetes mellitus. The recovery of hearing was almost the same in those with and without diabetes mellitus. Recovery was complete in 32.4%, Niarked in 32.4%, and slight in 21.6%. In 13.5%, no change was observed. Our results and data from previous reports, involving more than 70 Japanese patients treated with steroids alone, suggest that combination therapy with steroid and hyperbaric oxygenation is effective for SISNHL.     

Recovery from repeated sudden hearing loss with corticosteroid use in the presence of an acoustic neuroma.

Sensorineural hearing loss of sudden onset may be the presenting symptom in up to 14% of patients with acoustic neuroma. We present the first reported case of sudden hearing loss in an only hearing ear with recovery to normal levels after steroid therapy on four separate occasions. Evaluation revealed a 1.5-cm acoustic neuroma. After middle cranial fossa decompression, a fifth episode with recovery after steroid use was documented. A review of the recent literature is presented, emphasizing the possible causation of sudden sensorineural hearing loss with recovery to normal in patients with acoustic neuroma. Modalities of therapy for the dilemma of the acoustic neuroma in an only hearing ear are discussed, including surgery, radiotherapy, and chemotherapy. An aggressive approach to the evaluation of the cause of sudden hearing loss is suggested.     

Sudden hearing loss associated with methylphenidate therapy

An 8-year-old child diagnosed with attention deficit/hyperactivity disorder presented to our Department of Otolaryngology 4 days after suffering hearing loss, loss of balance, tinnitus, and fullness sensation of the left ear. Her symptoms occured with the first dose of methylphenidate. The medical history and physical examination revealed no other diseases associated with sudden hearing loss. The audiogram revealed a total hearing loss on the left ear. Stapedial reflexes, distortion product and transient-evoked otoacoustic emissions were absent in left ear. The absence of clinical, laboratory and radiological evidence of a possible cause for complaints, an association between methylphenidate and sudden hearing loss was suggested. The patient received a standard course of oral corticosteroid and hyperbaric oxygen therapy. Weekly otological and audiological examinations were performed. Conservative and medical treatments offered no relief from hearing loss. Sudden hearing loss is a serious and irreversible adverse effect of methylphenidate. Therefore, the risk of hearing loss should be taken into consideration when initiating methylphenidate therapy.     

Usefulness of high doses of glucocorticoids and hyperbaric oxygen therapy in sudden sensorineural hearing loss treatment.

OBJECTIVE: We investigated the effect of pharmacologic (steroids, vasodilators, vitamins, and Betaserc) and hyperbaric oxygen therapy on patients with sudden sensorineural hearing loss. METHODS: The pharmacologic arm of the study consisted of 52 patients with defined sudden sensorineural hearing loss treated simultaneously in the ENT Department and National Center for Hyperbaric Medicine of the Medical University of Gdansk, Poland, from 1997 to 2000 (Group A). The hyperbaric oxygen therapy consisted of exposure to 100% oxygen at a pressure of 250 kPa for a total of 60 minutes in a multiplace hyperbaric chamber. The control group included 81 patients with defined sudden sensorineural hearing loss treated in the ENT Department, Medical University of Gdansk, from 1980 to 1996 (Group B). Both groups were comparable regarding the age of the patients, season of hearing loss occurrence, tinnitus and vestibular symptom frequency, delay before therapy, and average threshold loss before the start of treatment. The treatment results (hearing gain) were estimated using pure-tone audiometry. We retrospectively analyzed the audiograms of all patients. RESULTS: Patients from Group A (blood flow-promoting drugs, glucocorticoids in high doses, betahistine, and hyperbaric oxygen therapy) showed significantly better recovery of hearing levels compared with those from Group B (blood flow-promoting drugs and glucocorticoids in low doses) at seven frequencies (500, 1,000, 2,000, 3,000, 4,000, 6,000, and 8,000 Hz) (p < 0.05) and four groups of frequencies (pure-tone average, high-tone average, pure middle-tone average, and overall average) (p < 0.05). Percentage hearing gain in all investigated frequencies was also better in Group A versus Group B, and the differences were statistically significant (p < 0.05). CONCLUSION: We conclude that hyperbaric oxygen therapy with high doses of glucocorticoids improves the results of conventional sudden sensorineural hearing loss treatment and should be recommended. In addition, the best results are achieved if the treatment is started as early as possible.     

针刺结合高压氧治疗低频下降型突发性聋的临床研究

目的探讨针刺结合高压氧治疗低频下降型突发性聋的临床疗效,为临床运用提供证据。方法将105例突发性聋的患者随机分为A组(高压氧组)、B组(针刺组)、C组(针刺结合高压氧组),每组35例,3组患者均进行基础药物治疗,连续治疗4周,治疗前后采用测听仪对其临床疗效进行评价。结果高压氧、针刺及针刺结合高压氧治疗低频下降型突发性聋,总有效率分别为68.6%、62.9%和82.9%。针刺结合高压氧治疗低频下降型突发性聋的疗效在全部受损听阈(低频段)、500Hz听阈和250Hz听阈不但优于针刺疗法(P=0.010、P=0.007、P=0.030),还优于高压氧疗法(P=0.016、P=0.002、P=0.010)。而高压氧和针刺疗法在治疗突发性聋的疗效上无统计学差异(P=0.843、P=0.661、P=0.701)。结论针刺结合高压氧治疗低频下降型突发性聋具有一定临床优势。     

Sudden sensorineural hearing loss associated with inner ear anomaly.

OBJECTIVE: This study was conducted to evaluate the frequency of inner ear anomaly in patients with sudden sensorineural hearing loss and in control subjects. STUDY DESIGN: Retrospective case review. SETTING: A tertiary referral center. PATIENTS AND INTERVENTION: We evaluated 366 patients (165 men and 201 women; age range, 3-91 yr) with sudden sensorineural hearing loss and 228 control subjects without sensorineural hearing loss using magnetic resonance imaging. Three hundred fifty-six patients had unilateral and 10 patients had bilateral sudden sensorineural hearing loss. RESULTS: Eleven (2.9%) of 376 ears with sudden sensorineural hearing loss had inner ear anomaly. Nine patients (2.5%) had inner ear anomaly associated with sudden sensorineural hearing loss, but none of the 228 control subjects had the anomaly. The current study demonstrated that the frequency of inner ear anomaly in patients with sudden sensorineural hearing loss was significantly higher than in control subjects. CONCLUSION: Our study reveals that inner ear anomaly may be associated with sudden sensorineural hearing loss in 2.5% of patients.     

Hyperbaric oxygenation therapy in idiopathic sudden sensory neural hearing loss

We analyzed statistically the prognosis of hearing impairment in patients with idiopathic sudden sensory neural hearing loss. 119 patients (HBO group) were treated with a combination of hyperbaric oxygenation (HBO) and stellate ganglion block (SGB), as well as oral administration of vasodilator and vitamins. Another 107 patients (control group) were treated with various other therapies. Collectively, the therapeutic outcome in the HBO group was better than in the control group. In addition, the recovery rate of hearing in the HBO group was superior to that in the control group for those cases which had severe hearing loss at the first medical examination, had been seen more than two weeks after onset, and had resisted other treatments. As a result of this study, we conclude that HBO is an effective therapeutic tool.     

Tube function in sudden hearing loss

The function of the Eustachian tube was assessed in 50 patients suffering from sudden hearing loss, using the pressure chamber impedance method. We investigated the existence of a relationship between sudden hearing loss and the occurrence of a patulous tube. We could not observe more patulous tubes in patients with sudden hearing loss compared to a control group with healthy ears. We registered the parameters "tissue resistance pressure" and "tubal opening pressure", both characterising the passive qualities of the Eustachian tube. There was no indication of a facilitated passive tubal opening nor a tendency to a patulous tube among our patients. Statistical evaluation of these parameters showed no significantly different tubal function on comparing the right and the left ear, as well as the ear affected by sudden hearing loss and the healthy ear. We conclude that there is no relationship between sudden hearing loss and patulous tube.