突发性聋预后研究进展

突发性聋是一种常见的耳科疾病,全球发病率较高.听力损失会极大程度降低患者生活质量,并带来沉重的公共医疗负担.为改善患者的预后,现有研究报告了一些影响预后的关键因素.最近,也有研究开始利用机器学习建立突聋预后的预测模型.充分了解影响预后的因素,建立预测预后的模型,有利于提高预测预后准确性,指导治疗方案的调整,到达改善预后...     

地西泮治疗伴有焦虑症状的突发性耳聋疗效分析

目的研究地西泮对伴有焦虑症状的突发性耳聋患者的治疗效果。方法将56例伴有焦虑症状的突发性耳聋患者随机分为两组:对照组28例,给予常规突发性耳聋治疗(糖皮质激素、改善微循环、营养神经等),研究组28例,根据睡眠障碍严重程度分为两组,在对照组的基础上给予地西泮片5mg(研究组1)或10mg(研究组2)口服,每日睡前服用。治疗20天后复查听力及HAMA评分。结果治疗20天后两研究组与对照组听力水平有显著差异(P1=0.003,P2=0.015),HAMA评分有显著差异(P1=0.004,P2=0.011);两研究组治疗前后和对照组治疗前后听力水平均有显著差异(P1=0.000,P2=0.001,P=0.018),两研究组治疗前后HAMA评分有显著差异(P1=0.001,P2=0.003),对照组无显著差异(P=0.159)。结论地西泮口服作为突发性耳聋伴焦虑情绪患者的补充治疗对患者负面情绪及听力恢复均有显著的疗效。     

儿童突发性感音神经性听力损失的诊治体会

对18例20耳8～14岁突发性感音神经性听力损失患儿的临床资料进行了总结和分析,结果表明儿童突发性感音神经性听力损失发病与首诊之间病程较长,部分患儿有上感、流行性腮腺炎病史,可能和听力损失发生有关.儿童突发性感音神经性听力损失治疗效果类似于成人患者,而全聋者疗效差.东菱克栓酶同样适于治疗儿童突发性感音神经性听力损失且疗效和安全性较好,无明显的出血倾向和其它并发症.     

Sudden Sensorineural Hearing Loss: Results of intratympanic steroids as salvage treatment

Objective

The aim of the present study was to verify the efficacy and the safety of intratympanic dexamethasone to treat sudden sensorineural hearing loss as salvage therapy.

Materials and methods

A prospective study was conducted on patients affected by idiopathic sudden hearing loss who were treated before with some systemic therapy, but without recovery of the hearing The patients able to undergo the study, but who refused salvage treatment were considered as control group. A solution of Dexamethasone 4 mg/ml was then injected through the posterior–inferior quadrant filling completely the middle ear. The follow-up in the following 6 months included an audiogram every month.

Results

The number of patients treated with salvage therapy was 36. The patients who refused treatment were further 10. The salvage treatment was done with a mean delay of 24.3 days from the onset of symptoms. Mean hearing threshold after the onset of sudden hearing loss at PTA was 66.5 dB. After the failed treatment the mean PTA was 59.6 dB. The mean PTA after the intratympanic steroid administration was 46.8 dB, with a mean improvement of 12.8 dB. No hearing change was noted in the 10 patients who refused salvage therapy. The patients that assumed systemic steroid as first therapy showed a better PTA threshold after the salvage intratympanic treatment (p < 0.01). A significant difference (p < 0.05) of hearing recovery was evidenced between non-smoker patients and those with smoking habit.

Conclusions

Our data showed that a salvage treatment with intratympanic dexamethasone should be suggested to all patients who failed the first systemic treatment. The systemic steroid therapy done before the salvage treatment seems to exert a protective role for the inner ear, as shown by our series. On the contrary the smoke habit is a negative prognostic factor in the hearing recovery.     

Serum and Cerebrospinal Fluid Pathology in Patients with Sudden Sensorineural Hearing Loss

The serum and cerebrospinal fluid (CSF) pathology of patients with sudden sensorineural hearing loss (SHL), both seropositive and seronegative to Borrelia burgdorferi (Bb), was prospectively studied. Nineteen consecutive patients were included and trends between the degree of hearing recovery and serum CSF pathology and given therapy were examined. The pilot study showed a high prevalence (68%) of pathology in serum and CSF in patients with SHL. In 54% of the patients, elevated levels of CSF proteins and or pathological CSF cell counts were present without positive antibodies to Bb. Positive levels of antibodies against Bb or pathological proteins in CSF were associated with better hearing recovery (means of 47.2 and 51.7%, respectively). The audiometric configuration ''high frequency sloping'' hearing impairment was associated with the lowest degree of hearing recovery. Patients with SHL and positive serology to Bb who received antibiotic treatment (oral tetracycline), with or without steroids, had the best hearing recovery in this study (61.7 and 48.4%, respectively). In conclusion, we found a high prevalence of serum and CSF pathology in a consecutive group of patients with SHL. Early appropriate antibiotic treatment may prevent the development of major late complications of Lyme disease borreliosis. We also find it justified to perform more general serological analyses, including CSF analysis, in patients with SHL. A more liberal approach to testing and development of test protocols for SHL patients will increase our knowledge in this field.     

Clinical Applications of Otoacoustic Emissions in Sudden Hearing Loss

Sudden hearing loss (SHL) is a controversial topic for which no definitive practical guidelines exist. Studies employing vasodilators, plasma expanders, anticoagulants, and carbogen inhalations have shown no improvement over the rate of spontaneous recovery. At present, there is insufficient evidence to support medical treatment for SHL, except steroid therapy in selected patients. Distortion product otoacoustic emissions (DPOAEs) are sensitive to cochlear disorders and are absent in ischemic injury to the cochlea, but can persist in cochlear neuritis. In a prospective study of 10 patients who presented to Albany Medical Center from 1995 to 1996, three patients with intact DPOAEs at presentation had an average improvement of 33 dB in the pure-tone average (PTA) of 0.5, 1.0, and 2.0 kHz with steroid therapy, whereas five of seven patients with absent DPOAEs had no improvement in hearing despite steroid therapy in six patients. The presence of DPOAEs may be a useful prognostic factor that positively correlates with recovery from SHL.     

突发性聋的病因及相关因素的研究现状

突发性聋（简称突聋）是指突然（可在数分钟、数小时或3天以内）发生、原因不明、听力至少在相连的2个频率上下降20dB以上的感音神经性听力损失,可伴有耳鸣．眩晕。自1944年DeKIevn首先描述该病以来．发病率有上升趋势．1984年Byl等报道10万人中有5～20人患此病,到2009年10万人中约有160人患此病。     

少年儿童突发性聋的治疗及预后分析

目的探讨少年儿童突发性聋临床特点、治疗及预后因素分析。方法回顾性分析2011年1月至2016年12月间我科收治的78例(81耳)儿童突发性聋的病例资料。共收集病例78例,81耳,双耳3例,其中男性40例(51.28%),女性38例(48.72%)。年龄9-18岁,平均年龄15.69岁。按照听力曲线分型,低频下降型27例,中高频下降型9例,平坦型17例,全聋型25例。分析不同类型突发性聋患儿的临床特点及治疗效果,运用logistic回归分析其预后因素。Fisher检验比较不同类型突发性聋患儿是否采用特殊治疗(鼓室/耳后注射激素)对预后的影响。结果各种类型的总有效率:低频下降型最高,为96.30%;其次为平坦型,全聋型次之,分别为76.47%,52.00%;中高频型最差,为44.44%。所有患儿总有效率为71.79%。无耳鸣患儿14例,总有效率为50%;伴耳鸣患儿64例,总有效率为76.56%。4例患儿耳后注射复方倍他米松,1例有效;21例患者采用鼓室注射甲强龙,14例有效;3例患者采用联合鼓室注射甲强龙和耳后注射复方倍他米松,1例有效。多因素Logistic回归分析结果显示,突发性聋分型、是否伴发耳鸣与少年儿童突发性聋治疗效果相关。结论低频型、伴发耳鸣的少年儿童突发性聋患者预后好,中高频型、无耳鸣的患儿预后较差。耳后注射及鼓室注射激素对首次治疗无效的患儿仍然有效。     

突发性聋的分型及药物治疗研究现状

突发性聋是耳科的常见急症之一,2015年我国发布的突发性聋诊断和治疗指南中根据听力曲线将突发性聋分为四型,并建议分型治疗.目前治疗突发性聋仍以药物治疗为主,常用糖皮质激素、改善微循环药物和营养神经药物.本文将从突发性聋的分型及药物治疗两个方面进行阐述,探讨各型突发性聋的特点和各类药物的作用机制.     

突发性聋的听力损失和前庭损害对其预后的影响

本文通过对３０例突发性聋患者行纯音听力检查及前庭功能系列检查，比较突发性耳聋听力下降程度和类型与眩晕和前庭功能检查结果的关系、前庭损害类型和程度、以及听力预后与眩晕和前庭损害的关系。得出（１）具有前庭损害的患者９１％为中、重度聋，８２％为平坦型和斜坡型听力损害。半规管麻痹者听力损害全部为中、重度聋，图型为平坦或斜坡型。（２）冷热试验（ＣＰ）值６３％、低频谐波加速试验（ＳＨＡＴ）６６％、重心平衡仪试验（ＶＳＲＺ）３６％呈现异常，以ＳＨＡＴ较为敏感；（３）突聋听力预后与是否伴有眩晕、前庭损害以及损害程度有密切关系。     

突发性耳聋患者内淋巴积水的客观影像检测

目的应用内耳核磁造影技术检测证实急性突发感音神经性耳聋患者的内淋巴积水的病理学客观证据,并初步探讨影响检测结果的可能因素,以期为临床检查和治疗提供帮助。方法连续选取来我院门诊就医的突发性耳聋(低频型、全聋型)患者作为研究对象,对其鼓室内注射造影剂,24小时后进行内耳核磁成像检查,以了解其是否存在内淋巴积水。结果 43例患者(低频聋23例,全聋20例)符合诊断并同意进行内耳核磁造影检查。在低频聋患者之中,14例患者的造影结果显示内淋巴积水,其中1例患者检查前已药物治疗;9例患者未显示内淋巴积水,其中4例病程超过30天,另外5例病程5-17天,检查前已药物治疗。20例全聋患者中4例检测到内淋巴积水。结论本检查证实了急性低频突发聋患者内淋巴积水这一客观病理发生机制,全聋患者发现少数病例存在内淋巴积水,提示可能为内耳原发性积水。     

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。     

单侧突发性聋患者脑磁共振扩散峰度成像研究

目的探讨单侧突发性聋患者脑部磁共振弥散峰度成像(diffasion kurtosis imaging, DKI)检查对突聋预后的评估作用。方法收集右侧突发性聋患者32例(突聋组),(病程≤3周,男16例,女16例,年龄39～73岁,平均52.31±8.59岁),正常对照组23例(男11例,女12例,年龄41～68岁,平均56.36±6.82岁),对照组和突聋组治疗前行常规磁共振检查及全脑DKI成像扫描;基于统计软件比较突聋组与正常对照组全脑DKI各参数图差异脑区;并根据治疗结果,将突聋组患者分为显效组(20例)和无效组(12例),再分别与正常对照组比较。结果双样本t检验结果显示,与正常对照组比较,突聋组左侧的颞上回、颞中回及颞下回、左侧的顶叶及枕叶等脑区的白质有不同程度的各向异性分数(FA)值减小,突聋组双侧额叶均有平均扩散峰度(MK)值及径向峰度(RK)值增加。突聋组的显效组20例和无效组12例分别与正常对照组比较,可见突聋组的轴向分度(AD)在右侧额上回、右侧额中回、左侧额中回减小,右侧中央后回减小,径向分度(RD)在左侧扣带回、左侧颞上回减小,扩散峰度各向异性(KFA)在左侧枕上...     

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。     

血脂对突发性聋预后的影响

目的研究血脂对突发性聋预后的影响,以便为临床上采取合适的干预措施提供理论依据。方法分析晨起空腹的63例高频和全频下降型突聋患者静脉血中低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、甘油三脂(TG)、血清总胆固醇(TC)、载脂蛋白β(Apo-β)、载脂蛋白a(Apo-A)的水平,分析血脂各指标与听力恢复的关系。结果听力下降程度及不同听力下降频率的突发性聋患者之间血脂各个指标的差异均没有统计学意义(P>0.05);听力恢复的程度与血脂各指标的差异均没有统计学意义(P>0.05);Logistic回归分析表明,TG、TC水平与疗效相关(P<0.05),其余各指标与疗效关系不明显(P>0.05)。结论血脂对突发性聋预后可能有一定的影响,是否有需要专门的降脂治疗,尚需进一步研究。     

老年突发性聋患者临床特征及治疗效果分析

目的：分析老年突发性聋患者的临床特征及治疗效果。方法回顾性分析2013年9月至2015年3月经郑州大学第一附属医院耳科确诊并治疗的66例老年单耳突发性聋患者（年龄60～83岁,老年组）的临床资料,另选择同期住院治疗的291例中青年单耳突发性聋患者（年龄19～59岁）为对照组,比较两组患者的临床特征及治疗效果。结果老年组听阈曲线为低频下降型者占1．51％,低于对照组（14．43％,P＝0．004）;高频下降型（22．73％）和全聋型（50．0％）高于对照组（分别为15．46％、39．52％）;老年组中伴随全身疾病（高血压、糖尿病等,60．61％）及对侧耳存在听力损失（57．58％）的患者所占比例较对照组（分别为17．53％、19．93％）高（ P＜0．05）。两组患者总有效率为70．03％,老年组与对照组的总有效率分别为60．61％、72．16％,差异无统计学意义（ P＞0．05）,老年组痊愈率仅为10．61％,明显低于对照组（29．21％）（ P＜0．05）。结论老年突聋患者多伴有高血压、糖尿病等全身疾病或者发病前患耳可能存在不同程度听力损失;突聋耳听力损失更易发生在高频或全频,治疗总有效率与中青年组相似,但痊愈率较低。     

药物治疗突发性聋的前瞻性疗效观察

对64例突发性聋随机分四组，分别用脉络宁、复方丹参、腹蛇抗栓酶及泛影葡胺，联合多种药物治疗。结果显示各组治疗的有效率无明显差异P＞0．05，但显效率差异显著P＜0．05．使用脉络宁、复方丹参、腹蛇抗栓酶三组对听力改善的程度较泛影葡胺组好。     

突发性聋患者急性期听皮层代谢~1H-MRS研究

目的利用氢质子磁共振波谱(hydrogen proton magnetic resonance spectroscopy,1 H-MRS)技术观察突发性聋患者急性期听皮层代谢变化。方法选取单侧突发性聋患者20例(右侧12例,左侧8例)和10例正常志愿者行1 H-MRS检测,测定双侧颞横回N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)、谷氨酰胺和谷氨复合物(Glx)的峰下面积并计算NAA/Cr、Cho/Cr、Glx/Cr比值,分析突聋组和对照组之间听皮层代谢的差异。结果突聋组与对照组比较,两侧听皮层NAA/Cr、Cho/Cr比值差异均无统计学意义(P>0.05));突聋组耳聋侧听皮层Glx/Cr比值与对照组比较差异无统计学意义(P>0.05),但聋耳对侧听皮层Glx/Cr比值高于对照组,差异有统计学意义(P<0.05)。结论 1 H-MRS可以在活体状态下检测听觉中枢组织代谢变化,突聋患者聋耳对侧听皮层存在谷氨酸代谢异常。