我国突发性聋的临床研究现状

近年来，突发性聋发病率在上升并趋向年青化，已成为严重危害健康人群听力的耳科常见病。本属听力正常或基本正常者突然在短期内不明原因丧失听力，其中多数病例遗留永久性听力损失，有如突发心肌梗塞之于心脏，对患者的心理和生理无疑是一个严重的打击，已经引起耳科医师乃至一般人群的认识和重视。为了指导日常救治工作，便于学术交流和从事多中心临床研究，1996年中华医学会耳鼻咽喉科学分会，中华耳鼻咽喉科杂志编辑委员会在上海组织制定了“突发性聋诊断依据和疗效分级”，作为全国同行在诊治突发性聋和总结交流的共同文件。     

我国突发性聋多中心临床研究

1 背景 1996年和2005年中华医学会耳鼻咽喉头颈外科学分会分别在上海和济南召开了制定我国突发性聋诊疗指南的研讨会，会上虽然讨论热烈，但无论是在流行病学还是临床研究方面都没能提供具有说服力、大样本的研究数据，因而很难制定出完善的相关疾病诊疗指南。2005年济南会议制定的突发性聋诊疗指南内容仅380余字，而德国2004年12月制定的德语国家突发性聋诊疗指南翻译成汉语大约要9000余字，部分发达国家提出的突发性聋分型问题虽然很重要，但是由于其中没有结合我国自身情况和具体数据很难被采用。     

胰激肽原酶治疗突发性耳聋的临床观察

1资料与方法 1.1临床资料依照1997年中华耳鼻咽喉科学会、中华耳鼻咽喉科杂志编辑委员会颁布突发性耳聋诊断依据和分级标准[1],2002年11月-2004年6月临床随机抽取符合突发性耳聋标准病人61例分成二组.治疗组31例(35耳),男19例,女12例,年龄25-71岁,平均年龄47.5岁.发病开始到用药时间1-7天,平均3.7天.其中伴耳鸣者23例,伴眩晕者10例,耳聋、耳鸣、眩晕同时存在者9例.对照组30例(34耳),男21例,女9例,年龄22-69岁,平均年龄48.2岁,发病开始到用药时间1-6天,平均3.5天.伴耳鸣者18例,伴眩晕者11例,耳聋、耳鸣、眩晕同时存在者8例.治疗前对病人病情、治疗过程及可能出现临床疗效预先告之.     

突发性聋的研究进展——病因、病理及治疗策略

突发性聋(sudden hearing loss,SHL)是指单耳或双耳不明原因的突发听力下降,诊断标准为数小时至3天内,纯音测听检查至少连续三个频率感音神经性听力损失大于或等于30dB[1]。SHL可以伴有眩晕和耳鸣,眩晕多伴发于高频听力有严重损失患者。     

突发性聋的诊断和治疗指南(2005年,济南)

定义突然发生的，可在数分钟、数小时或3天以内，原因不明的感音神经性听力损失，至少在相连的2个频率听力下降20dB以上。     

突发性聋的诊断和治疗指南(2005年,济南)

定义突然发生的，可在数分钟、数小时或3天以内，原因不明的感音神经性听力损失，至少在相连的2个频率听力下降20dB以上。     

联合疗法治疗突发性聋的疗效观察

突发性聋为耳鼻咽喉科常见病、多发病,属耳鼻咽喉科常见急症之一,临床表现为瞬间突然发生重度感音神经性耳聋,可伴有耳鸣、眩晕、恶心、呕吐等,属中医"暴聋",其发病原因尚未完全明了,临床治疗颇为棘手.我科于2003年4月～2004年4月收治该病例96例,将其随机分成联合疗法治疗组(中药十中药血管扩张剂 耳穴 声信息)60例,对照组(高压氧十凯时 低分子右旋糖酐)36例.现将其临床疗效评价总结如下.     

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。     

对阻塞性睡眠呼吸暂停低通气综合征诊疗标准(杭州标准)的讨论

2001年中华医学会呼吸病学分会睡眠呼吸疾病学组制定了我国第一个阻塞性睡眠呼吸暂停低通气综合征诊疗指南（草案）并于2002年正式发表。其后．《中华耳鼻咽喉科杂志》又发表了由中华医学会耳鼻咽喉科学会和中华耳鼻咽喉科杂志编委会共同制定的阻塞性睡眠呼吸暂停低通气综合征诊断依据和疗效评定标准暨悬雍垂腭咽成形术适应证（以下简称“杭州标准”）。这些标准的制定和发表对于规范、促进和推动我国阻塞性睡眠呼吸暂停低通气综合征的临床和科研工作起到了积极的作用。然而任何一个疾病的诊疗标准都不是绝对完美的,都需要在工作中接受实践的检验,需要广泛听取各家的不同意见并及时加以修改和补充．使其日臻完善。为此,我编辑部特邀数位本领域的专家．就“杭州标准”中存在的一些问题进行讨论。[编者按]     

梅尼埃病的诊断依据和疗效评估(2006年,贵阳)

一、定义 梅尼埃病是一种特发性膜迷路积水的内耳病，表现为反复发作的旋转性眩晕，波动性感音神经性听力损失，耳鸣和（或）耳胀满感。     

产褥期突发性耳聋的诊治经验

目的探讨产褥期妇女突发性耳聋的治疗方案,积累治疗经验。方法选取2例产褥期突发性耳聋患者,分析其耳聋分型及听力损失级别,充分考虑患者所处的特殊时期,2例患者均采用2~3周短期断乳+改善内耳微循环药物治疗方案。采用改善内耳微循环、抗凝、营养神经、口服糖皮质激素等综合治疗方法。结果2例患者均取得满意的治疗效果。病例1停药后7 d复诊,眩晕消失,患耳各频率听力提高50 dB左右。病例2停药后7 d复诊,眩晕基本缓解,耳鸣减轻,患耳各频率听力提高30 dB左右。两例患者均在停药后1周恢复哺乳,1个月后复查,新生儿发育正常,患者听力稳定,无再次下降。结论妊娠合并突发性耳聋药物治疗主要以营养神经为基础,配合改善循环、清除自由基,改善情绪,调整睡眠等治疗,且强调早期治疗,用药期间建议短期断母乳,牛乳喂养,停药后1周恢复哺乳,不会造成新生儿营养不良。     

The results of sudden deafness treatment

In years 1980-1994, 180 sudden hearing loss cases were diagnosed and treated. Sudden deafness is a symptom of a variety of diseases. Time is often the most important factor in the overall recovery. However the etiology was difficult to identify, precise examinations permitted to determine the probable diagnosis and to apply appropriate treatment. In cases with expected vascular etiology Nimodypine was additionally employed with good results. The most frequent reason for sudden hearing loss was vascular factors (50%), next viral infections (25%), acoustic trauma (10%), allergy (5%), and unknown causes (10%). The best results were obtained in the patients under treatment between 1 and 7 days of sudden deafness persistence. Remarkably better results were received in cases of sudden deafness concerning wide frequency band than in those within high tones only.     

国内突发性聋临床诊治研究论文的再评价

目的复习国内近5年来有关突发性聋疗效的报道,分析突发性聋诊断和治疗的现状,重点分析1996年中华医学会耳鼻咽喉科学分会制定的诊断和疗效评定标准的执行情况.方法检索中国生物医学文献数据库和中国期刊网医学专题全文数据库,以突发性聋和治疗为关键词检索2000～2004年发表的有关突发性聋诊治的研究文章.依据国际循证医学标准,进行逐篇分析.结果共检出2000-2004年发表的有关突发性聋诊治的研究文章234篇.其中2000-2002年发表的有关突发性聋诊治的研究文章176篇,有关药物疗效的126篇,在关于药物疗效的文章中,以1996年中华医学会耳鼻咽喉科学会在上海制订的诊断和疗效标准为标准的文章26篇,占20.6%,设有对照试验的89篇,占70.6%,其中符合临床随机对照试验(randomized controlledtrials,RCT)的36篇约占28.5%.2003-2004年发表的有关突发性聋诊治的研究文章58篇,其中有关药物疗效的25篇,全部均标明以1996年中华医学会耳鼻咽喉科学会在上海制订的诊断和疗效标准为标准.但全部234篇文章设有空白对照试验的0篇,有长期随访记录的文章0篇,做组间均衡性检验的文章0篇,记有不良反应的文章共为6篇,平均疗效最低60.3%,最高94.5%.结论目前国内治疗突发性聋的报道很多,但对其诊断和疗效的评估标准认识不够统一,1996年制定的标准执行情况不容乐观.有必要进行标准修订,而且应该增加治疗原则的制定,有利于规范治疗,指导临床.多中心RCT研究对突发性聋的临床研究非常重要.     

突发性聋138例诊治体会

目的探讨突发性聋的病因、治疗及预后.方法分析138例突发性聋的临床资料.结果138例中经综合治疗有效108例,其中治愈38例,显效44例,有效26例,总有效率为75%,108例中发病时间在1周内65例,占60%,40岁以下36例(男22例),占60%.结论突发性聋的病因为病毒感染或内耳供血障碍或圆窗膜破裂等,宜采取综合治疗,预后与初诊听阈、年龄、性别、病程、有无眩晕、高低频音听阈差有关.     

Hyperbaric oxygen in the treatment of sudden deafness

Currently, the treatment of sudden deafness (SD) is based mainly on complete bed rest and the administration of corticosteroids. Hyperbaric oxygen therapy (HBOT) has previously been suggested as adjunctive treatment. We describe two cases of successful HBOT for SD. The first patient presented with moderate mid-frequency hearing loss without accompanying symptoms, whereas the second patient had moderate low-frequency hearing loss with persistent tinnitus and a single episode of vertigo. HBOT in addition to conventional treatment soon after diagnosis resulted in full recovery of hearing in both patients. The pathogenesis of SD may involve a reduction in cochlear blood flow and perilymph oxygenation, making early HBOT a reasonable treatment modality for this condition.     

Calcium antagonists in the treatment of sudden deafness

In the treatment of patients with sudden deafness, we found no significant difference between an oral calcium antagonist (nifedipine) and intravenous naftidrofuryl given concomitantly with vitamin A, vitamin E, and zinc. This prospective randomized study in 50 patients again shows that recovery to useful hearing levels tends to be spontaneous and independent of the type of medical treatment given. Irrespective of their capability to prevent contractions of cerebral vascular smooth muscle induced by neurotransmitter and vasoconstrictor substances and of their rheological properties, currently available calcium antagonists of the nifedipine type are unable to enhance hearing recovery at the present time.     

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.     

Calcium antagonists in the treatment of sudden deafness

Summary In the treatment of patients with sudden deafness, we found no significant difference between an oral calcium antagonist (nifedipine) and intravenous naftidrofuryl given concomitantly with vitamin A, vitamin E, and zinc. This prospective randomized study in 50 patients again shows that recovery to useful hearing levels tends to be spontaneous and independent of the type of medical treatment given. Irrespective of their capability to prevent contractions of cerebral vascular smooth muscle induced by neurotransmitter and vasoconstrictor substances and of their rheological properties, currently available calcium antagonists of the nifedipine type are unable to enhance hearing recovery at the present time.