高压氧治疗突发性聋的再评价

目的　观察突发性聋高压氧 (hyperbaricoxygenation ,HBO)治疗前后血清脂质过氧化物代谢产物丙二醛 (maiondialdehyde ,MDA)和超氧化物歧化酶 (superoxidedismntase ,SOD)的浓度变化及对高压氧治疗效果的影响。方法　 6 0例 79耳突发性聋的患者 ,随机分为综合组 30例 43耳和单纯组 (单纯高压氧组 ) 30例 36耳 ,另有 30名健康志愿者做正常组。治疗前后比较听力变化 ,用硫代巴比妥酸法检测MDA、用放射免疫法检测SOD。结果　 2组治疗后听力比较 ,差异有显著性意义 ( χ2 =6 .48,P<0 .0 5 )。SOD测试 :综合组治疗后与正常组、单纯组比较 ,差异均有非常显著性意义 (前者t=2 3 2 7,P <0 .0 1,后者t =2 7.17,P <0 .0 1) ;综合组治疗前后比较 ,差异有非常显著性意义 (t =2 9.2 7,P <0 .0 1) ;单纯组治疗前后比较 ,差异无显著性意义 (t=1.33,P >0 .0 5 )。MDA测试 :综合组与单纯组治疗后比较 ,差异有非常显著性意义 (t=8.86 ,P <0 .0 1) ;综合组治疗前后比较 ,差异有非常显著性意义 (t=7.2 8,P <0 .0 1) ;综合组治疗后与正常组比较 ,差异无显著性意义 (t=1.2 4,P >0 .0 5 ) ;单纯组治疗后与正常组比较 ,差异有非常显著性意义 (t=7.0 9,P <0 .0 1)。结论　单纯高压氧治疗突发性聋的治愈率极低。     

地塞米松治疗突发性聋

目的对地塞米松(dexamethasone,DM)等综合治疗突发性聋的疗效进行临床观察及探讨一氧化氮(nitricoxide,NO)和谷胱甘肽过氧化物酶(glutat-hioneperoxidase,GSH-px)与突发性聋的关系。方法将本院60例突发性聋患者按就诊顺序随机分为DM治疗组30例(35耳)和非DM治疗组30例(36耳)。DM组采用DM治疗,非DM组采用生理盐水治疗;两组同时采用ATP等其它相同的治疗。30名健康志愿者做对照。两组在治疗前后做纯音测听及检测NO、GSH-px。结果DM组和非DM组治疗前患耳气导平均听阈分别为(70.34±18.02)dBHL和(71.23±17.45)dBHL(t=0.175,P>0.05);治疗后DM组30例中痊愈17例(21耳)、显效8例(8耳)、有效3例(4耳)、无效2例(2耳),治愈率60%;非DM组30例中痊愈6例(6耳)、显效8例(9耳)、有效10例(15耳)、无效6例(6耳),治愈率16.67%。两组经统计学处理差异有显著性(x2=13.49,P<0.01)。NO和GSH-px的检测结果:两组治疗前后比较及治疗前后与对照组比较差异均有显著性,按本实验剂量应用未发现明显副作用。结论DM治疗突发性耳聋的效果肯定,可应用于临床工作。     

益气活血法对体内自由基的影响及其治疗突发性聋的疗效机理

目的从自由基清除角度探讨益气活血法治疗突发性聋的机理。方法60例突发性聋患者（65耳）,随机分为治疗组30例（33耳）和对照组30例（32耳）。对照组应用高压氧联合药物（尼群地平等）疗法,治疗组在此基础上加用益气活血汤进行治疗,疗程持续20天。另取健康志愿者30名作为正常对照组。采用硫代巴比妥酸法检测MDA,放射免疫法检测SOD,分别比较两组患者治疗前后的相关检测指标及听力变化。同时应用邻三苯酚法检测实验小鼠的自由基变化,观察益气活血汤的抗自由基效用。结果治疗组痊愈6耳,显效13耳,有效10耳,总有效率87.88%;对照组痊愈6耳,显效6耳,有效9耳,总有效率65.63%。两组疗效比较差异有统计学意义（χ^2=4.54,P〈0.05）。比较SOD和MDA检测结果,治疗组治疗前后的差异有统计学意义。不同组别的实验动物也显示了相似的变化趋势。结论益气活血汤所用中药可能通过有效清除体内自由基而对突发性聋发挥更好的治疗效用。     

启聋汤治疗突发性聋疗效观察

目的观察西药配合启聋汤治疗突发性聋的临床疗效。方法将60例(65耳)确诊的突发性聋患者随机分为对照组(30例,31耳)和治疗组(30例,34耳),对照组采用低分子右旋糖酐、三磷酸腺苷、辅酶A及地塞米松治疗,治疗组在使用相同西药治疗基础上加用启聋汤,比较两组的临床疗效。结果治疗组痊愈5耳,显效8耳,有效13耳,无效8耳,有效率76.47%;对照组痊愈2耳,显效6耳,有效11耳,无效12耳,有效率61.29%,两组疗效经卡方检验差异有统计学意义(χ2=4.866,P<0.05)。结论西药配合启聋汤治疗突聋的临床效果优于单纯西药治疗。     

注射用甲泼尼龙琥珀酸钠耳后注射治疗突发性聋

目的　探讨以耳后注射用甲泼尼龙琥珀酸钠作为突发性聋初始激素治疗的效果。方法　72例突发性聋患者随机分为两组,耳后注射组35例（耳）,给予注射用甲 泼尼龙琥珀酸钠20 mg,耳后乳突骨膜下注射,每3 d给药1次;静脉用药组37例（耳）,给予地塞米松磷酸钠注射液10 mg,静脉滴注,每日1次,3 d后减量至5 mg,继续用药3 d后停药。结果　耳后注射组痊愈16耳,显效6耳,有效4耳,无效9耳,总有效率74.3%;全身用药组痊愈17耳,显效5耳,有效4耳,无效11耳,总有效率70.3%。两组差异无统计学意义。结论　耳后注射皮质类固醇激素治疗突发性聋疗效可靠,可作为突发性聋激素治疗的初始给药方法。     

三磷酸胞苷加地塞米松等综合治疗突发性聋的临床观察

目的　对三磷酸胞苷 (cyntridinitriphosphatis ,CTP)加地塞米松等综合治疗突发性聋的疗效进行临床观察。方法　将 2 0 7例 (312耳 )突发性聋患者按照就诊顺序分成CTP组 10 6例 (15 9耳 )和对照组 10 1例 (15 3耳 )。CTP组使用CTP治疗 ,对照组采用传统的ATP、辅酶A、肌苷 0 4g和维生素C治疗 ;两组还同时加用地塞米松、维生素B、吸氧、丹参等完全相同的治疗。如有明确的感冒受凉史(CTP组 2 5例 ,对照组 2 7例 ) ,则加用抗病毒药及干扰素。两组在治疗前和治疗后 2d开始每 4d用纯音电测听测试患者的听力。结果　CTP组和对照组在治疗前平均听阈分别为 (76 5 6± 19 0 4 )dBHL和 (74 0 1± 17 0 7)dBHL(P >0 0 5 ) ;治疗后 ,CTP组 10 6例中痊愈 6 7例 (94耳 )、显效 2 1例 (35耳 )、有效 16例 (2 7耳 )及无效 2例 (3耳 ) ,治愈率 5 9 12 % ,平均听阈为 (43 0 8± 2 1 4 7)dBHL ,听力平均提高(2 7 39± 18 4 4 )dB ,未见任何副作用 ;对照组 10 1例 (15 3耳 )中痊愈 16例 (2 5耳 )、显效 19例 (32耳 )、有效 5 1例 (73耳 )及无效 15例 (2 3耳 ) ,治愈率 16 34% ,平均听阈分别为 (5 7 13± 32 4 1)dBHL ,平均听力提高 (19 4 5± 19 12 )dB。两组经统计学处理差异有显著性 (P <0 0 5 )。结论　CTP治疗突发     

血栓通联合长春西汀治疗突发性聋的临床观察

目的对血栓通联合长春西汀治疗突发性聋的疗效进行临床观察。方法92例（114耳）突发性聋患者按就诊顺序分成实验组50例（59耳）和对照组42例（55耳）。实验组血栓通联合长春西汀治虎对照组用复方丹参治疗;两组均常规行激素、能量合剂、高压氧、B族维生素治疗。两组在治疗前和治疗后4d开始每3d用纯音电测听测试患者听力。结果经治疗后,实验组50例（59耳）中痊愈23例（27耳）,显效16例（18耳）,有效6例（7耳）,无效5例（7耳）,治愈率为45．8％,对照组42例（55耳）中痊愈9例（12耳）,显效8例（13耳）,有效15例（15耳）,无效10例（15耳）,治愈率为21．8％,两组统计学处理差异有显著性（K0．05）。结论血栓通联合长春西汀治疗突发性聋能显著提高疗效。     

老年与中青年突发性聋的疗效比较

目的 了解老年与中青年突发性聋患者的不同临床特征和疗效。方法 回顾 分析123例（129耳）突发性聋资料,分成两组：老年组（60≥岁）72例（76耳）,中青年组（＜60岁）51例（53耳）。所有患者行皮质类固醇激素、能量合剂等治疗,一部分患者加用高压氧和东菱克栓酶辅助治疗,5例上述治疗无效患者行甲强龙鼓室灌注治疗。结果分析用χ2检验和ｔ检验。结果 两组治疗后的总有效率（痊愈、显效、有效之和）分别为59.2％和69.8％,差异无统计学意义（χ2＝3.26,P＞0.05）,总显效率（痊愈、显效之和）为34.2％和56.6％,差异有统计学意义（χ2＝6.37,P＜0.05）。患者发病至就诊时间差异有统计学意义（t=2.14,P＜0.05）。治疗前健患侧听力差分别为(28.5±13.9)dB和(42.1±28.2)dB ,差异有统计学意义（t=3.64,P＜0.01）。老年组患者合并糖尿病、高血脂症（25/76,48/76）的比例较中青年组（9/53,12/53）高。结论 老年突发性聋患者往往有基础的听力损失,发病呈渐进性和隐匿性,虽然总有效率与中青年患者相似,但显效率较低。类固醇激素鼓室灌注经圆窗渗透对一般治疗无效的部分患者仍有效。     

突发性聋伴高脂血症患者降脂干预的临床研究

目的　探讨突发性聋伴高脂血症患者血浆P选择素、血小板、蛋白激酶C( proteinkinaseC ,PKC)、脂蛋白 (a) [lipoproten(a) ,Lp(a) ]、血清一氧化氮 (NO)水平变化及降脂干预的价值。 方法　60例患者 ,分为试验组和对照组 (各 30例 ) ,对照组采用高压氧及扩血管剂治疗 ,试验组加用降脂药物。采用双位点双抗夹心法测定Lp(a) ,酶标多克隆抗体夹心法测定P选择素 ,硝酸还原酶比色法测定NO ,双试剂免疫比浊法测定血脂 ,血细胞分析仪测定血小板。另选 30名健康者作为健康对照组。结果　治疗后听力恢复试验组治愈 1 8耳 ,显效 9耳 ,有效 6耳 ,无效 5耳。对照组治愈 7耳 ,显效 1 1耳 ,有效 1 0耳 ,无效 1 3耳。两组比较 ,差异存在显著性 ( χ2 =3 86,P <0 0 5 )。血液检测表明 :试验组血小板、Lp(a)、膜性PKC(membranousPKC ,M PKC)、P选择素、NO治疗前与健康组比较 ,差异存在显著性 ;治疗后比较 ,差异无显著性。试验组治疗前后比较 ,差异存在显著性。对照组血小板、Lp(a)、M PKC、P选择素、NO治疗前、后与健康组比较 ,差异均有显著性。对照组治疗前后比较 ,差异无显著性。试验组血小板、Lp(a)、M PKC、P选择素、NO治疗前与对照组比较 ,差异无显著性 ;治疗后比较 ,差异存在显著性。结论　通过降脂干预 ,能够有效地     

银杏达莫与巴曲酶联合治疗平坦型突发性聋的疗效观察

目的探讨使用银杏达莫与巴曲酶联合治疗平坦型突发性聋(简称突聋)的疗效。方法将66例平坦型突聋患者随机分为2组,治疗组(36例,40耳)用银杏达莫与巴曲酶联合治疗,对照组(30例,32耳)用巴曲酶注射液治疗,其他治疗两组相同,对两组患者治疗前后进行纯音听阈测试,观察两组患者的听力改善情况。结果治疗组36例(40耳)中治愈18耳,显效16耳,有效4耳,无效2耳,总有效率95.00%(38/40);对照组治愈9耳,显效10耳,有效7耳,无效6耳,总有效率81.25%(26/32)),治疗组总有效率高于对照组(P<0.05)。结论银杏达莫与巴曲酶联合治疗平坦型突聋较单一使用巴曲酶疗效好。     

Histological studies on inherited and on post-rubella deafness

Summary The histological changes in the inner ear of a newborn male with unquestionable genetically determined deafness of the Scheibe type are reported. They resemble those of a healed mild serous labyrinthitis. Unusual findings are several large cysts in the stria vascularis and a slight cochlear hydrops.Examination of the temporal bones of 6 infants with maternal rubella ranging in age from newborn to 21/2 months show inner pathology in three, again compatible with the diagnosis of a healed serous labyrinthitis of viral origin.A review of the observations of genetically determined deafness of the Scheibe type shows that they can be divided into two groups. The first group to which case I described in this paper belongs is characterized by findings resembling those observed in healed serous or viral labyrinthitis of a mild degree, and in mild posthydropic neuroepithelial degeneration. The second group shows purely degenerative atrophic changes which appear to resemble a mild genuine neuroepithelial degeneration.The hypothesis is considered that the changes found in both groups could be the result of certain types of malfunction of the stria vascularis which interfere with the ability of the stria to maintain the normal chemical constitution of the endolymph. This possible explanation is put forth in view of the similarities between the changes produced by genetic and the changes produced by extrinsic factors.The pathognomonic significance of the PAS positive concrements which are sometimes found in the stria vascularis and the saccular epithelium in cases of genetically determined deafness but not in healed viral endolabyrinthitis, remains obscure.

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Zusammenfassung Die histologischen Innenohrveränderungen eines Neugeborenen mit zweifellos genetisch bedingter Taubheit vom Scheibe-Typ ähnelten denen einer leichtgradigen serösen Labyrinthitis. Ungewöhnliche Befunde waren ein geringer Hydrops cochlearis and mehrere große Cysten in der Stria vascularis.Von den Schläfebeinen von sechs Säuglingen mit mütterlicher Rubella während der ersten 3 Monate der Schwangerschaft zeigten drei Befunde, die wiederum denen bei einer geheilten leichtgradigen serösen Labyrinthitis glichen.Die Befunde beim Typus Scheibe können in zwei Gruppen eingeteilt werden. Die erste Gruppe, zu der auch die erste der hier mitgeteilten Beobachtungen gehört, erinnnert an die Befunde bei leichtgradiger posthydropischer Neuroepithel-Degeneration. Die zweite Gruppe zeigt rein degenerativ-atrophische Veranderungen, ähnlich denen bei einer leichtgradigen genuinen Neuroepitheldegeneration.Die Veranderungen in beiden Gruppen könnten möglicherweise auf verschiedenartige Funktions-Störungen der Stria vascularis zurückgeführt werden, die dieselbe außerstande setzen, die normale chemische Zusammensetzung der Endolymphe aufrecht zu erhalten. Ein derartiger Erklärungsversuch wird durch die Ähnlichkeiten zwischen den genetisch bedingten and den durch äußere Faktoren verursachten Veränderungen nahegelegt.

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This work was supported by grant NB 0-3376/061 A of the National Institute of Health and by the Research Fund of the American Otological Society.     

Adult-children's perspectives on a parent's hearing impairment and its impact on their relationship and communication

Objective: The aim of the study was to describe third-party disability experienced by adult-children as a result of hearing impairment (HI) in a parent. Design: Using semi-structured interviews, participants were asked to describe the impact of a parent's HI on their relationship and communication. Interpretative phenomenological analysis, a qualitative method to explore participant's perceptions and viewpoints, was used as the method of analysis. Study sample: Twelve participants between the ages of 22 and 58 who each had a parent with confirmed HI who owned hearing aids. Results: Within the contextual factors of family relationships, communication situations, and the parent's personality, adult-children considered their coping strategies and feelings that arose as a result of the HI. Coping strategies included putting forth effort in communication, yelling as an ineffective communication strategy, and providing support to the parent with HI. The described feelings included frustration, uncertainty, and loss surrounding their communication and relationship with their parent with HI. These feelings arose as a result of implementing coping strategies, plus these feelings drove the employment of coping strategies. Conclusions: Adult-children of parents with HI experience third-party disability, however, the participation restrictions and activity limitations experienced by children appear less than experienced by spouses.     

Stimulus and transducer effects on threshold

Abstract

Objective: This study examined differences in thresholds obtained under Sennheiser HDA200 circumaural earphones using pure tone, equivalent rectangular noise bands, and 1/3 octave noise bands relative to thresholds obtained using Telephonics TDH-39P supra-aural earphones. Design: Thresholds were obtained via each transducer and stimulus condition six times within a 10-day period. Study sample: Forty-nine adults were selected from a prior study to represent low, moderate, and high threshold reliability. Results: The results suggested that (1) only small adjustments were needed to reach equivalent TDH-39P thresholds, (2) pure-tone thresholds obtained with HDA200 circumaural earphones had reliability equal to or better than those obtained using TDH-39P earphones, (3) the reliability of noise-band thresholds improved with broader stimulus bandwidth and was either equal to or better than pure-tone thresholds, and (4) frequency-specificity declined with stimulus bandwidths greater than one equivalent rectangular band, which could complicate early detection of hearing changes that occur within a narrow frequency range. Conclusions: These data suggest that circumaural earphones such as the HDA200 headphones provide better reliability for audiometric testing as compared to the TDH-39P earphones. These data support the use of noise bands, preferably ERB noises, as stimuli for audiometric monitoring.     

mtDNA~(CD4977)与老年性聋相关性的研究进展

半个世纪以来,老年性聋发病率在全球范围内持续增长。据美国公共卫生署统计,75岁以上的老年人约40%~66%的有听力损失,而超过80岁的老年人80%以上有听力损失[1-3]。老年性聋是随着年龄逐步进展,双耳对称性的,以感音神经性为主的慢性进行性听力减退,又称年龄相关的听力损失[4-6]。它是年龄增长后听觉器官逐步衰老的过程,是听觉系统精细结构处理信息发生障碍的过程[7]。老年性聋是由多种危险因子的长期累积损害而成,其中年龄是最重要的危险因子。而长期慢性疾病,如高血压、糖尿病能引起内耳供血的减少,也会进一步加重听力的损害[1,8-9]。随着生物医学的不断发展,许多学者发现老年性聋患者不仅伴有核基因组的改变,线粒体DNA(mitochondrial DNA,mtDNA)的突变和缺失在老年性聋的发生、发展过程中也发挥重要作用[2,6,10]。