高压氧治疗不同分型突发性聋研究进展

突发性聋的发病机制尚不明确, 各型突发性聋的治疗方案也存在差异。高压氧治疗是突发性聋的一种辅助疗法, 主要作为初始治疗和药物治疗无效的补救治疗措施, 常与激素等药物联合使用, 具有安全、经济、有效等特点。了解高压氧在不同分型突发性聋中的作用机制、使用方案和疗效, 对高压氧治疗突发性聋的临床应用和理论研究具有重要意义。     

糖皮质激素耳后注射治疗突发性聋的基础与临床研究

突发性聋是72小时内突然发生的原因不明的感音神经性听力损失,治愈率较低,有遗留听力残疾的可能,严重影响患者的生活质量。本文回顾分析了突发性聋的分型、循证治疗和糖皮质激素治疗的相关文献,归纳了耳后注射糖皮质激素治疗突发性聋的临床和基础研究现状,提出了目前突发性聋治疗中存在的问题,以助力突发性聋的临床诊治工作。     

高压氧联合药物治疗突发性聋

目的探讨高压氧联合药物治疗突发性聋的临床疗效及其治疗机理.方法将突发性聋166例随机分为高压氧联合药物治疗与单纯药物治疗2组各83例.高压氧治疗为0.2MPa下吸纯氧60min,每日1次,配合使用扩血管营养神经药物.对照组单纯使用药物治疗.比较两组疗效结果治疗组总有效率81.93%,听力开始恢复时间在治疗后1～12d.对照组总有效率39.76%,听力开始恢复时间1～15d,差异有显著性(P＜0.05).结论高压氧联合药物治疗突聋疗效明显优于单纯药物治疗者.     

微波治疗突发性聋的临床研究

目的研究微波治疗突聋的疗效.方法将突发性聋94例、106耳随机分为单纯药物组和微波组.并观测微波组辐射前后颅内底血流及脑地形图的变化.结果微波组治愈率37.1%,显效率40%,药物组治愈率14.1%,显效率15.5%,2组差异有显著性(P＜0.05).微波辐射前后颅内底血流及脑地形图无差异性.采用WE-2102A多功能微波机治疗突发性聋的最佳参数为输出功率80～90W,测温40～41℃.剂量参照患者的主观感觉以耳温热量为度.结论微波治疗突发性聋的效果好于单纯的药物治疗,在药物治疗的基础上加微波辐射可取得更好的疗效.     

探讨激素在突发性聋治疗中的作用机制

突发性聋是指72 h内突然发生的、原因不明的感音神经性听力损失,至少在相邻的两个频率听力下降≥20 dBHL.目前突发性聋国际公认的最有效治疗药物之一是糖皮质激素,本文从突发性聋的发病原因、糖皮质激素的治疗机制、给药方式及特点等方面来综述糖皮质激素在突发性聋治疗中的应用.     

针灸联合药物治疗平坦下降型突发性聋的疗效观察

目的 探讨针灸联合药物治疗平坦下降型突发性聋的疗效.方法 将我科于2017年2月-2020年5月收治入院的82例平坦下降型突发性聋患者随机分为观察组和对照组.观察组使用针灸配合药物治疗,对照组采用单纯药物治疗.结果 治疗后从整体疗效、听力损失程度、就诊前发病时间等方面进行比较,观察组整体疗效明显优于对照组(P＜0.05...     

老年突发性聋患者血液纤维蛋白原和黏附分子测定及其临床意义

目的　探讨老年突发性聋患者血液纤维蛋白原,可溶性细胞间黏附因子（soluable intercellular adhesion molecule-1,sICAM-1）,可溶性血管内皮黏附因子-1（soluable vascular cell adhesion molecule-1,sVCAM-1）的变化以及不同分型突发性聋患者的差异。方法　40例老年突发性聋患者按照中华医学会最新的诊断治疗指南分型,并按有无合并症进行分组,40例健康的老年体检者作为对照组。测定血液纤维蛋白原水平,sICAM-1和sVCAM-1表达,结果进行统计学分析。结果　老年突发性聋血纤维蛋白原、sICAM-1和sVCAM-1表达均高于对照组,差别有显著性意义。不同突发性聋分型患者间以上指标的表达无显著性差别,但有合并症突发性聋以上指标的表达高于无合并症,差别有显著性意义。结论　老年突发性聋血液纤维蛋白原、sICAM-1和sVCAM-1表达增高,微循环障碍可能在老年突发性聋发病中占主导地位。     

凯时及传统方法治疗突发性聋的疗效观察

目的比较凯时及传统方法治疗突发性聋的临床疗效.方法分别对120例突发性聋患者采用凯时、高压氧(凯时组)及传统方法治疗.结果凯时组疗效明显优于传统方法组,差异有显著性(P＜0.05).结论凯时是治疗突发性聋的有效药物.     

全频突发性聋的分型探讨

目的 了解全频突发性聋的分型及其治疗效果的差异.方法 对2005年8月至2008年3月就诊的87例全频突发性聋患者进行研究.所有病例均采用甲基泼尼松龙+巴曲酶注射液(东菱迪芙)+血栓通治疗.结果 根据听力下降的速度将全频突发性聋分为缓降型和骤降型,缓降型的有效率及显效率分别为84.4%(27/32)及68.8%(22/32),骤降型的有效率及显效率分别为52.7%(29/55)及32.7%(18/55);缓降型预后明显好于骤降型(P<0.01).根据听力下降的程度将全频突发性聋分为平坦型和全聋型,以平均听阈90 dB作为划分标准时平坦型的有效率及显效率分别为73.3%(44/60)及53.3%(32/60),全聋型的有效率及显效率分别为44.4%(12/27)及29.6%(8/27);平坦型预后明显好于全聋型(有效率P<0.01,显效率P<0.05).结论 全频突发性聋有必要进一步分型.根据听力下降的速度可分为缓降型和骤降型,缓降型预后明显好于骤降型;根据听力下降的程度可分为平坦型和全聋型,全聋型预后较差,以平均听阈90 dB作为平坦型和全聋型的划分标准更为合适.     

血液光量子治疗突发性聋

目的：探讨自血光量子治疗突发性聋的疗效。方法：采用血液光量子法加常规药物、高氧压疗法加常规药物以及单纯药物治疗突发性聋各42例（48耳）。结果：光量子组、高氧压组、药物组治疗突发性聋总有效率分别为90.5%、90.5%、69.0%,光量子组与高氧压组差异无统计学意义（P＞0.05）,光量子组与药物组、高氧压组与药物组差异有统计学意义(P均＜0.01)。结论：血液光量子治疗突发性聋简便有效。     

突发性耳聋伴眩晕患者听力预后分析

摘要：目的回顾性分析突发性耳聋（sudden deafness,SD）患者的听力损失程度、预后与发病时是否伴有眩晕发作的关系。探索突发性耳聋单发听力损失、突发性耳聋伴眩晕的诊断、治疗及预后评价。 方法按中华医学会耳鼻咽喉头颈外科学分会颁布的突发性耳聋诊断标准，2012年1月~2015年12月收治突发性耳聋患者196例。对所有患者进行扩管溶栓、营养神经、抗病毒及高压氧治疗，按2007年中华耳鼻咽喉学会颁布的突发性耳聋疗效及分级标准，针对听力恢复进行疗效评价。结果伴有眩晕症状患者发病率为30.7%，听力损失在50 dB以上，听力恢复有效率23%；不伴有眩晕症状患者发病率为69.3%，听力恢复有效率73%。结论伴发眩晕的突发性耳聋患者，往往其听力损失严重，且预后不佳。     

摩拉联合扩血管药物治疗突发性耳聋的临床观察

目的探讨摩拉联合扩血管药物治疗突发性耳聋的疗效。方法选取2013年10月~2016年10月120例（128耳）突发性耳聋患者为研究对象,将所有患者按入院时间随机分为两组,A组患者60例（66耳）给予摩拉治疗以及改善微循环、糖皮质激素及营养神经等综合治疗12 d;B组患者60例（62耳）单纯给予改善微循环、糖皮质激素及营养神经等综合治疗12 d。观察两组治疗情况。结果A组的治疗总有效率为90.91%,高于B组的74.19%,经比较且差异具有统计学意义（P＜0.05）。结论摩拉联合扩血管药物治疗突发性耳聋,能够显著提高临床疗效,且无毒副作用,值得应用推广。     

病程超过3周的突发性聋患者的临床疗效分析

目的 了解对病程超过3周的突发性聋患者以糖皮质激素等药物进行治疗的意义.方法 对北京大学人民医院耳鼻咽喉科2002年11月至2010年7月住院治疗的48例(58耳)病程超过3周的突发性聋患者的临床资料进行同顾性分析.根据本次入院治疗前的听力曲线分为3组,分别采用不同的治疗方案,观察其疗效.以SPSS 17.0统计软件对数据进行分析,患者治疗前后纯音测听阈值采用t检验.结果 低频下降型(6耳)、高频下降型(22耳)、全频下降型(30耳)治疗后有效率分别为83.3%、31.8%、36.7%.病程≥1年的共12耳,其治疗有效率58.3%(7耳).全频下降型中本次治疗前气导听阈均值≥90 dB(听力级)的9耳,7耳(77.8%)治疗有效,其中3耳(33.3%)达到显效标准;本次治疗前气导听阈均值＜90 dB的患者21耳,其中3耳(14.3%)治疗有效.结论 病程超过3周的突发性聋患者仍有积极治疗的意义.其中低频下降型治疗有效率最高,高频下降型有效率最低,全频下降型有效率居中.病程≥1年的突发性聋患者经积极治疗仍有改善听力可能.全频下降型、听功能损失程度较重的患者,通过积极治疗获益较大.

Abstract：

Objective To investigate and analyze the significance of a course of glucocortieosteroids and other drugs for the treatment of patients with sudden deafness present for at least three weeks.Methods A retrospective review was done on 48 patients (58 ears) with sudden deafness present for at least three weeks or more,who were admitted to the Department of Otorhinolaryngology,Peking University People's Hospital from November 2002 to July 2010.The patients were devided into three groups by the type of hearing threshold.The different treatments were used in the three groups.The SPSS 17.0 software was used to analyze the data.Results In patients with a low tone hearing loss (6 ears) ,83.3% improved.For patients with a high tone loss (22 ears) 31.8% improved.For a flat tone hearing loss (30 ears) 36.7% improved.For patients with a hearing loss more than one year (12 ears) there was improvement in 58.3% (7 ears)of the patients.In 9 ears which had a flat tone hearing loss of 90 dB or greater before treatment,77.8% (7 ears) improved with 33.3% (3 ears) having a significant improvement.In 21 ears which had a hearing threshold was under 90 dB,14.3% (3 ears) improved.Conclusions In the treatment of patients with sudden deafness which was longer than 21 days the treatment was significant,especially for those who had a 90 dB or greater flat-tone type hearing threshold before treatment.Even though the hearing loss was more than a year in some patients there was still a benefit from treatment.     

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.     

Acute unilateral deafness caused by mumps--a case description

Reports of the aetiology of mumps induced deafness in the auditory pathway have not appeared in the literature in recent years. It is now possible to distinguish between sensory deafness and other types of profound hearing loss by combining the results of promontory testing (PT) and electrocochleography (ECochG). A very extensive examination of a case of profound sudden hearing loss due to mumps is described. It was impossible to prove a relation between the mumps virus and sudden hearing loss in this case but the site of the lesion in the auditory pathway could be localised. The hearing loss in this case was of sensory type, profound, irreversible and resistant to treatment.     

"Sudden deafness" in childhood and adolescence. Symptoms, therapy and prognosis--a retrospective study]

Fourteen children and adolescents aged between four and 17 years with genuine sudden hearing loss were analyzed in a retrospective study. The symptoms of hearing loss, tinnitus and vertigo were similar to those found in adults. The study's findings suggest that younger children particularly below the age of 14, will not suffer from these symptoms. Consequently, the disease was frequently diagnosed in younger children after the parents had observed defective hearing. In an 13-year-old child it was not possible to provoke a caloric vestibular response. As in the case of the other children (below 14 years of age) this patient did not complain of vertigo. -The prognosis of sudden hearing loss in children is poor. Thus 22% (two out of nine) of all patients treated with drugs became deaf. Moreover, 29% (four out of 14) of all patients examined (with and without therapy) remained deaf after sudden hearing loss. It is concluded that, due to this poor prognosis, a therapeutic attempt should be performed analogous to the treatment given to adults.     

Traces of perilymph detected in epipharyngeal fluid: perilymphatic fistula as a cause of sudden hearing loss diagnosed with beta-trace protein (prostaglandin D synthase) immunoelectrophoresis

The incidence of perilymphatic fistula as cause of sudden hearing loss is not known. We present a case with sudden unilateral hearing loss associated with a positive beta-trace protein test of an epipharyngeal fluid sample. The patient presented with sudden sensorineural hearing loss on the right side. A stapedotomy had been performed nine months previously due to otosclerosis. Intravenous therapy for the treatment of sudden hearing loss was unsuccessful. At the time of sudden hearing loss, epipharyngeal fluid was collected using a Raucocel sinus pack. Investigation using rocket immunoelectrophoresis showed the presence of beta-trace protein. Upon repeating tympanoscopy there was no obvious labyrinthine fluid egress, but the oval window was sealed with fibrin sponge and fibrin glue. The patient's hearing improved over a period of five months.     

经鼓室应用类固醇激素治疗内耳疾病进展

类固醇激素可以改善内淋巴积水和耳蜗循环功能、减轻内耳炎症水肿,是治疗内耳疾病比较公认且临床普遍应用的制剂。近年来经鼓室应用类固醇激素治疗内耳疾病以其给药后耳蜗淋巴液中药物浓度高、疗效可靠、副作用极少等优点,越来越受到重视。本文回顾了近十几年国内外学者关于经鼓室应用类固醇激素治疗梅尼埃病、突发性聋、耳鸣等疾病的相关文献,对鼓室内类固醇激素治疗的优势、疗效等进行综述。尽管目前最佳的药物类型、剂量、疗程、持续时间等都未确定,但经鼓室应用类固醇激素的前景十分乐观,是否可以成为全身激素治疗的一种替代疗法,仍需进一步深入的实验研究和调查。     

突发性聋伴发良性阵发性位置性眩晕的临床特点及疗效观察

目的　探讨突发性聋伴发良性阵发性位置性眩晕（benign paroxysmal positional vertigo,BPPV）的临床特点,观察其疗效。方法　观察2012年10月～2014年6月耳 鼻咽喉科收治的36例突发性聋伴发BPPV发病情况,并与同期原发性BPPV患者40例及突发性聋不伴眩晕患者40例进行疗效比较。结果　伴发BPPV的36例突发性聋患者,受累半规管均与突发性聋发病侧一致,其中水平半规管BPPV 6例,占16.7%（6/36）;后半规管BPPV 27例,占75.0%（27/36）;混合管BPPV 3例,占8.3%（3/36）。36例患者出现BPPV的时间均在突发性聋发病后数小时至数天（＜10天）发生。突发性聋伴发BPPV组1次治愈率明显低于原发性BPPV组,但两种治疗方法的总治愈率均为100%。不伴眩晕突发性聋组的痊愈率、显效率及有效率均高于伴发BPPV组。结论　伴发于突发性聋的BPPV以后半规管多见,与原发性BPPV经耳石复位治疗后均可取得较好疗效。而不伴眩晕的突发性聋其疗效优于伴发BPPV的突发性聋。     

Noise-induced autoimmune sensorineural hearing loss

Typically, autoimmune sensorineural hearing loss has been described as a slowly progressive, asymmetric hearing loss that is responsive to medications traditionally used in the treatment of other autoimmune conditions. These medications include steroids and cytotoxic drugs. Inciting factors in autoimmune inner ear disease are rarely cited. We describe a case of episodic sudden hearing loss triggered consistently by environmental noise. The hearing loss was responsive to steroids at the time of each occurrence and was determined to be autoimmune. This case raises questions about the relationship between autoimmune inner ear disease and sensitivity to environmental noise that warrant further research.