全频下降型突发性聋预后的相关因素分析

目的　分析全频下降型突发性聋患者预后相关的影响因素。方法　选择收治的78例全频下降型突发性聋患者，分为治疗有效和无效两组。比较血液学检验相关参数的差异。分别采用Logistic回归和ROC曲线分析上述参数对于全频下降型突发性聋预后的影响及预测价值。结果　全频下降型突发性聋治疗有效组纤维蛋白原和C-反应蛋白水平明显低于治疗无效组（P 分别为0.001和0.025）。Logistic回归分析发现，只有纤维蛋白原水平能显著影响其预后（P =0.032）。而且，纤维蛋白原水平对全频下降型突发性聋有显著的预测价值（P =0.001），预测的敏感性和特异性分别为85.4%和60.0%。结论　血清纤维蛋白原水平与全频下降型突发性聋的预后有明显相关性，可作为评估其预后的临床应用指标。     

巴曲酶治疗全频下降型突发性耳聋的疗效观察及与凝血功能的相关性分析

目的 探讨巴曲酶治疗全频下降型突发性耳聋的疗效与巴曲酶敏感性及凝血功能指标的相关性。方法 回顾性分析2019年1月—2021年2月全频下降型突发性耳聋患者48例,根据患者纤维蛋白原(FIB)的变化分为敏感组及非敏感组,检测患者凝血功能包括活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、FIB的变化及治疗前后纯音听阈变化。结果 ①48例患者总有效率为75.0%,其中平坦型总有效率为72.4%,全聋型总有效率为78.9%,敏感组有效率为85.7%,非敏感组有效率为60.0%,敏感组有效率高于非敏感组,差异具有统计学意义(P<0.05);②敏感组患者治疗后与治疗前相比FIB、APTT下降,TT、PT升高,差异具有统计学意义(P<0.05),非敏感组患者治疗后较治疗前FIB降低,TT升高,差异具有统计学意义(P<0.05)。治疗后,敏感组FIB低于非敏感组,TT、PT高于非敏感组,差异具有统计学意义(P<0.05)。结论 巴曲酶敏感性与临床治疗效果具有相关性,主要与FIB、PT、TT密切相关,与APTT相关性不大,但机体可能通过APTT内源性凝血功能,降低出血风险。巴曲酶可增强抗凝血功能,促进内耳微循环,使抗凝、纤溶和凝血在一定范围内保持平衡,安全性良好。     

全聋型突发性聋患者的预后及相关因素分析北大核心CSCD

目的分析全聋型突发性聋的临床特征及影响预后的因素,为该类型突聋的治疗及预后评估提供参考。方法回顾性分析2012年1月到2017年1月住院治疗的98例(98耳)全聋型突发性聋患者(250~8 000 Hz平均听阈94.94±8.30HL)的临床资料,根据疗效将患者分为有效组(34例)及无效组(64例),采用单因素及多因素分析的方法分析患者的性别、耳侧、年龄、病程、初诊听阈,是否伴发耳鸣、眩晕及耳闷胀感,是否有高血压、糖尿病史及鼓室注药、纤溶酶溶栓等多种因素对预后的影响。结果治疗后患者平均听阈为70.79±10.13dB HL,痊愈2耳、显效21耳、有效11耳,无效64耳,总有效率为34.69%(34/98),其中痊愈率、显效率及有效率分别为2.04%、21.43%和11.22%。多因素分析有效组和无效组上述各因素与疗效关系结果显示,初诊听阈越高,预后越差(P<0.05);伴发眩晕不利于患者的预后(P<0.05);给予鼓室注药及纤溶酶溶栓治疗有利于患者的预后(P<0.05)。结论全聋型突发性聋就诊时听力损失程度越轻、不伴发眩晕、鼓室注药及纤溶酶溶栓治疗的患者预后较好;积极治疗后,仍有好转甚至痊愈的可能。     

鼓室内与静脉注射地塞米松治疗突发性聋疗效比较北大核心CSCD

目的探讨鼓室内与静脉注射激素治疗突发性聋的疗效。方法 121例单耳突发性聋患者进行前瞻性随机对照研究,分为治疗组(60例,地塞米松3~5mg鼓室内注射,1次/天,连续7d)和对照组(61例,地塞米松10mg/d静脉滴注,持续3~5d),并于治疗前及治疗后第1、4及8w行纯音听阈测试,比较两组治疗后的有效率;并分别比较两组低频下降型、高频下降型及全频下降型患者之间治疗后气导听力提高值及3型之间总体听力提高值。结果 (1)治疗后1周治疗组痊愈11例,显效15例,有效20例,总有效率76.7%(46/60);对照组痊愈9例,显效16例,有效18例,总有效率71.67%(43/60),两组间总有效率比较差异无统计学意义(P>0.05)。治疗后4w及8w,两组间总有效率比较差异均无统计学意义(P>0.05)。(2)治疗后8w治疗组低频下降型及高频下降型突聋患者听力提高值分别为26.35±4.77及17.04±9.60dB,对照组分别为20.60±3.60及14.08±7.43dB,治疗组疗效较对照组更优(P<0.05)。(3)两组合计治疗后低频下降型突发性聋患者听力提高值(23.48±4.52dB)明显优于高频下降型(15.39±8.97dB)及全频下降型(10.73±7.11dB)(P<0.01)。结论连续1周每日鼓室内注射地塞米松治疗突发性聋是一种安全有效的方法,对于低频及高频下降型突发性聋患者,其较静脉给药疗效更优,值得临床推广。     

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。     

耳后注射甲强龙作为补救方案在中高频听力下降型突发性聋治疗中的疗效及可行性分析

目的探析中高频听力下降型突发性聋采取耳后注射甲强龙治疗的临床效果及可行性。方法选取2019年5月~2020年7月本院耳鼻喉科就诊的中高频听力下降型突发性聋患者,共纳入病例54例,以随机法分组,即常规组(n=27)和观察组(n=27),常规组予常规治疗,观察组采取耳后注射甲强龙,比较两组效果。结果观察组有效率相比于常规组显著提高(P<0.05);治疗3周后,观察组2000~8000Hz频率听力提高值与常规组比(P<0.05)。结论中高频听力下降型突发性聋采取耳后注射甲强龙治疗效果理想,值得推广。     

治疗前听力图形状与突发性聋预后关系分析

目的探讨突发性聋患者治疗前听力图形状与预后的关系。方法回顾性分析我科收治的339例突发性聋患者的临床资料。按患者治疗前听力图形状,分为上坡型,下坡型,凹陷型,平坦型,极重度聋型,全聋型六组。对突发性聋患者的治疗前听力图形状和预后的关系进行秩和检验分析,检验方法有Kruskal-Wallis Test和Mann-Whitney Test。结果经秩和检验分析,治疗前六组听力图形状和预后的差异有统计学意义。突发性聋患者听力图形状呈凹陷型和上坡型的预后较好,总有效率分别为83.8%和78.2%;听力图形状呈下坡型,平坦型,极重度聋型预后较差,总有效率分别为46.2%,64.8%和57.1%;全聋型预后最差,总有效率仅为30.6%。结论突发性聋患者治疗前听力图形状为全聋型的预后最差,听力图形状为凹陷型和上坡型的预后较好。     

突发性聋与血脂代谢异常和血浆纤维蛋白原增高的相关性分析

目的分析突发性聋(sudden hearing loss,SHL)患者血脂代谢特点及血浆纤维蛋白原的水平,探讨其与突发性聋发病的相关性。方法 180例突发性聋患者(SHL组)根据纯音听阈曲线类型分为低中频下降组(低中频组)40例、高频下降组(高频组)90例、全频下降组(全频组)50例;另选取180例同期住院治疗、听力正常的鼻中隔偏曲、声带息肉患者作为对照组。检测各组对象的外周血甘油三脂(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、血糖(GLU)、血浆纤维蛋白原(FIB)的水平并行对比分析;对有意义的因素进行多因素Logistic回归分析。结果 SHL组(尤其是全频下降型和低中频下降型)TC、LDL-C、Glu、FIB高于对照组,HDL-C低于对照组,差异有统计学意义(P<0.05),TG与对照组差异无统计学意义(P>0.05);Logistic多因素分析显示LDL-C、FIB水平增高是突发性聋发病的主要相关危险因素。结论突发性聋患者血脂代谢异常,LDL-C和FIB水平增高是突发性聋发病的相关危险因素。     

血白细胞及C-反应蛋白对评价突发性聋发病及预后的作用

目的探讨血白细胞(WBC)及C-反应蛋白(C-reaction protein,CRP)与突发性聋发病及预后的关系。方法选取突发性聋患者162例,按照入院血常规检查结果及是否应用抗生素治疗,分为WBC正常组78例(WBC≤10×109/L),给予常规治疗;高WBC常规治疗组42例(WBC>10×109/L),给予常规治疗;高WBC联合治疗组42例(WBC>10×109/L),给予常规治疗同时联合抗生素治疗。分别检测三组患者治疗前后纯音听阈,比较治疗前后WBC及CRP水平的变化。结果高WBC常规治疗组有效率85.7%,高WBC联合治疗组有效率83.3%,均高于白细胞正常组的64.1%,差异有统计学意义(P<0.05);高WBC常规治疗组与高WBC联合治疗组有效率差异无统计学意义(P>0.05)。高WBC常规治疗组和高WBC联合治疗组治疗后WBC和CRP含量较治疗前均显著降低,差异均有统计学意义(P<0.05);但两组间治疗前后WBC和CRP水平相比,差异均无统计学意义(P>0.05)。低频下降型突聋患者中WBC升高者比例较其他听阈曲线类型者高,且治疗总有效率高于高频下降型和全频下降型患者。结论突聋的发病可能与炎症相关,但不是细菌感染引起的炎症反应,可能是机体的应激系统或免疫系统发挥作用,白细胞升高患者的治疗效果好于白细胞正常者,对白细胞升高的突聋患者采用抗生素治疗无临床意义。     

影响突发性聋患者耳鸣疗效的相关因素分析

目的探讨影响突发性聋患者耳鸣疗效的相关因素,为突发性聋伴耳鸣患者的临床诊治及预后判断提供依据。方法前瞻性分析比较117例突发性聋患者中符合入组条件的70例(74耳)突发性聋伴耳鸣患者的耳鸣疗效与性别、耳别、年龄、听力损失程度、听力曲线类型、耳鸣严重程度、听力损失疗效的关系。结果本组117例突发性聋患者中102例伴耳鸣(87.18%,102/117),其中,70例(74耳)入组对象中治疗后听力损失(耳)的总有效率为66.22%(49/74),耳鸣的总有效率为74.32%(55/74)。耳鸣疗效在不同性别、耳别、年龄、耳鸣程度患者之间的差异均无统计学意义(P>0.05);极重度聋、全聋型者的耳鸣总有效率明显低于其他各程度听力损失及各听力曲线类型者(P<0.01),听力损失疗效为无效者的耳鸣总有效率明显低于听力损失疗效为痊愈、显效、有效者(P<0.01)。结论伴耳鸣的突发性聋患者耳鸣疗效略好于其听力损失疗效,耳鸣疗效与性别、耳别、年龄、耳鸣程度无关;极重度听力损失、全聋型患者、听力损失治疗无效者的耳鸣疗效较差。     

早期联合鼓室注射糖皮质激素治疗突发性聋效果分析

目的　探讨早期联合鼓室注射糖皮质激素治疗突发性聋的疗效。方法　178例突发性聋患者纳入研究,中低频下降型44例,高频下降型50例,平坦型44例,全聋型40例,随机分为两组,其中联合鼓室注射组（CT组）82例,全身口服激素组（OP组）96例,CT组在口服醋酸泼尼松片治疗同时给予鼓室注射甲泼尼龙琥珀酸钠,治疗后 8周复查纯音纯音听力阈值。结果　中低频突发性聋患者中,CT组纯音听力阈及其提高值分别为（26.14±14.91）dB、（41.23±12.61）dB,而OP组为（37.91±13.98）dB、（30.00±13.30）dB,两者差异均具有统计学意义（P 均＜0.05）,而两组在高频型、平坦型及全聋型的差异无统计学意义（P 均＞0.05）,CT组纯音听力阈提高值为（26.52±14.03）dB,高于OP组（22.06±11.17）dB（t =2.361,P ＜0.05）;中低频突发性聋患者中,CT组治愈16 例（72.73%）,OP组治愈9例（40.91%）,差异有统计学意义（χ2=4.539,P＜0.05）,有效、显效及总有效的比较结果显示,两组中低频型突发性聋的治疗效果差异无明显统计学意义,而在高频型、平坦型及全聋型的比较上,CT组与OP组无论是在治愈、有效、显效还是在总有效上,两组差异均无明显统计学意义,CT组共治愈33例（40.24%）,优于OP组的25例（26.04%）（χ2=4.061,P＜0.05）,而两组在显效、有效及总有效率上的差异未见明显统计学意义。结论  中低频型突聋患者,早期联合鼓室注射糖皮质激素会获得更好听力恢复及疗效,对高频型、平坦型及全聋型突聋患者,推荐全身激素用药。     

Sudden sensorineural hearing loss: does application of glucocorticoids make sense?

BACKGROUND: Treatment of sudden sensorineural hearing loss (SSNHL) consists of administration of blood flow-promoting drugs with or without the addition of glucocorticoids. General guidelines based on scientific data do not currently exist. OBJECTIVE: To investigate the effect of glucocorticoids on the treatment of SSNHL. SETTING: Academic medical center. PATIENTS AND METHODS: We retrospectively analyzed the audiograms of 603 patients with SSNHL: 301 patients (cared for between January 1, 1986, and December 31, 1991) received intravenous blood flow-promoting drugs without glucocorticoids and 302 patients (cared for between January 1, 1992, and December 31, 1998) received intravenous blood flow-promoting drugs with glucocorticoids (intravenous +/- oral application). The age distribution of patients with SSNHL in lower, middle, and higher frequencies was similar in both groups. RESULTS: Patients with SSNHL in lower and middle frequencies (250-2000 Hz) who received glucocorticoids (prednisolone-21-hydrogen-succinate) showed significantly better recovery of hearing levels compared with those who did not receive glucocorticoids (P<.05). There was no significant difference at higher frequencies between the 2 groups. Patients with SSNHL throughout all frequencies (pancochlear hearing loss) who received glucocorticoids also had significantly better recovery of hearing levels compared with those who received blood flow-promoting drugs alone (P<.05). Also, patients with elevated blood sedimentation rates had better improvement of their hearing levels after receiving glucocorticoids. CONCLUSIONS: Administration of glucocorticoids should be recommended for treatment of patients with SSNHL. In particular, patients with SSNHL in the lower and middle frequency range and pancochlear hearing loss have significantly better recovery of hearing levels.     

弗明汉危险评分与突发性聋听力预后的相关性

目的 探讨弗明汉危险评分(Framingham risk score)与突发性聋(突聋)患者听力预后的相关性.方法 以2018年1月至2020年1月住院治疗的242例突聋患者为研究对象,利用弗明汉危险评分公式评估其心血管危险因素并计算弗明汉危险评分积分值,评估患者未来10年冠心病的发病风险,并根据发病风险大小将研究对象...     

Sudden sensorineural hearing loss: a review of diagnosis, treatment, and prognosis

Sudden sensorineural hearing loss (SSNHL) is commonly encountered in audiologic and otolaryngologic practice. SSNHL is most commonly defined as sensorineural hearing loss of 30 dB or greater over at least three contiguous audiometric frequencies occurring within a 72-hr period. Although the differential for SSNHL is vast, for the majority of patients an etiologic factor is not identified. Treatment for SSNHL of known etiology is directed toward that agent, with poor hearing outcomes characteristic for discoverable etiologies that cause inner ear hair cell loss. Steroid therapy is the current mainstay of treatment of idiopathic SSNHL in the United States. The prognosis for hearing recovery for idiopathic SSNHL is dependent on a number of factors including the severity of hearing loss, age, presence of vertigo, and shape of the audiogram.     

前庭诱发肌源性电位预测突聋患者疗效的临床价值

目的 分析单侧突发性耳聋患者的疗效,探讨前庭功能与预后的关系。 方法 回顾性分析59例(59耳)突发性耳聋患者的临床资料,观察临床疗效,根据前庭功能结果探讨对预后的影响。 结果 59例突发性耳聋患者在治疗前共进行了183项前庭功能检查,眼性前庭诱发肌源性电位(oVEMP)和颈性前庭诱发肌源性电位(cVEMP)异常的突聋患者显示出更低的治疗总有效率;oVEMP和cVEMP正常的突聋患者受损频率听力提高更明显。冷热试验(Caloric Test)和视频头脉冲试验(vHIT)的正常与否对突聋患者的总有效率和受损听力的提高无影响。cVEMP和oVEMP都异常的患者治疗无效率比仅其中一项异常的患者高,受损听力恢复程度也比仅其中一项异常的患者差。 结论 oVEMP和cVEMP异常的突聋患者疗效较差,oVEMP和cVEMP正常的突聋患者有更好的听力恢复。oVEMP和cVEMP功能可能是预测突发性聋患者预后的有效指标。前庭功能异常提示突发性聋患者的内耳病变范围较大、程度较重。     

代谢综合征对突发性聋患者听力预后的影响

目的探讨代谢综合征(metabolic syndrome, MS)对突发性聋(突聋)患者听力预后的影响。方法以178例突聋患者为研究对象,根据是否合并MS分为MS组(70例)和非MS组(108例),通过单因素及多因素分析分析性别、年龄、病程、初诊听阈值、高血压病、糖尿病、体重指数(BMI)、高脂血症对突聋患者听力预后的影响。结果 MS组患者的BMI、收缩压、舒张压、甘油三酯、空腹血糖水平高于非MS组,而高密度脂蛋白水平低于非MS组,差异均有统计学意义(均为P<0.05);治疗后,MS组中痊愈率和显效率分别为7.14%和8.57%,低于非MS组(分别为20.37%和29.63%),MS组中的无效率为51.43%,高于非MS组(25.00%)(P<0.05);多因素分析结果显示MS、糖尿病和高脂血症为突聋患者听力预后的不利因素,初诊听阈值越高、病程越长,听力预后越差。结论合并MS的突聋患者听力预后差;就诊时听力损失程度轻、病程短及无伴发糖尿病和高脂血症的患者预后较好。     

Comparison of intratympanic dexamethasone therapy and hyperbaric oxygen therapy for the salvage treatment of refractory high-frequency sudden sensorineural hearing loss

Objective

This study aimed to compare the efficacy of intratympanic dexamethasone (ITD) therapy and hyperbaric oxygen(HBO) therapy for the salvage treatment of patients with high-frequency sudden sensorineural hearing loss (SSNHL) after the failure of conventional therapy.

Prognostic predictors of sudden sensorineural hearing loss in defibrinogenation therapy

Conclusions: Defibrinogenation therapy rather than corticosteroids therapy should be chosen for patients specifically with profound hearing loss and with initial high fibrinogen. Objectives: Corticosteroids therapy is the standard treatment for sudden sensorineural hearing loss (SSNHL) and prognostic factors by this therapy were reported. Defibrinogenation therapy is one of the treatment options for SSNHL. Aims of this study were to identify prognostic factors and correlative markers with hearing improvement in treating SSNHL by defibrinogenation therapy. Methods: During the early phase of the study, consecutive 61 patients were treated by defibrinogenation therapy with batroxobin (50 units), whereas corticosteroids (500?mg/day of hydrocortisone tapered by 9 days) were used for consecutive 64 patients during the late phase. Blood data that could predict a complete recovery were identified. Coagulation/fibrinolysis markers correlated with hearing improvement by defibrinogenation therapy were investigated. Results: Although there were no overall differences in hearing improvement between the two therapies, recovery rate in profound hearing loss patients was better in defibrinogenation therapy. In patients who showed complete recovery, serum fibrinogen level before treatment was significantly higher in the defibrinogenation group than the corticosteroid group. Responses of several fibrinolysis markers to defibrinogenation therapy evaluated by post-/pre-values were negatively correlated with hearing improvement.     

Analysis of hearing improvement in patients with severe to profound sudden sensorineural hearing loss according to the level of pure tone hearing threshold

Patients with profound sudden sensorineural hearing loss (SSNHL) have a poor prognosis regardless of the type of treatment they receive. However, there is evidence that a proportion of patients with profound hearing loss may exhibit variable degrees of recovery, and this has yet to be specifically investigated. Here, we report a comparison of levels of hearing improvement in patients stratified according to their level of hearing threshold before treatment. We divided patients with severe to profound SSNHL into three groups: patients with an initial hearing threshold of 80–89?dB (n?=?18), 90–99?dB (n?=?16), and ≥100?dB (n?=?34). We compared improvements in hearing threshold at different frequencies and recovery rates between the three groups. No significant differences were observed in hearing threshold improvements at different frequencies in the three groups after treatment. However, in the group with an initial hearing threshold of ≥100?dB, significantly less complete and partial recoveries occurred compared to those in the 80–89 or 90–99?dB groups. Our results suggest that initial hearing threshold in excess of 100?dB alters the likelihood of satisfactory recovery in patients with severe to profound SSNHL.