儿童及成人突发性聋预后的对比分析

目的对比分析儿童及成人突发性聋预后的相关因素,为临床实践及患者预后评估提供依据。方法回顾性分析2008年1月~2016年12月住院治疗的237例（258耳）突发性聋患者的临床资料,其中儿童突发性聋患者（儿童组）26例（29耳）,成人突发性聋患者（成人组）211例（229耳）,采用单因素及多因素分析的方法对比分析两组突发性聋患者的年龄、性别、耳侧、初诊时间、就诊听阈、听力曲线、有否伴有耳鸣、眩晕及耳闷等因素对预后的影响。结果儿童突发性聋患者人数占总人数的11.0%;儿童组就诊听阈平均为（88.7±15.8）dB,高于成人组［（71.8±23.6）dB,(P＜0.05)］;儿童组听力曲线为全聋型的占69.0%,高于成人组（44.5%,P＜0.05）;经治疗后,儿童组的总体有效率为51.7%,成人组总体有效率为45.4%,两者差异无统计学意义（P＞0.05）。对儿童组预后的相关因素分析显示就诊听阈及伴发眩晕对疗效的影响具有统计学意义(P＜0.05);成人组中,初诊时间、就诊听阈及伴发眩晕对疗效的影响具有统计学意义（P<0.05）。结论儿童突发性聋患者就诊时听力损失较成人重,但治疗后两者总体有效率无明显差异（P>0.05）;儿童及成人突发性聋患者中听力损失程度越轻且不伴发眩晕者预后较好;就诊时间越早越有利于成人突发性聋患者的预后;而年龄、性别、耳侧以及是否伴发耳鸣、耳闷对儿童及成人突发性聋的预后无明显影响。     

鼓室注射甲强龙补救治疗全聋型突聋的临床分析

目的探讨鼓室注射甲强龙补救治疗全聋型突聋的疗效。方法55例经初始系统治疗2周无效的全聋型突聋患者纳入研究,均为单耳发病。按数字随机法分为实验组（鼓室注射甲强龙+口服甲钴胺）和对照组（口服甲钴胺）,其中实验组26例,对照组29例,两组行相对应治疗结束后4周复查纯音听力阈值。结果实验组纯音听力阈平均值为（59.88±9.54）dB,对照组为（67.62±7.63）dB,两者差异具有统计学意义（t=3.338,P=0.002）,实验组听力改善（18.08±10.06）dB,高于对照组的（11.48±6.34）dB（t=2.869,P=0.006）。结论常规系统治疗无效的全聋型突聋患者采用鼓室内注射甲强龙,可以明显改善听力,提高疗效,值得推荐。     

急性低频感音神经性聋的临床研究

目的探讨急性低频感音神经性聋（acute low-frequency sensorineural hearing loss,ALHL）的临床特征和疗效,提高对该疾病的认识和鉴别能力。方法回顾性分析42例（42耳）ALHL的临床表现、听力学检测结果和2～5年的随访情况,总结ALHL的临床发病特征。结果本组42例（42耳）ALHL呈急性发病,年龄27～44岁。男16例（38.10%）,女26例（61.90%）。20例（20耳）伴低调耳鸣,17例（17耳）伴耳部堵闷,11例（11耳）伴听觉过敏现象,6例（6耳）伴有头昏。0.125～1kHz平均听阈为（38.74&#177;4.62）dBHL,2～8kHz平均听阈为（13.52&#177;3.86）dBHL,治疗后上述平均听阈分别为（21.05&#177;9.74）dBHL和（19.85&#177;9.44）dBHL。所有病人的听性脑干反应（auditory brainstem response,ABR）各波潜伏期及波间期正常。畸变产物耳声发射（distortion product otoacoustic emissions,DPOAE）在低频区引出率为16.67%,高频区引出率为85.71%。结论ALHL以单侧发病为主,常伴低调耳鸣、耳部堵闷及胀满感。该病多见于青年女性。纯音听阈以低频听阈升高为特征,ABR正常。病变可能位于耳蜗顶周。     

鼓室内灌注醋酸泼尼松龙治疗突发性聋的初步观察

目的探讨鼓室内灌注醋酸泼尼松龙对常规治疗无效的突发性聋患者的治疗效果。方法选择病史在2个月以上常规治疗无效和未治的突发性聋患者12例,鼓室内注入醋酸泼尼松龙,观察治疗前后0.25～4kHz听阈变化。结果本组患者治疗前的平均听阈为62.75±9.71dBHL,治疗后听力提高了12.97±7.28dB;其中,痊愈2例,有效4例。结论鼓室内应用激素能改善常规治疗无效的突发性聋患者的听力。     

耳内镜下经外耳道切除上鼓室胆脂瘤35例疗效分析

目的探讨耳内镜下经外耳道入路治疗上鼓室胆脂瘤的可行性、手术方法及疗效。方法回顾分析2014年1月～2017年1月在徐州市中心医院接受耳内镜手术的35例（35耳）中耳上鼓室胆脂瘤患者的临床资料。35例患者中男20例，女15例；年龄22～66岁，平均年龄42.8岁；病程2～20个月，平均10个月。所有患者均在全麻耳内镜下手术，根据胆脂瘤大小决定手术范围。12例行上鼓室重建，10耳听骨链破坏或缺失者，行部分人工听骨重建（partial ossicular replacement prosthesis，PORP）。结果35耳上鼓室胆脂瘤病灶均彻底清除，未出现面瘫及脑脊液漏等并发症。所有患者术后随访1年以上，患者鼓膜愈合良好，移植物形态良好。耳内镜检查或者颞骨薄层CT检查未见胆脂瘤复发，术后听力提高22例（62.8%），听力无变化10例（28.6%），听力下降3例（8.6%），平均气导听阈与气骨导差均有改善，术后0.5、1、2、4 kHz平均气导听阈为（29.234±8.38）dB，与术前的（43.64±8.38）dB比较差异具有统计学意义（P<0.05）；术后0.5、1、2、4 kHz平均气骨导差值为（15.27±6.74）dB，与术前的（28.27±5.94）dB比较差异具有统计学意义（P<0.05）。结论耳内镜下经外耳道上鼓室胆脂瘤切除术是有效的手术方法，复发率低，听力改善明显，与传统显微镜手术相比有优越性。     

地塞米松鼓室内注射补救治疗突发性聋

目的 观察地塞米松鼓室内注射对经过常规治疗没有痊愈或无效的突发性聋的疗效.方法选择门诊经过常规治疗没有痊愈的突发性聋患者45耳,随机分成2组,实验组21耳,地塞米松经鼓膜穿刺鼓室内注射2毫克/次,2次（一周）一个疗程;对照组24耳,给谷维素及复合维生素B口服,用药一周.观察治疗前后纯音听阈及耳呜、耳闷感的变化情况.结果纯音测听结果显示实验组6耳有效（6/21）,对照组1耳有效（1/24）,两组比较差异有统计学意义（P＜0.05）;耳呜改善实验组有5耳（5/15）,对照组1耳（1/19）,两组比较差异有统计学意义（P＜0.05）;耳闷感改善实验组有3耳（3/11）,对照组1耳（1/13）,两组比较差异无统计学意义（P＞0.05）.结论地塞米松鼓室内注射可以改善常规治疗没有痊愈的突发性聋患者的听力及耳鸣症状.     

鼓室注射地塞米松治疗自身免疫性聋的疗效观察

目的了解鼓室内注射地塞米松对难治性自身免疫性感音神经性聋的疗效。方法对已经确诊为自身免疫性感音神经性聋的病例32例,在全身应用大剂量糖皮质激素后,听力无明显改善的病例15例,药物减量后听力再次出现反复的病例17例,予鼓室内注射地塞米松约3mg,每日一次,注射7天后,复查听力,听力无好转,再注射7天,随诊6个月,并监测听力变化,比较注射前与注射后14天、3个月、6个月（500、1K、2K、4KHz）气导纯音听阈的平均阈值和听性脑干电反应的波V反应阈。结果32例自身免疫性感音神经性聋患者,鼓室注射治疗前平均听阈为64.92±25.36dBHL,听性脑干电反应波V平均反应阈为69.88±18.27dBnHL。治疗结束后平均听阈为46.58±29.32dBHL,波V平均反应阈为51.36±20.12dBnHL,经配对t检验,差异有统计学意义（P＜0.05）。结论鼓室内注射地塞米松治疗自身免疫性感音神经性聋安全、有效,可用于对自身免疫性感音神经性聋的辅助治疗。     

高压氧辅助治疗突发性聋的预后及相关因素分析

目的分析高压氧辅助治疗突发性聋的疗效,并探讨其相关预后因素。方法回顾性总结分析2012年1月~2017年1月在南华大学附属第一院诊断并住院治疗的167例突发性聋患者的一般临床资料,根据疗效将患者分为总体有效组（84例）及无效组（83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、初诊听阈、是否伴发耳鸣及眩晕、高血压、糖尿病、入院到高压氧治疗间隔、高压氧次数及听力曲线类型等对预后的影响。结果患者总体有效率为50.3%,其中痊愈率、显效率及有效率分别为15.6%、15.6%和19.2%。多因素分析结果显示,初诊听阈、伴发眩晕及入院到高压氧治疗间隔对疗效的影响具有统计学意义（P＜0.05）。结论高压氧辅助治疗突发性聋时,20次左右的高压氧可能足以实现其治疗效果;听力损失程度轻、不伴发眩晕、早期行高压氧治疗的突聋患者预后较好。     

突聋后期再治疗临床效果观察

目的观察突聋后期再治疗的临床效果。方法选择经常规治疗2个月以上效果不理想的突聋患者103例（112耳）,给予碳酸氢钠250ml加地塞米松10mg静脉滴注2天后,应用东菱迪芙5BU每天静脉滴注一小时,治疗6天,全疗程共8天。治疗前后进行纯音测听并作统计学分析。结果治疗前后平均听阈分别为56.34dBHL和49.22dBHL,差异有统计学意义（P〈0.01）,有效率46.43%（52/112）。结论突聋后期治疗中应用碳酸氢钠加激素和东菱迪芙对挽救或提高部分听力有一定效果。     

不同类型听力下降伴耳鸣治疗的疗效分析

目的通过分析耳鸣与听力下降的关系,总结耳鸣与不同类型听力下降的关联性,以及不同类型听力下降所伴有耳鸣的治疗效果。方法分析2016年1月~2017年6月因“耳鸣”或者因“听力下降伴有耳鸣”就诊的急性耳鸣患者188例,其中男102例,女86例;年龄23~62岁,平均年龄44岁。双侧耳鸣者65例,单侧耳鸣者123例。所有患者入院时均进行电测听及耳鸣检查,根据听力曲线类型对耳鸣患者进行分组,其中听力正常者12例,低频听力下降者36例,高频听力下降者84例,平坦听力下降者42例,全聋型14例。入院后所有患者予以行营养神经、改善循环、激素冲击等治疗,并于入院当日、第3天、第5天及第10天行听力检查及耳鸣检查,比较各组患者耳鸣治疗的疗效。结果不同听力下降类型的耳鸣患者构成比比较,差异具有统计学意义（P＜0.05）。听力正常者耳鸣治疗有效率为91.67%（11/12）,低频听力下降组耳鸣治疗有效率为83.33%（30/36）,高频听力下降组耳鸣治疗有效率为54.76%（46/84）,平坦型听力下降组耳鸣治疗有效率为69.05%（29/42）,全聋型听力下降组耳鸣治疗有效率为28.57%（4/14）,对各组的耳鸣治疗有效率进行比较,差异具有统计学意义（P＜0.05）。结论高频听力下降者耳鸣发生率最高,听力正常者耳鸣发生率最低。听力正常及低频听力下降者耳鸣治疗有效率最高,高频听力及全聋者耳鸣治疗效果较差。     

Sudden sensorineural hearing loss during pregnancy: clinical characteristics,management and outcome

Background: Sudden sensorineural hearing loss (SSNHL) may occur during pregnancy with a rare prevalence, and little is known about it.

Aims: To retrospectively analyze cases of SSNHL during pregnancy and investigate their clinical characteristics, management and outcome.

Material and methods: Records of 30 SSNHL patients during pregnancy were reviewed, including age, localization, duration from onset to treatment, gestation period, accompanying symptoms, initial hearing threshold, final hearing threshold, audiogram, treatment and outcome.

Results: Twenty-four patients (80.0%) suffered SSNHL in the second trimester or the last trimester with a high rate of tinnitus (70.0%). The initial hearing threshold was 63.4?±?25.1?dB, and most audiograms were flat and profound. The overall recovery rate was 60.0%, including complete recovery (33.3%) and partial recovery (26.7%). Further, 16 patients received adjuvant intratympanic steroid showed a better audiologic outcome (improvement 27.1?±?16.4 vs. 15.7?±?12.0?dB, p?=?.042) than those who had not.

Conclusions and significance: SSNHL during pregnancy often occurred in the second trimester or the last trimester with a severe hearing loss, the most audiogram configurations are flat and profound. Dextran-40 is a safe and beneficial therapy for SSNHL patients during pregnancy and adjuvant intratympanic steroid increase the probability of hearing recovery.     

Sudden sensorineural hearing loss and delayed complete sudden spontaneous recovery

This is a case report of a 53-yr-old female who experienced sudden sensorineural hearing loss (SSNHL) accompanied by roaring tinnitus in her right ear. The patient's hearing partially improved in the low frequencies in response to intratympanic injections. Given that her hearing loss did not improve further, the patient was fitted with a hearing aid to mask the tinnitus and restore a sense of balance between the two ears. Approximately 9 mo postonset of the SSNHL, a complete spontaneous recovery of hearing occurred. Such a delayed and complete recovery is highly unusual. This case highlights that the spontaneous recovery in hearing indicates that the pathological cause for the SSNHL involved a process that was capable of repair or regeneration, thus ruling out pathologies related to cochlear hair cell destruction or nerve fiber loss. This leaves a possibility that the event causing the onset of the SSNHL resulted in a disruption of the ion homeostatic properties of the cochlea via the production of the endocochlear potential.     

Comparison of therapeutic results in sudden sensorineural hearing loss with/without additional hyperbaric oxygen therapy: a retrospective review of 465 audiologically controlled cases

Clin. Otolaryngol. 2011, 36 , 121–128 Objective: To investigate the necessity of routine application of hyperbaric oxygen therapy for sudden sensorineural hearing loss. Design/setting and participants: A retrospective chart review looked at 465 patients, with 353 of them receiving pharmacologic treatments alone. Among these patients, 76 underwent systemic steroid treatment only (steroid group) and 277 received systemic steroids and dextran (steroid–dextran group). The remaining 112 patients were treated with hyperbaric oxygen in addition to pharmacologic agents (steroid–dextran–hyperbaric oxygen group). Main outcome measures: The outcome was determined by comparing the difference of pure‐tone thresholds and absolute hearing gains after treatment calculated at each audiometric octave frequency or grouped frequencies of audiograms. On the basis of the severity of initial hearing loss, patients were classified at three scales of hearing impairments measured in decibels hearing level (dBHL): ≦70 dBHL, less severe; 71–90 dBHL, severe; and ≧91 dBHL, profound. The outcomes of their hearing recovery were classified into three recovery grades: good, fair and poor. Results: In those patients with initial hearing loss >90 dBHL, the addition of hyperbaric oxygen to steroid–dextran gave a significant hearing gain difference (P = 0.030) by showing a greater hearing gain of 24.5 ± 2.7 dB compared with steroid only (12.9 ± 3.7 dB) or steroid–dextran (15.6 ± 2.7 dB). This outcome was confirmed when we compared the outcome using the recovery grading; steroid–dextran–hyperbaric oxygen group showed that more patients with initial profound (≧91 dBHL) hearing loss responded to hyperbaric oxygen treatment by exhibiting good and fair recoveries (2% and 70%) as compared with steroid only (0% and 42%) or steroid–dextran (8% and 46%) groups (P = 0.043), while the patients with initial severe (71–90 dBHL) and less severe (≦70 dBHL) hearing loss responded to the addition of hyperbaric oxygen treatment with less favourable recoveries. Furthermore, the addition of dextran in steroid–dextran group showed no significant benefit compared with the steroid group (P =0.435). Conclusions: When applied as an adjuvant to pharmacologic agents, hyperbaric oxygen benefits patients with initial profound sudden sensorineural hearing loss. Therefore, we recommend the routine application of hyperbaric oxygen in conjunction with pharmacologic agents for those patients. The addition of dextran to steroid has no benefit and cannot be recommended.     

An investigation of the audiologic handicap associated with unilateral sudden sensorineural hearing loss

OBJECTIVE: To determine the incidence of tinnitus and associated handicap after unilateral sudden sensorineural hearing loss (SSNHL); in addition, to determine the hearing handicap experienced as a consequence of such a loss. STUDY DESIGN: Identification of patients and determination of demographic and audiologic data by retrospective case review; determination of handicap and distress by postal questionnaire. SETTING: Teaching hospital department of otolaryngology. PATIENTS: Thirty-eight patients were identified as having been treated for a unilateral sudden sensorineural hearing loss in the period 1988 through 1997. Of those, 21 (55.3%) replied to the questionnaire. MAIN OUTCOME MEASURES: Audiometric data at admission and at 4-week follow-up, Tinnitus Handicap Inventory (THI), visual analogue scales of tinnitus loudness and distress, Hearing Handicap Inventory in Adults (HHIA). RESULTS: The questionnaire responder group did not significantly differ from the questionnaire nonresponder group on demographic nor audiometric variables, and hence were considered to be a representative sample. Tinnitus was present in 14 patients (67%). Hearing handicap was found in 86% of patients (of the 21 questionnaire responders) and tinnitus handicap in 57% (of the 14 with tinnitus). Correlations were found between tinnitus loudness, distress, and handicap. There was no correlation between time elapsed since SSNHL and tinnitus or hearing handicap, nor was there a correlation between the extent of audiometric loss and hearing or tinnitus handicap. A strong negative correlation was, however, found between recovery in audiometry in the first 4 weeks after onset and tinnitus and hearing handicap. The audiometric status of the contralateral ear correlated with hearing handicap. CONCLUSIONS: A majority of patients after unilateral SSNHL have a perceived handicap associated with tinnitus and hearing. Although this condition is an otologic emergency, careful thought should be given to the audiologic rehabilitation of this patient group.     

咽鼓管置管在治疗鼻咽癌放疗后分泌性中耳炎中的价值

目的：探讨咽鼓管置管治疗鼻咽癌（NPC）放疗后分泌性中耳炎（SOM）的价值。方法：分析鼻内窥镜下经咽鼓管置管治疗106例(112耳) NPC放疗后SOM的疗效。结果：患者接受治疗后,耳鸣消失81耳(72.32%) ,好转 25耳(22.32%), 无效6耳(5.36%) ,总有效率94.64%。耳闷塞感消失 92耳(82.14%) ,好转18耳(16.07%),无效2耳(1.79%),总有效率98.21%。无1例发生耳漏。声阻抗检查：鼓室曲线A型56耳(50.00%),As型42耳(37.50%),B型2耳(1.79%),C型12耳(10.71%)。治疗前后0.5、1.0、2.0?kHz气导听阈均值分别为（47.0±5.0）dBHL和（28.5±3.0）dBHL,两者具有统计学差异(P<0.001)。结论：咽鼓管置管治疗NPC放疗后SOM,对咽鼓管具有一定的支撑作用,能有效地避免耳漏。     

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。     

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.

Sudden sensorineural hearing loss in children and adolescents: Clinical characteristics and age-related prognosis

Objective

Although many studies have investigated sudden sensorineural hearing loss (SSNHL) in adults, there were few studies on SSNHL in the pediatric population; especially research on treatment and prognosis of pediatric SSNHL was limited. The aim of this study was to evaluate clinical characteristics, treatment outcomes and prognostic factors in children and adolescents with SSNHL.

鼻咽癌放疗后突发性聋18例

目的 探讨鼻咽癌放疗后突发性聋(突聋)的临床特征及预后,为该类疾病的临床诊治提供依据.方法 收集并分析18例鼻咽癌放疗后突聋患者的临床资料,包括年龄、性别、耳侧、病程、伴随症状、听力曲线类型、听力损失程度、放疗后突聋发病间隔以及听力预后.结果 18例均为单侧发病,左侧10耳(55.56％),右侧8耳(44.44％);其...     

不同时机鼓室内注射糖皮质激素治疗重度以上突发性聋的疗效分析

目的 观察全身联合不同时机鼓室内注射糖皮质激素治疗重度以上突发性聋的疗效,探讨鼓室内注射时机,分析影响重度以上突发性聋预后的因素。方法 回顾性分析108例重度以上突发性聋患者的临床资料及治疗效果,其中全身联合初始鼓室组64例,全身联合延后鼓室组44例;对两组患者出院时与随访时疗效分别进行比较,并分析治疗有效组和无效组临床特征。结果 出院时和随访时两种治疗方案平均听阈、平均听阈改善值、总有效率比较差异均无统计学意义（P均>0.05）,两种治疗方案痊愈率比较差异具有统计学意义（P<0.05）。两种治疗方案治疗前与出院时、治疗前与随访时分别比较差异均具有统计学意义（P均<0.001）。108例患者中,有效83例（76.9%）,伴眩晕者治疗有效率低（P<0.05）,治疗有效率与患者初始听阈损失程度（P<0.05）及听力曲线类型（P<0.05）相关,与年龄、性别、侧别、是否伴发耳鸣均无明显相关性（P均>0.05）。结论 对于重度以上突发性聋,听力损失程度、曲线类型、是否伴发眩晕与预后相关,治疗上建议尽早全身联合局部应用糖皮质激素。