突发性耳聋治疗过程中听力损失加重的临床特点及病因分析

摘 要: 【目的】 了解突发性耳聋患者治疗过程中听力损失加重的频率分布及程度,并试图探讨其原因或诱因?【方法】回顾性分析54例2009年8月到2013年6月在我院治疗过程中听力损失加重的突发性耳聋患者的纯音听力检查资料,统计各频率的发生几率及程度;并通过详细询问病史及必要的检查以探讨其原因或诱因?【结果】 54例治疗过程中听力变差患者占同期突发性耳聋患者的比例为7.55%(54/715),均发生在发病3 ~ 16 d范围内,其中左耳26例,右耳28例;各频率的发生率及听力下降程度(dB)分别为:125 Hz,88.9%(48/54),28.3 ± 16.2;250 Hz,94.4%(51/54),29.0± 18.8;500 Hz,81.2%(44/54),26.6± 18.1;1 kHz, 55.6%(30/54),25.2± 17.2;2 kHz, 44.4%(24/54),25.4± 17.6;4 kHz,22.2%(12/54),26.3± 18.0;8 kHz,18.5%(10/54), 25.5± 17.4;各频率间听力下降程度无统计学差异(P = 0.955),各频率的发生率存在统计学差异(P = 0.000)?13例患者休息欠佳和精神压力大,占24.1%;3例患者诉伴发的眩晕?耳鸣症状加重影响测试,占5.6%;1例疑为激素减量所致,占1.9%;其余37例未找到明确诱因?听力曲线分型:23例平坦型,6例全聋型,8例中低频型?【结论】 部分突发性耳聋的患者在治疗过程中会出现听力损失加重的情况,发生率呈现由低频向高频逐渐下降趋势,发生率最高出现在250 Hz,最低出现在8 kHz?导致听力损失加重的原因或诱因包括:休息欠佳和精神压力大;伴随症状加重影响检查结果;激素减量影响;属于缓降型突聋?溶栓治疗导致内耳出血加重?缺血再灌注损伤?膜迷路积水加重等?

Clinical Characteristics and Etiology Analysis of Sudden Sensorineural Hearing Loss Deterioration during Treatment

Abstract: 【Objective】 To analyze the etiology or incentive, frequency distribution and extent of hearing loss deterioration during treatment in sudden deafness patients. 【Methods】 A retrospective analysis of the pure tone threshold of 54 sudden deafness patients whose hearing loss deteriorated during treatment from August 2009 to June 2013 was conducted. The probability and extent of every hearing deteriorating frequency were calculated based on their audiogram. Thorough medical history was asked and necessary examinations were conducted to investigate the etiology or incentive. 【Results】 Part of the sudden deafness patients suffered hearing loss deterioration during treatment (7.55%), all of them happened between 3days to 16 days, 26 patients suffered in their left ears, and the other 28 in their right ears. The probability and extent of every frequency deterioration, 125 Hz, 88.9% (48/54), 28.3 ± 16.2 dB; 250 Hz, 94.4% (51/54) 29.0 ± 18.8 dB; 500 Hz, 81.2% (44/54), 26.6 ± 18.1 dB; 1 kHz, 55.6% (30/54) 25.2 ± 17.2 dB; 2 kHz, 44.4% (24/54) 25.4 ± 17.6 dB; 4 kHz , 22.2% (12/54) 26.3 ± 18.0 dB; 8 kHz, 18.5% (10/54) 25.5 ± 17.4 dB. There was no significant difference between the extent of every frequency,(P = 0.955) but the difference of the probability was significant. (P = 0.000). 13 patients (24.1%) suffered from insufficient rest and mental stress; 3 patients (5.6%) complained the accompany symptoms; 1 patient (1.9%) was attributed to corticosteroid reduction. Identified etiology or incentive were not found in the 37 patients.【Conclusions】 Part of the sudden deafness patient suffered hearing loss aggravation during treatment. There is a downtrend from low frequency to high frequency. The probable etiology or incentive of the hearing loss deterioration include lack of rest and mental stress; the aggravation of the accompanying symptoms; corticosteroid reduction; gradually sudden deafness; inner ear hemorrhage due to thrombolytic therapy, ischemical reperfusion injury, worsen of membranous labyrinth hydrops.