Narozny Waldemar, Kuczkowski Jerzy, Kot Jacek, Stankiewicz Czeslaw, Sicko Zdzislaw, Mikaszewski Boguslaw
Department of Otorhinolaryngology, Medical University of Gdansk, 7 Debinki Str, 80-211 Gdansk, Poland.
Ann Otol Rhinol Laryngol. 2006 Jul;115(7):553-8. doi: 10.1177/000348940611500710.
We investigated prognostic factors in sudden sensorineural hearing loss (SSNHL).
Our study group consisted of 133 patients with SSNHL who were treated at our department between 1980 and 2000. Eighty-one of them (group B) were treated between 1980 and 1996; they received vasodilators and small doses of steroids. The others (52 patients; group A) were treated between 1997 and 2000; they received vasodilators, steroids at high doses, and hyperbaric oxygen. A multivariate stepwise linear regression was used to identify the prognostic factors that were related to hearing improvement as measured by objective change of gain in the overall average (0.5, 1, 2, 4, 6, 8 kHz), the pure tone average (0.5, 1, 2 kHz), the high tone average (4, 6, 8 kHz), and the pure middle tone average (0.5, 1, 2, 4 kHz). The following factors were included in the analysis: group (method of treatment), age, gender, seasonal occurrence of disease, presence of tinnitus and vestibular symptoms, time delay before first visit, type of initial audiogram, and type of caloric reaction. In group A, an additional analysis was conducted to include the results of certain laboratory tests: blood morphology parameters, erythrocyte sedimentation rate, glucose level, coagulogram, lipidogram, thyroid-stimulating hormone, autoantibodies (antimitochondrial antibodies, smooth muscle antibodies, and anti-brush border antibodies), and immunoglobulins G, A, and M. Values for p of less than .05 were considered significant.
Our analysis suggests the presence of the following prognostic factors for SSNHL: method of SSNHL treatment (better results in group A); time delay before the start of treatment (better results when treatment started within 10 days of the first symptoms of SSNHL); and type of caloric reactions (worse results in patients with canal paresis). In group A, the factors for poor prognosis for absolute hearing improvement were as follows: delayed treatment, labyrinth responsiveness disorders, and decreased level of thyroid-stimulating hormone. In group A, better hearing improvement was observed in those patients in whom SSNHL was diagnosed in the spring.
A short time delay before starting treatment (within 10 days), treatment with high doses of steroids and hyperbaric oxygen, preserving complete caloric function of the labyrinths, normal function of the thyroid, and seasonal occurrence of the disease in the spring were positive prognostic factors for hearing recovery in SSNHL.
我们研究了突发性感音神经性听力损失（SSNHL）的预后因素。
我们的研究组由1980年至2000年间在我科接受治疗的133例SSNHL患者组成。其中81例（B组）在1980年至1996年间接受治疗；他们接受血管扩张剂和小剂量类固醇治疗。其余患者（52例；A组）在1997年至2000年间接受治疗；他们接受血管扩张剂、高剂量类固醇和高压氧治疗。采用多元逐步线性回归分析来确定与听力改善相关的预后因素，听力改善通过总体平均增益（0.5、1、2、4、6、8kHz）、纯音平均（0.5、1、2kHz）、高音平均（4、6、8kHz）和纯中音调平均（0.5、1、2、4kHz）的客观变化来衡量。分析中纳入了以下因素：组（治疗方法）、年龄、性别、疾病的季节性发作、耳鸣和前庭症状的存在、首次就诊前的时间延迟、初始听力图类型和冷热试验反应类型。在A组中，进行了额外的分析以纳入某些实验室检查结果：血液形态学参数、红细胞沉降率、血糖水平、凝血图、血脂图、促甲状腺激素、自身抗体（抗线粒体抗体、平滑肌抗体和抗刷状缘抗体）以及免疫球蛋白G、A和M。p值小于0.05被认为具有统计学意义。
我们的分析表明SSNHL存在以下预后因素：SSNHL的治疗方法（A组效果更好）；治疗开始前的时间延迟（在SSNHL首次症状出现后10天内开始治疗效果更好）；以及冷热试验反应类型（半规管轻瘫患者结果较差）。在A组中，绝对听力改善预后不良的因素如下：治疗延迟、迷路反应性障碍和促甲状腺激素水平降低。在A组中，春季诊断为SSNHL的患者听力改善更好。
治疗开始前的短时间延迟（10天内）、高剂量类固醇和高压氧治疗、保持迷路的完全冷热功能、甲状腺功能正常以及疾病在春季发作是SSNHL听力恢复的积极预后因素。
