Babic Borivoj B, Petakov Milan S, Djukic Vojko B, Ognjanovic Sanja I, Arsovic Nenad A, Isailovic Tatjana V, Milovanovic Jovica D, Macut Djuro, Damjanovic Svetozar S
Institute of Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrande, Serbia.
Otol Neurotol. 2006 Sep;27(6):865-70. doi: 10.1097/01.mao.0000201429.57746.1b.
There have been rare conflicting results reported concerning possible higher frequency of hearing loss in acromegalic patients. Our goal was to determine whether there is higher frequency of conductive hearing loss in acromegalics and what may cause it if there is any.
Prospective study.
Tertiary referral center.
Thirty previously untreated patients with acromegaly were compared with 20 age- and sex-matched healthy control subjects.
In all subjects: Otomicroscopy, tuning fork tests, audiometry tympanometry, cochleostapedial reflex, otoacoustic emissions. In acromegalics: endocrinologic assessment, MRI and if necessary, epipharyngoscopy.
We searched for: 1) Signs of ossicle fixation: absence of stapedial reflex in the presence of normal tympanogram, conductive hearing loss, and absence of or grossly disturbed OAE; 2) Disturbances of middle ear ventilation: excessive negative pressure (tympanogram type C), or middle ear effusion (tympanogram type B).
The only statistically significant difference between untreated acromegalics and healthy subjects was the presence of middle ear ventilation problem: 7/30 acromegalics (23%) in comparison to none out of 20 healthy controls (0%), p = 0.033. The acromegalics with middle ear ventilation problem were significantly older, had longer duration of the disease, and lower mean growth hormone (GH) levels in comparison with acromegalics without this problem (51.6 +/- 1.7 vs. 44.4 +/- 2.5 years, 11.6 +/- 2.4 vs. 7.7 +/- 0.4 years, 21.68 +/- 4.89 vs. 49.98 +/- 12.54 microg/L respectively).
Patients with active acromegaly have more frequent middle ear ventilation problem than normal population, especially those with longer duration of the disease. Possible causes are discussed.
关于肢端肥大症患者听力损失频率可能更高的报道，结果罕见且相互矛盾。我们的目标是确定肢端肥大症患者中传导性听力损失的频率是否更高，以及如果存在这种情况，其可能的原因是什么。
前瞻性研究。
三级转诊中心。
将30例未经治疗的肢端肥大症患者与20例年龄和性别匹配的健康对照者进行比较。
对所有受试者进行：耳显微镜检查、音叉试验、听力测定、鼓室图检查、镫骨肌反射、耳声发射检查。对肢端肥大症患者进行：内分泌评估、磁共振成像（MRI），必要时进行咽内镜检查。
我们寻找：1）听小骨固定的体征：在鼓室图正常、传导性听力损失且耳声发射缺失或严重受干扰的情况下镫骨肌反射缺失；2）中耳通气障碍：负压过大（鼓室图C型）或中耳积液（鼓室图B型）。
未经治疗的肢端肥大症患者与健康受试者之间唯一具有统计学意义的差异是中耳通气问题的存在：30例肢端肥大症患者中有7例（23%），而20例健康对照者中无一例（0%），p = 0.033。与没有中耳通气问题的肢端肥大症患者相比，有中耳通气问题的肢端肥大症患者年龄显著更大，病程更长，平均生长激素（GH）水平更低（分别为51.6±1.7岁对44.4±2.5岁，11.6±2.4年对7.7±0.4年，21.68±4.89μg/L对49.98±12.54μg/L）。
活动性肢端肥大症患者比正常人群更频繁地出现中耳通气问题，尤其是病程较长的患者。文中讨论了可能的原因。
