Young C A, Fraser W D, Mackenzie I J
Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, L9 7LJ, UK.
Bone. 2007 Jan;40(1):189-93. doi: 10.1016/j.bone.2006.07.001. Epub 2006 Sep 8.
Paget's disease of bone is known to be associated with hearing loss but there are limited data on the prevalence of hearing impairment and handicap in people with Paget's disease. Previous published population studies have used patient-completed questionnaires or review of GP records, none have included audiometry. 80 Paget's subjects were selected at random from a hospital database, 75 (94%) entered the study and were matched by age and gender with 76 controls. All participants completed a screening questionnaire for hearing handicap, the HHIE-S; a questionnaire on perception of hearing-related handicap, noise exposure, hearing aids and GP consultations regarding hearing; and audiometry. The results show significant problems from hearing loss in people with Paget's disease of bone. Paget's patients were significantly more likely to perceive hearing handicap (P=0.0001), 41% Paget's patients rated themselves moderate-severe compared to none of the controls. Paget's patients were significantly more likely to report difficulties such as hearing normal speech, watching TV or hearing over background noise (all P=0.0001). They were more likely to consult their GP due to hearing problems (P=0.004) or tinnitus (P=0.0001), or use a hearing aid (P=0.0001). Audiometry confirmed higher rates of deafness in Paget's patients. 41/75 Paget's patients compared to 19/76 controls had at least 40 decibels hearing loss (dBHL) (P=0.0001). The HHIE-S proved to be an effective screening tool. A score of greater than 8 increased the odds ratio of detecting moderate hearing impairment (>40 dBHL) in people with Paget's disease by 5.1. The specificity of HHIE-S >8 as a screening tool to select for audiometry appears good, 1/46 (2%) of Paget's patients would have proved to have normal hearing thresholds. The sensitivity is better with worse hearing loss, 7/16 Paget's patients with moderate loss (>40 dBHL) and 2/25 with severe-profound loss (>60 dBHL) would have been missed. In conclusion, 55% unselected Paget's patients have at least moderate levels of hearing loss, compared to 25% of age and gender matched controls. Paget's patients and controls under-reported hearing problems, many of which can be ameliorated. Screening for hearing problems in Paget's disease of bone can be done using the HHIE-S.
已知骨Paget病与听力损失有关，但关于Paget病患者听力障碍和听力残疾患病率的数据有限。以往发表的人群研究使用患者自行填写的问卷或全科医生记录回顾，均未包括听力测定。从医院数据库中随机选取80例Paget病患者，75例（94%）进入研究，并按年龄和性别与76例对照进行匹配。所有参与者均完成了听力残疾筛查问卷HHIE-S；一份关于听力相关残疾感知、噪声暴露、助听器以及关于听力的全科医生咨询的问卷；以及听力测定。结果显示，骨Paget病患者存在明显的听力损失问题。Paget病患者更有可能感知到听力残疾（P=0.0001），41%的Paget病患者将自己评为中度至重度，而对照组无一例如此。Paget病患者更有可能报告诸如听清正常言语、看电视或在背景噪声中听清声音等困难（所有P=0.0001）。他们因听力问题（P=0.004）或耳鸣（P=0.0001）咨询全科医生的可能性更大，或使用助听器的可能性更大（P=0.0001）。听力测定证实Paget病患者耳聋发生率更高。41/75例Paget病患者与19/76例对照相比，至少有40分贝听力损失（dBHL）（P=0.0001）。HHIE-S被证明是一种有效的筛查工具。得分大于8可使检测Paget病患者中度听力障碍（>40 dBHL）的比值比增加5.1。HHIE-S >8作为选择进行听力测定的筛查工具的特异性似乎良好，1/46（2%）的Paget病患者听力阈值被证明正常。听力损失越严重，敏感性越好，将有7/16例中度听力损失（>40 dBHL）的Paget病患者和2/25例重度至极重度听力损失（>60 dBHL）的患者漏诊。总之，未经过筛选的Paget病患者中有55%至少有中度听力损失，而年龄和性别匹配的对照组为25%。Paget病患者和对照组对听力问题报告不足，其中许多问题可以得到改善。骨Paget病患者的听力问题筛查可使用HHIE-S进行。
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