Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Braz J Med Biol Res. 2009 Aug;42(8):712-6. doi: 10.1590/s0100-879x2009000800004.
The aim of this study was to analyze clinical aspects, hearing evolution and efficacy of clinical treatment of patients with sudden sensorineural hearing loss (SSNHL). This was a prospective clinical study of 136 consecutive patients with SSNHL divided into three groups after diagnostic evaluation: patients with defined etiology (DE, N = 13, 10%), concurrent diseases (CD, N = 63, 46.04%) and idiopathic sudden sensorineural hearing loss (ISSHL, N = 60, 43.9%). Initial treatment consisted of prednisone and pentoxifylline. Clinical aspects and hearing evolution for up to 6 months were evaluated. Group CD comprised 73% of patients with metabolic decompensation in the initial evaluation and was significantly older (53.80 years) than groups DE (41.93 years) and ISSHL (39.13 years). Comparison of the mean initial and final hearing loss of the three groups revealed a significant hearing improvement for group CD (P = 0.001) and group ISSHL (P = 0.001). Group DE did not present a significant difference in thresholds. The clinical classification for SSNHL allows the identification of significant differences regarding age, initial and final hearing impairment and likelihood of response to therapy. Elevated age and presence of coexisting disease were associated with a greater initial hearing impact and poorer hearing recovery after 6 months. Patients with defined etiology presented a much more limited response to therapy. The occurrence of decompensated metabolic and cardiovascular diseases and the possibility of first manifestation of auto-immune disease and cerebello-pontine angle tumors justify an adequate protocol for investigation of SSNHL.
本研究旨在分析突发性聋（SSNHL）患者的临床特征、听力演变和临床治疗效果。这是一项对 136 例连续 SSNHL 患者进行的前瞻性临床研究，根据诊断评估结果将患者分为三组：明确病因组（DE，N=13，10%）、合并症组（CD，N=63，46.04%）和特发性突发性聋（ISSHL，N=60，43.9%）。初始治疗包括泼尼松和己酮可可碱。评估了患者的临床特征和最长 6 个月的听力演变情况。CD 组在初始评估中有 73%的患者存在代谢失代偿，明显比 DE 组（41.93 岁）和 ISSHL 组（39.13 岁）更年长。对三组患者的初始和最终听力损失均值进行比较，发现 CD 组（P=0.001）和 ISSHL 组（P=0.001）的听力均有显著改善，但 DE 组的听力阈值没有显著差异。SSNHL 的临床分类可以识别年龄、初始和最终听力障碍以及对治疗反应的可能性方面的显著差异。年龄较高和合并症的存在与初始听力损害更大和 6 个月后听力恢复较差相关。明确病因的患者对治疗的反应更为有限。代谢和心血管疾病失代偿的发生以及自身免疫性疾病和桥小脑角肿瘤首次表现的可能性，都需要为 SSNHL 的检查制定一个适当的方案。
