Sakagami Masaharu, Kitahara Tadashi, Okayasu Tadao, Yamashita Akinori, Hasukawa Akihito, Ota Ichiro, Yamanaka Toshiaki
Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
Auris Nasus Larynx. 2016 Dec;43(6):632-6. doi: 10.1016/j.anl.2016.02.006. Epub 2016 Feb 26.
To examine the backgrounds of patients with audiovestibular disease regarding what influences their psychological state.
During a 12-year period, 375 successive patients with audiovestibular diseases were enrolled in this study. Diseases included unilateral (n=174) and bilateral (n=51) Menière's disease, sudden deafness with vertigo (n=70), and vestibular neuritis (n=80). Diagnosis, sex, age, duration of disease, vertigo frequency, persistent nystagmus, and ipsilateral/contralateral hearing levels were recorded. Cornell Medical Index (domains III-IV=neurosis) and Self-Rating Depression Scale (score>40=depression) were applied during acute vertigo remissions in all patients.
Neurosis and depression, respectively, were diagnosed in 62.7% and 82.4% of bilateral Menière's, 32.7% and 48.9% of unilateral Menière's, 15.7% and 38.6% of sudden deafness/vertigo, and 12.7% and 31.3% of vestibular neuritis patients. Multivariable logistic regression analysis showed that Menière's disease with longer disease duration (Oz 1.212; P=0.021) and worse hearing in the secondary affected ear (Oz 1.131; P=0.042); sudden deafness/vertigo with persistent nystagmus (Oz 1.895; P=0.005); and vestibular neuritis with longer disease duration (Oz 1.422; P=0.019) and persistent nystagmus (Oz 1.950; P=0.0003) had mental illness significantly more often than those with shorter-duration disease, better hearing and no persistent nystagmus.
Mental disorder increased in accordance with solo vertigo, vertigo/hearing loss, repeated symptoms, and bilateral lesions. Treatment strategies should be carefully constructed for patients with persistent nystagmus, long disease duration, and hearing loss in the secondary affected ear to avoid psychological disorders.
研究患有听觉前庭疾病的患者其心理状态受哪些因素影响。
在12年期间，本研究纳入了375例连续的听觉前庭疾病患者。疾病包括单侧（n = 174）和双侧（n = 51）梅尼埃病、突发性聋伴眩晕（n = 70）以及前庭神经炎（n = 80）。记录诊断结果、性别、年龄、病程、眩晕频率、持续性眼震以及患侧/对侧听力水平。在所有患者急性眩晕缓解期应用康奈尔医学指数（III - IV领域 = 神经症）和自评抑郁量表（得分>40 = 抑郁）。
双侧梅尼埃病患者中神经症和抑郁症的诊断率分别为62.7%和82.4%，单侧梅尼埃病患者分别为32.7%和48.9%，突发性聋/眩晕患者分别为15.7%和38.6%，前庭神经炎患者分别为12.7%和31.3%。多变量逻辑回归分析显示，病程较长的梅尼埃病（比值比1.212；P = 0.021）以及患侧耳听力较差的梅尼埃病（比值比1.131；P = 0.042）；伴有持续性眼震的突发性聋/眩晕（比值比1.895；P = 0.005）；病程较长且伴有持续性眼震的前庭神经炎（比值比1.422；P = 0.019）以及（比值比1.950；P = 0.0003），相较于病程较短、听力较好且无持续性眼震的患者，患精神疾病的频率显著更高。
精神障碍随着单纯眩晕、眩晕/听力丧失、症状反复以及双侧病变而增加。对于伴有持续性眼震、病程较长以及患侧耳听力丧失的患者，应精心制定治疗策略以避免心理障碍。
