136例儿童突发性感音神经性听力损失的临床研究
Clinical Study on 136 Children with Sudden Sensorineural Hearing Loss.
作者信息
Li Feng-Jiao, Wang Da-Yong, Wang Hong-Yang, Wang Li, Yang Feng-Bo, Lan Lan, Guan Jing, Yin Zi-Fang, Rosenhall Ulf, Yu Lan, Hellstrom Sten, Xue Xi-Jun, Duan Mao-Li, Wang Qiu-Ju
机构信息
Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, Beijing 100853, China.
出版信息
Chin Med J (Engl). 2016 Apr 20;129(8):946-52. doi: 10.4103/0366-6999.179791.
BACKGROUND
The prevalence of sudden sensorineural hearing loss in children (CSSNHL) is consistently increasing. However, the pathology and prognosis of CSSNHL are still poorly understood. This retrospective study evaluated clinical characteristics and possible associated factors of CSSNHL.
METHODS
One hundred and thirty-six CSSNHL patients treated in Department of Otolaryngology-Head and Neck Surgery and Institute of Otolaryngology at Chinese PLA General Hospital between July 2008 and August 2015 were included in this study. These patients were analyzed for clinical characteristics, audiological characteristics, laboratory examinations, and prognostic factors.
RESULTS
Among the 136 patients (151 ears), 121 patients (121 ears, 80.1%) were diagnosed with unilaterally CSSNHL, and 15 patients (30 ears, 19.9%) with bilateral CSSNHL. The complete recovery rate of CSSNHL was 9.3%, and the overall recovery rate was 37.7%. We found that initial degree of hearing loss, onset of treatment, tinnitus, the ascending type audiogram, gender, side of hearing loss, the recorded auditory brainstem response (ABR), and distortion product otoacoustic emissions (DPOAEs) had prognostic significance. Age, ear fullness, and vertigo had no significant correlation with recovery. Furthermore, the relevant blood tests showed 30.8% of the children had abnormal white blood cell (WBC) counts, 22.1% had elevated homocysteine levels, 65.8% had high alkaline phosphatase (ALP), 33.8% had high IgE antibody levels, and 86.1% had positive cytomegalovirus (CMV) IgG antibodies.
CONCLUSIONS
CSSNHL commonly occurs unilaterally and results in severe hearing loss. Initial severe hearing loss and bilateral hearing loss are negative prognostic factors for hearing recovery, while positive prognostic factors include tinnitus, gender, the ascending type audiogram, early treatment, identifiable ABR waves, and DPOAEs. Age, vertigo, and ear fullness are not correlated with the recovery. Some serologic indicators, including the level of WBC, platelet, homocysteine, ALP, positive CMV IgG antibody, fibrinogen, and some immunologic indicators, are closely related to CSSNHL.
背景
儿童突发性感音神经性听力损失（CSSNHL）的患病率持续上升。然而，CSSNHL的病理和预后仍知之甚少。本回顾性研究评估了CSSNHL的临床特征及可能的相关因素。
方法
本研究纳入了2008年7月至2015年8月在中国人民解放军总医院耳鼻咽喉头颈外科及耳鼻咽喉研究所接受治疗的136例CSSNHL患者。对这些患者的临床特征、听力学特征、实验室检查及预后因素进行了分析。
结果
在136例患者（151耳）中，121例患者（121耳，80.1%）被诊断为单侧CSSNHL，15例患者（30耳，19.9%）为双侧CSSNHL。CSSNHL的完全恢复率为9.3%，总体恢复率为37.7%。我们发现听力损失的初始程度、治疗开始时间、耳鸣、上升型听力图、性别、听力损失侧别、记录的听性脑干反应（ABR）及畸变产物耳声发射（DPOAE）具有预后意义。年龄、耳闷胀感及眩晕与恢复无显著相关性。此外，相关血液检查显示30.8%的儿童白细胞（WBC）计数异常，22.1%的儿童同型半胱氨酸水平升高，65.8%的儿童碱性磷酸酶（ALP）升高，33.8%的儿童IgE抗体水平升高，86.1%的儿童巨细胞病毒（CMV）IgG抗体阳性。
结论
CSSNHL常见单侧发病并导致严重听力损失。初始严重听力损失及双侧听力损失是听力恢复的负面预后因素，而正面预后因素包括耳鸣、性别、上升型听力图、早期治疗、可识别的ABR波及DPOAE。年龄、眩晕及耳闷胀感与恢复无关。一些血清学指标，包括WBC、血小板、同型半胱氨酸、ALP水平、CMV IgG抗体阳性、纤维蛋白原及一些免疫学指标，与CSSNHL密切相关。
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