Zhang Yi, Liu Bo, Wang Rui, Jia Ruo, Gu Xin
Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730; Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing 100730, China.
Chin Med J (Engl). 2016 Oct 20;129(20):2445-2450. doi: 10.4103/0366-6999.191767.
Meniere's disease is a unique, progressive disease of the inner ear. The complex manifestation presents diagnostic challenges. The cochlear symptoms often present before vertigo and tend to be ignored. This study aimed to analyze the characteristics of cochlear symptoms and functions associated with Meniere's disease to investigate the regularity of the development of this disorder.
One-hundred fifteen patients who were diagnosed with definite unilateral Meniere's disease at the Hearing and Vestibular Clinic of the Department of Otorhinolaryngology of Beijing Tongren Hospital from August 2013 to November 2015 were recruited in this retrospective study. Initial symptoms, duration from initial symptoms to the diagnosis, hearing thresholds, audiogram patterns, and caloric test results were collected and analyzed for each patient. Data were analyzed using SPSS 13.0 statistical software by Spearman's correlation, Kruskal-Wallis H test, Chi-square test, and Fisher's exact test.
The average hearing threshold of these patients was 45.24 ± 18.40 dB HL. A majority of the patients (55.65%) were in Stage 3. The initial presentation of the disorder in 58 cases (50.43%) comprised only cochlear symptoms without vertigo. A weak, positive correlation was found between the degree of hearing loss and duration of the disease from initial symptoms to the diagnosis (rs = 0.288, P = 0.002). Upward-sloping, inverted "V," downward-sloping, and flat pattern were the main audiometric patterns observed with a distinctive distribution between stages (P < 0.001). Based on the configurations of audiograms, the audiometric patterns had a weak correlation to the duration (rs = 0.269, P = 0.004), and there was a tendency of duration to rising from upward-sloping, inverted "V", downward-sloping to flat pattern. (H = 10.024, P = 0.018). Frequencies of tinnitus in 56 patients (64.4%) were at the lowest points of the audiograms, i.e., the frequencies of the poorest hearing threshold. The patients at an advanced stage (Stage 3 [56] and Stage 4 [73]) exhibited a significantly higher abnormality of canal paresis than those at the earlier stages (Stage 1 [23] and Stage 2 [42]) (χ2 = 5.973, P = 0.015).
Patients with definite Meniere's disease always have a moderate to severe sensorineural hearing loss before diagnosis. Cochlear symptoms are the most common initial presentation. With the progression of the duration, the hearing impairment becomes more severe and the distribution of the audiometric pattern is distinctive between stages.
梅尼埃病是一种独特的、进行性的内耳疾病。其复杂的表现带来了诊断挑战。耳蜗症状通常先于眩晕出现，容易被忽视。本研究旨在分析梅尼埃病相关的耳蜗症状及功能特点，以探讨该疾病发展的规律。
本回顾性研究纳入了2013年8月至2015年11月在北京同仁医院耳鼻咽喉科听力与前庭门诊确诊为单侧梅尼埃病的115例患者。收集并分析每位患者的初始症状、从初始症状到诊断的持续时间、听力阈值、听力图类型及冷热试验结果。使用SPSS 13.0统计软件，通过Spearman相关性分析、Kruskal-Wallis H检验、卡方检验和Fisher精确检验进行数据分析。
这些患者的平均听力阈值为45.24±18.40 dB HL。大多数患者（55.65%）处于3期。58例患者（50.43%）疾病的初始表现仅为耳蜗症状，无眩晕。发现听力损失程度与从初始症状到诊断的疾病持续时间之间存在弱的正相关（rs = 0.288，P = 0.002）。上升型、倒“V”型、下降型和平坦型是观察到的主要听力图类型，各期之间分布有显著差异（P < 0.001）。根据听力图的形态，听力图类型与持续时间有弱相关性（rs = 0.269，P = 0.004），且持续时间有从上升型、倒“V”型、下降型到平坦型逐渐增加的趋势（H = 10.024，P = 0.018）。56例患者（64.4%）耳鸣频率处于听力图的最低点，即听力阈值最差的频率。晚期患者（3期[56例]和4期[73例]）的半规管轻瘫异常率显著高于早期患者（1期[23例]和2期[42例]）（χ2 = 5.973，P = 0.015）。
确诊为梅尼埃病的患者在诊断前通常存在中度至重度感音神经性听力损失。耳蜗症状是最常见的初始表现。随着病程进展，听力损害加重，听力图类型在各期之间的分布具有显著差异。
