de Jong Marrigje Aagje, Luder Ari, Gross Menachem
Department of Otolaryngology-Head and Neck Surgery, Hadassah Hebrew-University Medical Center, Jerusalem, Israel.
Front Neurol. 2019 Aug 6;10:845. doi: 10.3389/fneur.2019.00845. eCollection 2019.
Hearing abnormalities frequently occur in Human Immunodeficiency Virus (HIV) infected individuals. Both conductive and uni- or bilateral sensorineural hearing loss (SNHL) have been described along with other audiological and vestibular symptoms such as tinnitus, vertigo and balance disturbances. While frequent middle ear infections may explain impairment of peripheral hearing abilities, the exact etiology of cochlear, and central auditory processing deficits still remains unclear. Direct effects of HIV, opportunistic infections, ototoxic side effects of antiretroviral therapy (ART), and immunologic responses to the central nervous system involving the auditory pathway have been proposed. We aim to review the audiological profile in HIV infected adults related to the effects of HIV and HAART on the inner ear structures. We present a review of the literature on cases of HIV related SNHL in adult patients and studies conducted to investigate audiometric changes in such patients. Data on presentation, diagnosis and pathophysiology were reviewed. Sensorineural hearing loss in the higher frequencies is a common form of hearing loss in HIV infected individuals throughout disease progression, along with decreased otoacoustic emission (OAE) responses, increased PTA hearing thresholds and prolonged latencies for auditory brainstem responses (ABR). HIV affects all stages of auditory perception in a way similar to accelerated aging of the auditory system. And we postulate that synaptic loss may be the first step, followed by cochlear damage and central pathology as the virus remains present in all the structures of the auditory pathway causing local inflammation and degeneration. Evaluation of hearing function among all patients diagnosed with HIV infection seems to be an accepted approach; it should include OAE testing, pure tone and speech audiometry, speech-in-noise tests and ABR measurements.
听力异常在人类免疫缺陷病毒（HIV）感染者中经常出现。传导性听力损失以及单侧或双侧感音神经性听力损失（SNHL）均有报道，同时还伴有耳鸣、眩晕和平衡障碍等其他听力学和前庭症状。虽然频繁的中耳感染可能解释外周听力能力的损害，但耳蜗及中枢听觉处理缺陷的确切病因仍不清楚。有人提出了HIV的直接作用、机会性感染、抗逆转录病毒疗法（ART）的耳毒性副作用以及涉及听觉通路的对中枢神经系统的免疫反应。我们旨在综述HIV感染成年人的听力学特征，这些特征与HIV和高效抗逆转录病毒治疗（HAART）对内耳结构的影响有关。我们对成年患者中与HIV相关的SNHL病例的文献以及为调查此类患者听力测定变化而进行的研究进行了综述。对临床表现、诊断和病理生理学的数据进行了回顾。在HIV感染个体整个疾病进展过程中，高频感音神经性听力损失是一种常见的听力损失形式，同时伴有耳声发射（OAE）反应降低、纯音听力阈值升高以及听觉脑干反应（ABR）潜伏期延长。HIV以类似于听觉系统加速老化的方式影响听觉感知的各个阶段。我们推测突触丧失可能是第一步，随后是耳蜗损伤和中枢病变，因为病毒在听觉通路的所有结构中持续存在，导致局部炎症和变性。对所有诊断为HIV感染的患者进行听力功能评估似乎是一种可接受的方法；它应包括OAE测试、纯音和言语听力测定、噪声中的言语测试以及ABR测量。
