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[低频型突发性感音神经性听力损失的预后因素分析]

[Analysis of prognostic factors of low-frequency type of sudden sensorineural hearing loss].

作者信息

Chen L, Wang Y J, Sun X, Zhang N, Li Y N, Fan Z M, Wang M M, Wang H B

机构信息

Department of Otological Medicine, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250022, China; Shandong Institution of Otolaryngology, Jinan 250022, China.

Department of Otological Medicine, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250022, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jul 7;55(7):652-657. doi: 10.3760/cma.j.cn115330-20191212-00756.

Abstract

To investigate the prognostic factors of patients with low-frequency type of sudden sensorineural hearing loss. From February 2017 to February 2019, adult patients with unilateral low-frequency type of sudden sensorineural hearing loss in Department of Otological Medicine, Shandong Provincial ENT Hospital, Shandong University were selected. All patients were examined by audiology, vestibular function evaluation, imaging examination and serum thyroid function test; the same treatment program was given, the curative effect was recorded and followed up for more than 3 months. SPSS 20.0 software was used to analyze concomitant symptoms (tinnitus, ear tightness, echo, rotatory vertigo), degree of deafness, inducement of deafness, basic disease, vestibular function (caloric test), electrocochleogram, inner ear gadolinium enhanced MRI radiography and thyroid function on prognosis of patients. Among the 155 patients, 76 cases were cured (49.0%), 1 case was markedly effective (0.6%), 19 cases were effective (12.3%), and 59 cases were ineffective (38.1%). The total effective rate was 61.9%. Among them, 24 cases (15.5%) had hearing fluctuations during follow-up, and 1 case (0.6%) developed Meniere's disease. Univariate analysis showed that vestibular function, electrocochleogram and inner ear MRI were correlated with prognosis. Multivariate logistic analysis showed that ear tightness, vestibular function, electrocochleogram and inner ear MRI were correlated with the prognosis of the patients. The two analyses showed that tinnitus, echo, rotational vertigo, degree of deafness, predisposing factors and underlying diseases were not significantly correlated with the prognosis of the patients (all >0.05). Rotational vertigo was closely related to gender, and women had a high incidence. There was a significant correlation between the degree of deafness and prognosis in patients with course of less than 1 week (<0.05). The abnormal rate of vestibular function in patients with course of disease ≤ 1 week was significantly different from that>1-≤2 and>2-≤4 weeks (<0.05). The rate of abnormal thyroid function was significantly higher than that of normal people (<0.05), but there was no significant correlation between thyroid dysfunction and hearing prognosis (χ(2)=0.009, =0.923) . The prognosis of low-frequency sudden sensorineural hearing loss is not related to clinical symptoms, inducements, underlying diseases and serological abnormalities of thyroid function, but the degree of deafness is positively related to the prognosis within 1 week from onset. Abnormal thyroid function is one of the risk factors of happening with low-frequency descending sudden deafness. Abnormal vestibular caloric test, electrocochleogram and endolymph hydrops are the factors of poor prognosis.

摘要

探讨低频型突发性聋患者的预后因素。选取2017年2月至2019年2月山东大学山东省耳鼻喉医院耳科医学科单侧低频型突发性聋的成年患者。所有患者均行听力学、前庭功能评估、影像学检查及血清甲状腺功能检查;给予相同治疗方案,记录疗效并随访3个月以上。采用SPSS 20.0软件分析伴随症状(耳鸣、耳闷、耳内回声、旋转性眩晕)、耳聋程度、耳聋诱因、基础疾病、前庭功能(冷热试验)、耳蜗电图、内耳钆增强磁共振成像及甲状腺功能对患者预后的影响。155例患者中,治愈76例(49.0%),显效1例(0.6%),有效19例(12.3%),无效59例(38.1%)。总有效率为61.9%。其中,24例(15.5%)在随访期间听力有波动,1例(0.6%)发展为梅尼埃病。单因素分析显示,前庭功能、耳蜗电图及内耳磁共振成像与预后相关。多因素logistic分析显示,耳闷、前庭功能、耳蜗电图及内耳磁共振成像与患者预后相关。两项分析均显示,耳鸣、耳内回声、旋转性眩晕、耳聋程度、诱发因素及基础疾病与患者预后无显著相关性(均>0.05)。旋转性眩晕与性别密切相关,女性发病率高。病程小于1周的患者耳聋程度与预后有显著相关性(<0.05)。病程≤1周患者的前庭功能异常率与病程>1~≤2周及>2~≤4周患者有显著差异(<0.05)。甲状腺功能异常率显著高于正常人(<0.05),但甲状腺功能异常与听力预后无显著相关性(χ(2)=0.009,P=0.923)。低频突发性聋的预后与临床症状、诱因、基础疾病及甲状腺功能血清学异常无关,但耳聋程度与发病1周内的预后呈正相关。甲状腺功能异常是低频下降型突发性聋发生的危险因素之一。前庭冷热试验异常、耳蜗电图及内淋巴积水是预后不良的因素。

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