Diao T X, Jing Y Y, Zhang J L, Wang Y X, Yu L S, Ma X
Department of Otolaryngology, People's Hospital, Peking University, Beijing 100044, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Feb 7;58(2):111-116. doi: 10.3760/cma.j.cn115330-20220406-00171.
To reclassify the flat type sudden deafness according to the types of audiogram shape, and to explore the correlation between different pattern of hearing loss and prognosis. All of 1 024 patients with unilateral sudden deafness (492 males and 532 females, aged from 19 to 65 years, with an average age of 41.2 years old) admitted to 33 hospitals nationwide from August 2007 to October 2011 were divided into four types according to Chinese Guideline of Sudden Deafness(2015): low-frequency, high-frequency, flat and total deafness. Then, 402 patients with flat type sudden deafness were further divided into ascending type, descending type and consistent type according to the audiogram shapes. First, we compared the clinical characteristics and prognosis among these three subtypes of flat deafness, then compared the clinical characteristics and prognosis between ascending flat deafness and low-frequency deafness, descending flat deafness and high-frequency deafness, consistent flat deafness and total deafness, explored the factors related to the prognosis of flat deafness. SPSS 21.0 software, ANOVA, χ test, -test and regression were used to analyze the data. The cure rates of flat ascending, flat descending and flat consistent sudden deafness groups were 70.7%, 17.1% and 34.0% respectively, with a statistically significant difference (χ=33.984, <0.001); However, there was no significant difference in age, sex and affected side (all >0.05). The independent related factors for the recovery of flat type sudden deafness were as follows: whether there was dizziness [=0.459; 95% confidence interval ( 0.271-0.777], the type of audiogram shape (=0.721; 95%: 0.530-0.981), and days from onset to therapy (=0.903, 95%: 0.835-0.978), all of which had values<0.05. There was no significant difference in the cure rates between ascending flat sudden deafness and low-frequency descending sudden deafness, descending flat sudden deafness and high-frequency descending sudden deafness (all >0.05). The pure tone average(PTA) of flat consistent sudden deafness and total deafness were (69.1±18.9) and (101.7±17.7) dB HL, respectively, with a statistically significant difference (=20.890, <0.001), and the cure rates were 34.0% and 14.5%, respectively, with a statistically significant difference (χ=29.012, <0.001). According to the audiogram shape, the flat type sudden deafness can be further divided into ascending flat sudden deafness, descending flat sudden deafness and consistent flat sudden deafness, which can more effectively evaluate the prognosis. The cure rate of ascending flat sudden deafness is similar to that of low-frequency sudden deafness, and the prognosis is well; The cure rate of descending flat sudden deafness is similar to that of high-frequency descending sudden deafness, and the prognosis is poor. The cure rate of consistent flat sudden deafness is higher than that of total deafness. PTA plays an important role in the prognosis of consistent flat sudden deafness and total deafness. Total deafness can be regarded as a single type of sudden deafness.
根据听力图形状对平坦型突发性聋进行重新分类，并探讨不同听力损失模式与预后的相关性。选取2007年8月至2011年10月全国33家医院收治的1024例单侧突发性聋患者（男492例，女532例，年龄19～65岁，平均41.2岁），按照《突发性聋诊断和治疗指南（2015）》分为低频下降型、高频下降型、平坦型和全聋型4种类型。将其中402例平坦型突发性聋患者根据听力图形状进一步分为上升型、下降型和一致型。首先比较平坦型聋这3种亚型的临床特征及预后，再比较上升型平坦聋与低频下降型聋、下降型平坦聋与高频下降型聋、一致型平坦聋与全聋型聋的临床特征及预后，探讨平坦型聋预后的相关因素。采用SPSS 21.0软件，运用方差分析、χ²检验、t检验及logistic回归进行数据分析。平坦型上升型、下降型、一致型突发性聋组的治愈率分别为70.7%、17.1%、34.0%，差异有统计学意义（χ²=33.984，P<0.001）；但年龄、性别及患侧差异均无统计学意义（均P>0.05）。平坦型突发性聋恢复的独立相关因素如下：是否有眩晕（β=0.459；95%置信区间（CI）：0.271～0.777）、听力图形状类型（β=0.721；95%CI：0.530～0.981）、发病至治疗天数（β=0.903，95%CI：0.835～0.978），差异均有统计学意义（均P<0.05）。上升型平坦突发性聋与低频下降型突发性聋、下降型平坦突发性聋与高频下降型突发性聋的治愈率差异均无统计学意义（均P>0.05）。一致型平坦突发性聋与全聋型聋纯音平均听阈（PTA）分别为（69.1±18.9）dB HL、（101.7±17.7）dB HL，差异有统计学意义（t=20.890，P<0.001），治愈率分别为34.0%、14.5%，差异有统计学意义（χ²=29.012，P<0.001）。根据听力图形状，平坦型突发性聋可进一步分为上升型平坦突发性聋、下降型平坦突发性聋和一致型平坦突发性聋，能更有效地评估预后。上升型平坦突发性聋治愈率与低频下降型突发性聋相似，预后良好；下降型平坦突发性聋治愈率与高频下降型突发性聋相似，预后较差。一致型平坦突发性聋治愈率高于全聋型聋。PTA在一致型平坦突发性聋与全聋型聋预后中起重要作用。全聋型可作为突发性聋的一种单独类型。
