Zhong Yao, Li Hongyan, Liu Gaifen, Liu Jia, Mo Jia-Jie, Zhao Xingquan, Ju Yi
Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2023 Nov 1;14:1293102. doi: 10.3389/fneur.2023.1293102. eCollection 2023.
Sudden sensorineural hearing loss (SSNHL) can be a prodromal symptom of ischemic stroke, especially posterior circulation strokes in the anterior inferior cerebellar artery (AICA) area. Early diagnosis and optimal treatment for vascular SSNHL provide an opportunity to prevent more extensive area infarction. The objective of our research was to find clues that suggest stroke at the stage of isolated sudden hearing loss.
We retrospectively investigated the medical records of patients who received an initial diagnosis of sudden sensorineural hearing loss upon admission from January 2017 to December 2022 at Capital Medical University Affiliated Beijing Tiantan Hospital. Among these patients, 30 individuals who developed acute ischemic stroke during their hospital stay were enrolled as the case group. To create a control group, we matched individuals from the nonstroke idiopathic SSNHL patients to the case group in terms of age (±3 years old) at a ratio of 1:4. We collected the clinical characteristics, pure tone hearing threshold test results, and imaging information for all patients included in the study.
Three models were constructed to simulate different clinical situations and to identify vascular sudden sensorineural hearing loss (SSNHL). The results revealed that patients with SSNHL who had three or more stroke risk factors, bilateral hearing loss, moderately severe to total hearing loss, and any intracranial large artery stenosis and occlusion (≥50%) were at a higher risk of developing ischemic stroke during hospitalization. Consistent with previous studies, the presence of vertigo at onset also played a significant role in the early detection of upcoming stroke.
Clinicians should be alert to SSNHL patients with bilateral hearing loss, moderately severe to total hearing loss and other aforementioned features. Early pure tone audiometric hearing assessment and vascular assessment are necessary for high-risk patients with SSNHL.
突发性感音神经性听力损失（SSNHL）可能是缺血性卒中的前驱症状，尤其是小脑前下动脉（AICA）区域的后循环卒中。对血管性SSNHL进行早期诊断和优化治疗可为预防更广泛区域梗死提供机会。我们研究的目的是在孤立性突发听力损失阶段找到提示卒中的线索。
我们回顾性调查了2017年1月至2022年12月在首都医科大学附属北京天坛医院入院时初次诊断为突发性感音神经性听力损失的患者的病历。在这些患者中，30例在住院期间发生急性缺血性卒中的患者被纳入病例组。为建立对照组，我们按照1:4的比例将非卒中特发性SSNHL患者中与病例组年龄（±3岁）匹配的个体纳入。我们收集了纳入研究的所有患者的临床特征、纯音听力阈值测试结果和影像学信息。
构建了三种模型来模拟不同临床情况并识别血管性突发性感音神经性听力损失（SSNHL）。结果显示，具有三种或更多卒中危险因素、双侧听力损失、中度至重度或全聋以及任何颅内大动脉狭窄和闭塞（≥50%）的SSNHL患者在住院期间发生缺血性卒中的风险更高。与既往研究一致，发病时眩晕的存在在即将发生的卒中早期检测中也起重要作用。
临床医生应警惕具有双侧听力损失、中度至重度或全聋以及其他上述特征的SSNHL患者。对于高危SSNHL患者，早期进行纯音听力测定听力评估和血管评估是必要的。
