Department of Otorhinolaryngology, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark.
Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
Ann Med. 2024 Dec;56(1):2411014. doi: 10.1080/07853890.2024.2411014. Epub 2024 Oct 11.
Sensorineural hearing loss (SNHL) has been suggested to occur in patients with Lyme neuroborreliosis (LNB); however, a clear association has never been documented. The present study prospectively investigated the development of SNHL in patients admitted for treatment of LNB using (DPOAE) as a measure of cochlear function.
DOAE were measured in patients with LNB on the day of diagnosis, during treatment, and 30-60 days after discharge. Frequencies were categorized as Low (1, 1.5, 2 kHz), Mid (3, 4, 5 kHz), Mid-high (6, 7, 8 kHz), and High (9, 10 kHz). Pure Tone Audiometry (PTA3) was performed at discharge and 60 days after. Patients were treated with i.v. ceftriaxone or oral doxycycline for 14 days according to guidelines.
DPOAE measurements were obtained in 25 patients with LNB at admission and in 18 patients at follow-up. Median age was 56 years (IQR, 48-64 years), and 16 (67%) were men. Fourteen (78%) of 18 patients showed improvement in Emission Threshold Levels (ETL) from admission to follow-up in low, mid-, and mid-high frequency categories, where ETLs increased by median levels of 3.2 (-4.1 to 8.3), 7.5 (-2.8 to 9.8), and 4.7 dB (-4.3 to 10.1). A decline was observed in the high frequency category, median -3.3 dB (-9.1 to 6.7). SNHL defined by pure tone average (PTA3) >20 dB was present in 11 out of 23 (48%) at discharge and in 9 out of 16 patients (56%) 60 days after discharge, which differed significantly from matched controls (Mann-Whitney test, = 0.036).
LNB can lead to cochlear outer-hair cell dysfunction, resulting in temporary and long-term SNHL.
已有人提出莱姆神经Borreliosis（LNB）患者会出现感觉神经性听力损失（SNHL），但一直未能明确二者的关联性。本研究前瞻性地通过耳声发射测试（DPOAE）来评估 LNB 患者的耳蜗功能，以观察患者在接受 LNB 治疗期间及治疗结束后 30-60 天内 SNHL 的发展情况。
LNB 患者在确诊当日、治疗期间及出院后 30-60 天进行 DPOAE 测试。频率分为低频（1、1.5、2 kHz）、中频（3、4、5 kHz）、中高频（6、7、8 kHz）和高频（9、10 kHz）。出院时和 60 天后进行纯音测听（PTA3）。根据指南，所有患者均接受静脉注射头孢曲松或口服多西环素治疗 14 天。
25 例 LNB 患者在入院时和 18 例患者在随访时进行了 DPOAE 测量。患者中位年龄为 56 岁（IQR，48-64 岁），16 例（67%）为男性。18 例患者中有 14 例（78%）在低频、中频和中高频类别的 Emission Threshold Levels（ETL）自入院至随访时均有改善，ETL 中位数分别增加了 3.2（-4.1 至 8.3）、7.5（-2.8 至 9.8）和 4.7 dB（-4.3 至 10.1）。高频类别中，ETL 中位数下降了 3.3 dB（-9.1 至 6.7）。23 例出院患者中有 11 例（48%），16 例出院后 60 天的患者中有 9 例（56%）出现了纯音平均（PTA3）>20dB 的 SNHL，与匹配的对照组相比差异有统计学意义（Mann-Whitney 检验， = 0.036）。
LNB 可导致耳蜗外毛细胞功能障碍，引起暂时和长期的 SNHL。
