Mitschke H
Fortschr Med. 1980 Mar 27;98(12):437-40.
Within a period of 7 years a total of 113 patients could be oto-rhino-laryngologically examined. The cases comprise chronic uremic patients under conservative therapy, patients with chronic intermittent haemodialysis treatment, and patients after successful renal transplantation. In 52% of all patients examined an impairment of hearing can be diagnosed and specified as inner ear deafness. As common etiological factors for inner ear deafness can be excluded, an accumulation of so-called uremic toxins is regarded to be the most probable cause of uremic deafness. This is confirmed by the fact that uremic deafness is not affected by haemodialysis treatment, but can be influenced favorably by a normal transplant function. Besides infiltrations of chronic inflammation and metaplasia of epithelium, nasal biopsies on uremic patients yielded histological findings invariably showing wide, thin-walled vessels in the subepithelium and the stroma. This phenomenon is possibly another pathogenic factor for epistaxis in chronic uremic patients. The depression of immunological resistance in uremia and the medication of immunosuppressive drugs after renal transplantation may explain the fact that serious otorhino-laryngological injections could frequently be observed in our patients. Careful observation may be helpful for early diagnosis and treatment of possible bacterial and mycotic infections in a very early stage.
在7年的时间里，总共对113名患者进行了耳鼻喉科检查。这些病例包括接受保守治疗的慢性尿毒症患者、接受慢性间歇性血液透析治疗的患者以及肾移植成功后的患者。在所有接受检查的患者中，52%被诊断出听力受损，并被明确为内耳性耳聋。由于可以排除内耳性耳聋的常见病因，所谓的尿毒症毒素蓄积被认为是尿毒症性耳聋最可能的原因。这一点得到了以下事实的证实：尿毒症性耳聋不受血液透析治疗的影响，但可以因正常的移植功能而得到改善。除了慢性炎症浸润和上皮化生外，对尿毒症患者进行的鼻活检组织学检查结果总是显示上皮下和基质中有宽大、薄壁的血管。这种现象可能是慢性尿毒症患者鼻出血的另一个致病因素。尿毒症患者免疫抵抗力的下降以及肾移植后免疫抑制药物的使用可能解释了我们的患者中经常观察到严重耳鼻喉科感染的原因。仔细观察可能有助于在非常早期阶段对可能的细菌和真菌感染进行早期诊断和治疗。
