摘要
目的探讨影响低频下降型突发性聋预后的相关因素。方法选取2017年2月至2019年2月在山东大学附属山东省耳鼻喉医院耳内科住院治疗的成人单侧低频下降型突发性聋患者,进行听力学、前庭功能评估、影像学检查和血清甲状腺功能检测;给予相同的治疗方案,记录疗效,并随访3个月以上。应用SPSS 20.0软件分析伴发症状(耳鸣、耳闷、回音、旋转性头晕)、耳聋程度、发病诱因、基础疾病、前庭功能(双温试验)、耳蜗电图、内耳MRI钆造影及甲状腺功能等因素对患者预后的影响。结果 155例患者中痊愈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%。其中有24例(15.5%)患者在随访中出现了听力波动,1例(0.6%)进展成梅尼埃病。单因素分析显示:前庭功能、耳蜗电图、内耳MRI与患者预后存在相关性。多因素Logistic分析显示:耳闷、前庭功能、耳蜗电图、内耳MRI与患者预后存在相关性。两种分析均表明耳鸣、回音、旋转性头晕、耳聋程度、发病诱因、基础疾病与患者的预后无显著相关性(P值均>0.05)。其中旋转性头晕与性别密切相关,女性高发。病程≤1周的患者耳聋程度与预后具有显著相关性(P<0.05)。病程≤1周患者的前庭功能异常率与>1~≤2周和>2~≤4周的患者间差异有统计学意义(P<0.05)。甲状腺功能异常率显著高于健康人群(P<0.05),但甲状腺功能异常与听力预后无明显相关性(χ^2=0.009,P=0.923)。结论低频下降型突发性聋患者的预后与耳鸣、回音、旋转性头晕、耳聋程度、诱因、基础疾病及甲状腺功能血清学异常无相关性;发病1周内就诊,耳聋程度与预后呈正相关;甲状腺功能异常是低频下降型突发性聋发病的危险因素之一,前庭双温试验、耳蜗电图异常及内耳MRI钆造影内淋巴积水是预后不良因素。
Objective To investigate the prognostic factors of patients with low-frequency type of sudden sensorineural hearing loss.Methods 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.Results 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 P>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(P<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(P<0.05).The rate of abnormal thyroid function was significantly higher than that of normal people(P<0.05),but there was no significant correlation between thyroid dysfunction and hearing prognosis(χ^2=0.009,P=0.923).Conclusions 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.
作者
陈磊
王英俊
孙晓
张娜
李亚楠
樊兆民
王明明
王海波
Chen Lei;Wang Yingjun;Sun Xiao;Zhang Na;Li Yanan;Fan Zhaomin;Wang Mingming;Wang Haibo(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 Otology Center,Shandong Provincial ENT Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250022,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2020年第7期652-657,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
听觉丧失
突发性
低频
预后
Hearing loss
sudden
Low frequency
Prognosis
