梅尼埃病首发症状的临床分析

Clinical analysis of the onset symptoms of Meniere's disease

目的了解梅尼埃病患者的性别、首发的年龄、症状,并根据首发症状进行临床分类。方法回顾分析准确提供首发症状的145例梅尼埃病患者,按照耳聋和(或)耳鸣(耳蜗症状)、半规管(旋转性眩晕)和耳石器症状(倾到或平衡障碍)进行分类。结果首发症状依次为耳鸣45例、耳蜗加眩晕症状30例、眩晕28例、耳鸣加耳聋27例、听力下降9例、耳石器症状6例。累及耳蜗及前庭系统30例；累及耳蜗81例；累及半规管28例；累及耳石器6例。小于20岁和大于60岁年龄组患者数最少。男性高发年龄较女性高发年龄早10年,男性和女性在30～49岁年龄段发病例数最多。三种类型梅尼埃病临床首发症状与典型症状出现的间隔差异均较大。结论梅尼埃病耳蜗受累明显高于前庭,首发症状耳鸣最常见,其次是听力下降,再次为眩晕,倾倒的出现率最低。对不典型病例的早期诊断酌情选择纯音测听、耳蜗电图、前庭双温试验和前庭诱发的肌源性电位等检查。

OBJECTIVE To classify the onset symptom of Meniere＇s disease and to analyze the age and sex distribution of Meniere＇s disease. METHODS A retrospective study was carried out on the age and sex distribution and classification of the onset symptoms in 145 patients with Meniere＇s disease according to symptoms related to cochlear insult （tinnitus and hearing loss）, semicircular canal insult （rotational vertigo）, balance disorder （Dysequilibrium and fall）. RESULTS Among onset symptoms,45 patients had tinnitus only, 30 had hearing loss, tinnitus and vertigo, 28 had vertigo only, 27 had hearing loss and tinnitus, 9 had hearing loss only, 6 had fall and dysequilibrium only. Generally speaking, 30 patients had cochlear and vestibular insult as the onset symptom; 81 had cochlear disorder manifestation as the first sign; 28 had only semicircular symptom and 6 manifested as vestibular disorders. The age distribution of the patients with Meniere＇s disease showed there were least population below 20 and over 60 years old. The peak onset age in male cases was 10 years earlier than that in female cases. And both male and female had their most patients at the age between 30 and 49 years old. The duration between the initial symptoms and the classic symptoms of Meniere＇s disease varied greatly in all three types patients. CONCLUSION The onset symptom of Meniere＇s disease had some diversity. There were more cochlear symptoms than vestibular symptoms. The three common symptoms were tinnitus, hearing loss and vertigo respectively. The incidence of fall was very low. Therefore, different clinical tests such as pure tone audiometry, electrocochleaography, alternate bithermal caloric test and vestibular evoked myogenic potentials（VEMP） should be utilized for early diagnosis, early management to decrease the cochleo-vestibular disability.