以突聋为首发表现的颅内肿瘤病例临床特征分析

A clinical analysis for sudden sensorineural hearing loss with intracranial tumors

目的描述以突聋为表现的颅内肿瘤病例临床特征,探讨听力学、影像学及实验室检查指标,以便更好的指导临床鉴别诊断,早期确定有效治疗方案。方法对4例以突聋为首发表现的颅内肿瘤患者的临床资料进行系统性分析,包括临床表现、听力学检查、影像学检查及治疗方法和疗效评估等,归纳总结该病发生发展及转归的特点。结果 4例患者中有3名男性,1名女性,均无明显诱因出现突发性听力下降。其中2例伴有持续高调耳鸣,1例伴有耳鸣及眩晕,1例无耳鸣及眩晕表现。听力学检查结果显示:4例患者颅内占位侧听力均表现为重度或极重度感音神经性聋,镫骨肌声反射均不能引出;3例患者听性脑干反应高低刺激和耳声发射均未引出,声发射均未引出;1例仅见Ⅰ波,耳声发射部分引出反应。前庭功能检查示:1例右侧水平半规管功能低下,1例正常,2例未查。核磁共振检查发现:1例为左侧后颅窝良性肿瘤性病变,表皮样囊肿可能性大;1例为右侧颞叶囊肿;2例为右侧听神经鞘瘤。经系统的耳内科保守治疗后,1例听力基本恢复正常,眩晕症状消失,耳鸣缓解;1例耳鸣缓解;2例无效。结论在接诊以突发性听力损失为首发症状的患者时,要考虑到有颅内占位性病变的可能性。ABR、声反射检查、言语识别率和前庭功能检查均有重要的提示意义。对于微小听神经瘤,早期可以通过耳内科治疗缓解症状。颅内占位病变的确诊还要依赖CT和MRI检查。

Objective Retrospective analysis of clinical data of sudden sensorineural hearing loss with Intracranial Tumors was applied to instruct diagnosis, early identification and effective treatment. Methods The clinical data of 4 cases with sudden sensorineural hearing loss with intracranial tumors were collected. To make detailed comparative analysis for the clinical hearing tests, imaging examinations and laboratory tests. Results All the cases, including three male and one female, had got sudden hearing loss with no obvious incentive. Two cases had high-profile tinnitus, while 1 case had tinnitus and vertigo. Audiological tests results showed that all cases suffered severe or profound sensorineural hearing loss, and were not measured acoustic stapedial reflex. All cases had abnormal results of stimulate auditory brainstem response and otoacoustic emission. One case had vestibular dysfunction. Imaging results showed that one case was a left benign tumor of the posterior fossa, one case was a right temporal lobe cyst, and two cases were right acoustic neurinoma. During systematic medical therapy, one case turned to normal hearing, dizziness disappeared, and tinnitus relief. One Case turned to tinnitus relief. Two cases were invalid. Conclusions Doctors must take into account the possibility of intracranial lesions when encountering patients who has had sudden hearing loss. All the examination methods, such as ABR, DPOAE, and Speech Discrimination Score, have important significance. Early medical treatment can relieve symptoms of small acoustic neuroma. The diagnosis of intracranial lesions depends on CT and MRI.