突发性极重度聋与全聋的预后特点及差异

Different prognostic characteristics between profound sudden sensorineural hearing loss and total sudden hearing loss

目的 研究突发性极重度聋和全聋的预后特点及差异.方法 回顾性研究复旦大学附属眼耳鼻喉科医院2007年6月至2008年9月收治的初始平均纯音听阈（pure tone average,PTA）〉90 dB、随访完整的204例患者,分为全聋和极重度聋两组,对两组的预后进行比较,并对预后与年龄、并发症、发病-就诊时间进行相关性分析.结果 全聋组57例,极重度聋组147例,耳鸣、眩晕、耳闷三大伴随症状中,耳鸣的伴随率最高,两组均达90%以上,眩晕的伴随率全聋组为64.9%（37/57）,极重度聋组为45.6%（67/147）,两组间差异有统计学意义（x2=5.72,P=0.017）.治疗后全聋组PTA下降（36.4±19.3）dB,极重度聋组下降（40.2±21. 3）dB,差异无统计学意义（t=1.165,P=0.245）.两组痊愈者均为1周内接受治疗者,全聋组痊愈率为2.6%（1/38）,极重度聋组为14.3%（14/98）,两组间差异有统计学意义（Fisher确切概率法,P=0.045）.全聋组治疗后PTA≤50 dB的患者占3.5%（2/57）,极重度聋组达29.9%（44/147）,两组间差异有统计学意义（x2=15.92,P=0.001）.两组的预后与发病-就诊的时间有关（P值均为0.01）,与年龄无关.结论 初始PTA〉90 dB的突发性聋可分为极重度聋与全聋,两者预后有差异,需分开进行研究.

Objective To clarify the different prognostic characteristics between profound sudden sensorineural hearing loss （SSNHL） and total SSNHL. Methods The patients with SSNHL who visited Eye Ear Nose and Throat Hospital from June 2007 to September 2008 were reviewed retrospectively. All the 204 patients, with pure tone average （PTA） threshold more than 90 dB, were enrolled and divided into two groups, including total SSNHL and profound SSNHL groups. The relationship between recovery rate and prognostic factors including the age, complications, time period between onset and therapy was analyzed.Results There were 57 cases of total SSNHL and 147 cases of profound SSNHL in this series. Tinnitus was complained in more than 90% of the patients in both groups, which was higher than that of dizziness and ear fullness. Dizziness was present in 64. 9% （37/57） patient with total SSNHL group and 45.6% （67/147）patients with profound SSNHL, which had significant difference between the two groups （x2 = 5.72,P =0. 017）. The PTA threshold improvement in total SSNHL group and profound SSNHL group was （36. 4 ±19.3） dB and （40. 2 ±21.3） dB respectively, which was no significant difference between the two groups （t = 1. 165 ,P =0. 245）. The cured patients were all those received therapy within 1 week following the onset of SSNHL, which was of 2. 6% （1/38） patients in the total SSNHL group and 14. 3% （14/98） patients in the profound SSNHL group（P =0. 045）. Furthermore, 3.5% （2/57） patients in total SSNHL group as well as 29. 9% （44/147） patients in profound SSNHL group obtained a good result with PTA threshold ≤50 dB after therapy（x2 = 15.92,P = 0. 001 ）. In addition, the favorable prognosis was related with the onsettherapy time point（ P = 0. 001 ）, but not related to the patients＇ age. Conclusion Profound SSNHL and total SSNHL though both with PTA threshold 〉 90 dB had significant differences recovery rate and need to be studied separately.