突发性聋预后因素分析

Analysis of prognostic factors for sudden sensorineural hearing loss

目的:探讨突发性聋预后的相关因素,指导其预后判断。方法:回顾性分析256例(280耳)突发性聋患者应用有序Logistic回归分析,筛选与突发性聋预后相关的因素,同一影响因素采用χ2检验,进一步量化指标,以指导预后分析。结果:年龄、病程、伴发症状、治疗前耳聋程度、听力曲线类型均与疗效有相关性;性别、耳聋侧别与疗效无相关性;病程≤3d与>3～9d疗效比较差异无统计学意义(P>0.05),>15d、>3～9d与>9～15d疗效比较均差异有统计学意义(均P<0.05);不伴耳鸣或(和)眩晕的患者治疗有效率要明显高于伴耳鸣或(和)眩晕的患者(P<0.05);初诊听力曲线上升型与平坦型、其余各型总的有效率比较均差异有统计学意义(均P<0.05);初诊听阈中度与极重度疗效差异有统计学意义(P<0.05)。结论:影响突发性聋预后的因素有年龄、病程、伴发症状、治疗前耳聋程度、听力曲线类型;随年龄增加,其预后呈不良趋势,以40岁为界,预后明显变差;发病9d以内疗效较好,其后有效率明显下降;伴耳鸣或(和)眩晕的患者预后明显差于不伴耳鸣或(和)眩晕的患者;下降型听力曲线发病率最高,但上升型曲线疗效明显好于其他组;治疗前的听阈水平与疗效并非简单的线性关系,中度水平的听阈疗效最好,极重度疗效最差,随听阈提高,总体疗效呈下降趋势。

Objective：To analysis the prognostic factors of the sudden sensorineural hearing loss（SHL）,to predict the prognosis of patient with SHL precisely.Method：Two hundred and fifty-six cases（280 ears） with SHL were reviewed retrospectively during January 2005 to Jun 2009.Possible influence factor was analysis with logistic stepwise regression to investigate the correlation with prognosis.All verified influence factors was analysis with single-factor analysis of variance.Result： The prognosis of SHL related to age,the trouble time before treatment,vertigo with（or） tinnitus,degree of hearing loss,the patterns of audiogram,but not to sex and trouble ear.With increasing of age,the prognosis of SHL becomes poor.Especially after 40 years old,the prognosis gets worse.Regarding to the relationship between the trouble time before treatment and the prognosis.The groups within 9 days have no significant difference（P0.05）.There are significant difference between group of 3-9 days and 9-15 days（P0.05）,9-15 days and 15 days（P0.05）.Compared with patients suffer from vertigo or（and） tinnitus,patients without vertigo or（and） tinnitus obtain a good result（P0.05）.As for initial hearing threshold,flat（upgrade） subgroup,downgrade（upgrade） subgroup,upgrade subgroup and valley-mountain subgroup have no significant difference（P0.05）.However,there are significant difference between upgrade subgroup and flat subgroup,upgrade subgroup and all the others.Furthermore,comparison with the low,midst,severe and profound hearing loss,the prognosis among them is no statistical different.But statistical different exists between media and profound subgroup.Conclusion：The factor of age,the trouble time before treatment,vertigo with（or） tinnitus,degree of hearing loss,the patterns of audiogram are correlated with prognosis of SHL.The prognosis has a poor tendency with age increasing,especially after 40 years old.Good result maybe achieved within 9 visiting days.After that,the recovery rates declined obviously.Patients have company complication,such as vertigo or（and） tinnitus have poor prognosis.The downgrade subgroup of audiogram has high incidence rate although upgrade subgroup has a good prognosis.The level of hearing loss before medication is not a simple linear correlation with prognosis.Media hearing loss demonstrate the best prognosis.On the contrary,profound hearing loss has the worst prognosis.With hearing threshold added,the total recovery rates goes down.