突发性聋患者伴发耳鸣的疗效分析

Multi-center study on the treatment of sudden deafness accompanied with tinnitus

目的探讨突发性聋伴耳鸣患者的临床特点及药物治疗效果。方法采用国际通用的标准化临床研究方法，统一设计、统一方案进行前瞻性临床多中心研究。收集符合人组条件（年龄在18～65周岁之间，病程在2周以内，未经任何相关医疗处理）的单侧突发性聋患者，按照听力曲线将患者分为低中频下降型、中高频下降型、平坦下降型和全聋型四种类型，每种类型有四种不同治疗方案，根据统一设计的随机表，随机选取其中一种方案进行治疗。其中低中频下降型为银杏叶提取物（金纳多）、泼尼松、巴曲酶（东菱迪芙）及其组合；中高频下降型为利多卡因、泼尼松、金纳多及其组合；平坦型或全聋型为东菱迪芙、金纳多、泼尼松及其组合。结果2007年8月至2011年10月全国33家医院共收集符合人组条件的单侧突发性聋患者1024例，其中922例（90．04％，922／1024）患者伴有耳鸣。其中低中频下降型伴耳鸣169例，耳鸣发生率82．44％（169／205）；中高频下降型伴耳鸣127例，耳鸣发生率90．07％（127／141）；平坦下降型伴耳鸣370例，耳鸣发生率92．04％（370／402）；全聋型伴耳鸣256例，耳鸣发生率92．75％（256／276）。突聋伴发的耳鸣以持续性、低调耳鸣为主，严重程度多在2～3级。经系统药物治疗后，耳鸣的总有效率低中频下降型最高，为96．18％；平坦下降型次之，为87．75％；中高频下降型为81．51％；全聋型为75．32％；各型之间耳鸣总有效率比较，差异具有统计学意义（X^2=125．33，P=0．000）。虽然各型突发性聋四种治疗方案之间耳鸣疗效的差异均无统计学意义（均P〉0．05），但单纯从总有效率来看，疗效最好的组中都使用了糖皮质激素。结论突发性聋患者伴发耳鸣的比例较高。低中频下降型突聋伴发的耳鸣疗效最好，平坦下降型次之，中高频下降型和全聋型伴发的耳鸣药物治疗效果欠佳。糖皮质激素对各型突聋伴发的耳鸣均有效。

Objective To investigate the clinical characteristics and the effects of different drug therapies in patients of sudden deafness accompanied with tinnitus. Methods The international standardized clinical research methods, the unified design and program were used in the study. The patients of sudden deafness accompanied with tinnitus, aged between 18 to 65 years old, were recruited, whose duration was less than two weeks with no medication. The patients were divided into four types according to the hearing curve：type A was acute sensorineural hearing loss in low tone frequencies, type B was acute sensorineural hearing loss in high tone frequencies, type C was acute sensorineural hearing loss in all frequencies and type D was total deafness. Each type had four different treatment programs, based on the unified designed randomized table. Results A total of 1024 cases with single side sudden deafness were recruited in the study by 33 hospitals in China from August 2007 to October 2011. Among the 1024 cases, 922 cases were accompanied with tinnitus （90. 04% ）. By classification of audiogram, among the 922 cases, 169 cases were type A（82. 44% ）, 127 cases were type B（90. 07% ）, 370 cases were type C（92. 04% ）, and 256 cases were type D （92. 75% ）. The tinnitus mostly was persistent and low tone tinnitus. The degree of the tinnitus was mostly 2 - 3 grade. The curative effects of different types were analyzed, type A had the highest rate of 96. 18% ,type C was 87. 75% ,type B was 81.51%, and type D had the lowest rate of 75.32%. Significant difference of curative rate between different types was detected （ X^2 = 125.33, P = 0. 000）. There had no significant difference between the four different treatment groups （ all P 〉 0. 05 ）. Conclusions In the cases with single side sudden deafness accompanied with tinnitus, the type in low tone frequencies has the best curative effect, followed by the type in all frequencies. The type in high tone frequencies and the total deafness type have poor curative results. The steroid plays a good effect in the treatment.