伴眩晕的突发性聋患者的临床特征与疗效分析

Study of clinical characteristics and curative effects of sudden hearing loss patients with vertigo

目的 分析伴眩晕的突发性聋患者的临床特征及疗效预后,探讨其诊断与治疗策略.方法 回顾性分析2008年7月至2012年8月住院治疗的240例伴有眩晕的突发性聋患者的临床资料,了解其临床特征并探讨不同因素对治疗效果的影响,应用SPSS 19.0软件进行统计处理.结果 240例伴眩晕的突发性聋患者,占同期住院突发性聋患者的27.5％;其中男性102例（42.5％）,女性138例（57.6％）;年龄9 ～ 76岁,平均（41.7±16.1）岁;单耳发病229例（95.4％）,双耳11例（4.6％）;发病至就诊时间1 ～180 d,中位数8d.患者听力损失程度以极重度聋居多（64.2％）,听力曲线以全聋型（43.8％）和中高频下降型（31.7％）为主.240例患者中219例详细记录了耳蜗症状与前庭症状出现的时间,其中122例听力下降与眩晕同时出现,80例听力下降出现早于眩晕,17例眩晕出现早于听力下降.共有97例患者进行了前庭功能检查,按照听力损失程度和听力曲线类型分类比较与前庭功能之间的关系,差异均无统计学意义（P值均＞ 0.05）;前庭功能正常者43例（44.3％）,一侧前庭功能低下者54例（55.7％）,其中53例与突发性聋患侧一致,1例不一致;共发现23例BPPV患者,其中21例与突发性聋患侧一致,2例不一致.经过规范的药物治疗,治疗总有效率为46.7％.经过统计学分析,患者性别、听力曲线类型、眩晕病程时间、前庭功能,均与听力疗效无关;但患者发病后的就诊时间与疗效明显相关.结论 突发性聋患者的眩晕发生率较高,以单耳发病为主,听力损失程度重,听力曲线以全聋型和中高频下降型居多.伴眩晕的突发性聋患者前庭功能可以表现为正常或低下,BPPV发生率较高,且一半以上的患者耳蜗症状和前庭症状是同时发生的.患者听力疗效与病程有关,与眩晕持续时间和前庭功能是否受损无关,发病后治疗越早效果越好.

Objective To analyze the clinical characteristics,prognosis and therapeutic effects of sudden sensorineural hearing loss （SSHL） patients associated with vertigo,and to investigate the strategy of diagnosis and treatment.Methods We retrospectively analyzed the clinical characteristics of 240 patients diagnosed as SSHL with vertigo,who were treated in the Chinese PLA General Hospital from July 2008 to August 2012.Various factors affecting the therapeutic effects were analyzed,such as audiological features,vestibular function tests,genders,audiograms,lasting before seeing a doctor,courses of vertigo and vascular factors.Result Among the contemporaneous SSHL patients （873 cases）,the cases with vertigo accounted for 27.49% （240/873）.Among the 240 patients with vertigo,the cases with different hearing impaired degree of mild,moderate,severe and profound were 30,13,28 and 34,respectively,primarily by the profound cases.Detailed vestibular function tests were performed in 97 patients,with 54 cases having unilateral vestibular disfunction and 43 patients having normal vestibular function,among which 23 cases were diagnosed as benign paroxymal positional vertigo （BBPV）.The relationship between vestibular function and different hearing impaired degrees or various audiogram types had no statistically significant difference.219 cases had detailed records of the onset time of cochlear and vestibular symptoms,including 122 patients with cochlear symptoms and dizziness occurring simultaneously.After standardized drug treatment,the total effective rate was 46.67%,with recovery in 17 cases,excellent in 34 cases,better in 61 cases and poor in 128 cases,respectively.Statistical analysis showed that different genders,audiogram types,vertigo courses of time,the results of vestibular function and neck vascular ultrasounds were not related to the curative effects,while,the treatment time after onset was significantly associated with treatment effects.Conclusions SSHL with vertigo has a high incidence,primarily single side affected,with relatively severe hearing impairment,and total deafness and downslope hearing curve mainly.Vestibular function can be normal or low in SSHL patients with vertigo,with a higher incidence of BPPV.Vestibular and cochlear symptoms occur simultaneously in more than half of the patients.The detection rate of vestibular dysfunction gradually increased,as the degree of hearing loss increased,without statistical significance although.The therapeutic effects of sudden hearing loss with vertigo cases have no relationship with dizziness duration or vestibular function,while the disease course plays an important role in treatment.