突发性耳聋的分型治疗及预后分析

Treatment and prognosis for sudden deafness

目的：探讨突发性耳聋分型治疗的必要性以及影响突发性耳聋治疗效果的预后因素。方法：回顾性分析2011年2月至2013年5月间我科收治的498例（526耳）突发性耳聋的病例资料。按照患者的听力曲线将其分为低中频下降型、中高频下降型、平坦型和全聋型4种类型。每种类型采用不同治疗方案,分析不同类型患者的治疗效果,并探讨其预后的影响因素。结果：共收集病例498例（526耳）,男女比例为0.95∶1;年龄13~86岁,平均年龄（45.39±15.78）岁。根据听力曲线分型：低中频下降型91耳（17.30%）,中高频下降型74耳（14.07%）,平坦型191耳（36.31%）,全聋型170耳（32.32%）。各种类型的总有效率：低中频型总有效率最高,为70.33%;中高频型总有效率最低,为35.14%;平坦型50.26%,全聋型51.76%,差异有统计学意义（χ2=20.918,P=0.000）。多因素logistic回归分析结果显示：年龄（OR=0.977,95%CI=0.965~0.989,P=0.000）、突发性耳聋分型（OR=0.977,95%CI=0.180~0.748,0.372~1.199,0.300~0.963,P=0.035）、患耳（OR=0.977,95%CI=0.450~0.989,0.161~0.628,P=0.002）、发病至干预时间（OR=0.977,95%CI=0.925~0.967,P=0.000）与突发性耳聋治疗效果相关。结论：突发性耳聋患者的预后与年龄、突发性耳聋分型、患耳、发病至干预时间、高血压有关。不同类型的突发性聋患者疗效差异大,低中频下降型疗效最好,全聋型、平坦型次之,中高频下降型疗效不佳。根据突发性耳聋患者的听力曲线进行分型,进而选择不同的治疗方案具有重要意义。

Objective：To investigate the necessity of treatment for sudden deafness and the influencing factors for its prognosis.Methods：Totally 498 cases（526 ears）with sudden deafness from February 2011 to May 2013 were retrospectively analyzed. The patients were divided into 4 types according to their audiometric curve：type A was acute sensorineural hearing loss（SNHL）in low tone frequencies,type B was acute SNHL in high tone frequencies,type C was acute SNHL in all frequencies（PTA≤80 d B HL）and type D was profound SNHL in all frequencies（PTA≥81 d B HL）. The patients were treated with different regimens based on their hearing types. The therapeutic effect and prognostic factors were analyzed. Results：All patients（526 ears）were recruited and the ratio of male to female was 0.95∶1. The average age was（45.39±15.78）years old. 91 ears were type A（17.30%）,74 ears were type B（14.07%）,191 ears were type C（36.31%）,and 170 ears were type D（32.32%）. The therapeutic effects of different types were analyzed. The effective rate was 70.33% in type A,50.26% in type C,51.76% in type D,and 35.14% in type B. The multivariate logistic analysis showed that age（OR=0.977,95%CI=0.965 to 0.989,P=0.000）,the type of audiometric curve（OR=0.977,95%CI=0.180 to 0.748,0.372 to 1.199,0.300 to 0.963,P=0.035）,the affected ear side（OR=0.977,95%CI=0.450 to 0.989,0.161 to 0.628,P=0.002）,interval from onset to intervention（OR=0.977,95%CI=0.925 to 0.967,P =0.000） were 4 independent risk factors correlated to therapeutic effect of sudden deafness. Conclusion：The curative effect of sudden deafness is closely related to the age,the type of audiometric curve,the affected ear side,interval from onset to intervention,and hypertension. Different types of sudden deafness have different curing effects. The curative effect for the type in low tone frequencies is the best,followed by the type of profound SNHL in all frequencies and acute SNHL in all frequencies. The result of the type in high tone frequencies is the poorest. It ＇s important to treat patients with sudden deafness with differential regimens based on the types of audiometric curves.