伴对侧耳感音神经性聋的突发性聋患者临床特征分析

A clinical analysis for sudden sensorineural hearing loss with contralateral sensorineural hearing loss

目的：分析伴对侧耳感音神经性聋的突发性聋患者的临床特征及预后效果,了解与该病发生及影响预后的相关因素。方法：对63例伴对侧感音神经性聋的突发性聋患者的临床资料进行系统性分析,包括临床表现、听力学检查、疗效评估以及对侧耳临床特征等,与同时起病双侧突发性聋和单侧突发性聋组资料对比,分析致病和影响预后的危险因素,总结该病发生、发展及转归的特点。结果：63例患者占本研究763例突发性聋患者的8.3%,男性大于女性,伴发眩晕比例和患有高血糖、高血脂的比例显著高于其他两组,现患耳听力损失程度分布以及听力曲线类型与单侧突发性聋组差异有统计学意义（P〈0.05）,但与双侧突发性聋组差异无统计学意义（P〉0.05）。59%的患者为对侧耳听力下降2~10年内出现现患耳的突发性聋。对侧耳听力损失的病史中突发性聋比例最高（49%）。现患耳治疗总有效率为14.3%,与双侧突发性聋组差异无统计学意义（P〉0.05）,单侧突发性聋组治疗总有效率为62.8%,明显高于其他2组,差异有统计学意义（P〈0.01）。对侧耳极重度或重度感音神经性聋的患者42例,现患耳治疗后总有效率为9.5%,低于对侧耳中重度和中度耳聋患者的23.8%,差异有统计学意义（P〈0.05）。结论：伴对侧耳感音神经性聋的突发性聋发病原因复杂,预后较差,尤其对侧耳极重度或重度感音神经性聋的患者,严重影响言语与生活质量,对急性期药物治疗后无效的病例需制定后续个性化听力康复治疗方案。

Objective：To analyze the clinical characteristics and prognosis,and to learn the impact factors of patients with sudden sensorineural hearing loss with contralateral sensorineural hearing loss（SSHLwCSHL）.Method：Clinical data of 63 cases of patients with SSHLwCSHL were analyzed systematically,including all the clinical manifestations,audiologic characteristics and the effect assessment,and compared with that of unilateral sudden sensorineural hearing loss（USSHL）and bilateral sudden sensorineural hearing loss（BSSHL）.Base on those,we summarized comprehensively the development and prognosis characteristics of the disease.Result：The incidence of SSHLwCSHL was 8.3percent of overall patients with SSNHL.SSHLwCSHL occurs more commonly in male patients,with more vertigo,diabetes mellitus,and lipid panel abnormalities compared with other groups.Hearing curve and the degree of hearing loss of the prevalence ear of SSHLwCSHL was statistically significant difference with USSHL（P〈0.05）.Most common reason of the contralateral hearing loss was sudden sensorineural hearing loss（49%）,and 59% patients of SSHLwCSHL suffered hearing loss of other ear after 2-10 years after contralateral hearing loss.The total effective rate was 14.3%,1in 63 patients cured,1excellence and 6effective.The total effective rate was 9.5%in patients with severe or profound sensorineural hearing loss in the contralateral ear,which was lower than that of patients with moderate and moderately severe sensorineural hearing loss in the contralateral-ear（p=0.021）.Conclusion：SSHLwCSHL has complex condition.The prognosis for improvement is poor.Recognition of similarities and differences between bilateral and unilateral SSNHL can help in counseling and managing the patients.