突发性聋伴眩晕与后循环供血不足研究进展

Research status of sudden deafness with vertigo and posterior circulation blood supply insufficiency

突发性聋是突然发生的、原因不明的感音神经性听力下降,部分患者伴有眩晕、耳鸣等不适症状。内耳的血供主要来自椎基底动脉、小脑前下动脉或小脑后下动脉分出的内听动脉,内听动脉为终末支动脉,后循环供血不足会引起耳蜗缺血,导致听功能和(或)平衡功能障碍,故内耳血供障碍学说作为突发性聋的发病原因之一受到重视。由于听觉前庭损伤可先于后循环缺血的症状或体征发生,因此听觉前庭损伤的早期诊断和适当处理可提供防止梗塞进展到后循环较大区域的窗口期。临床医师应考虑急性听觉前庭损伤可能预示即将发生后循环区域梗死的可能性,尤其是当患者在脑磁共振成像上有基底动脉闭塞性疾病时。

Sudden deafness (SD) is a sudden and unexplained sensorineural hearing loss. Some patients are accompanied by discomfort symptoms such as vertigo and tinnitus. The blood supply of the inner ear mainly comes from the internal auditory artery separated from vertebrobasilar artery, anterior inferior cerebellar artery or posterior inferior cerebellar artery. The internal auditory artery is the terminal branch artery. The insufficiency of blood supply in the posterior circulation will lead to cochlear ischemia, resulting in dysfunction of hearing function and/or balance function. Therefore, the theory of inner ear blood supply dysfunction is paid attention as one of the pathogenesis of sudden deafness. Because auditory vestibular injury can occur before central symptoms or signs of posterior circulation ischemia, early diagnosis and appropriate treatment of auditory vestibular injury can provide a window period to prevent infarction from progressing to a larger area of posterior circulation. Clinicians should consider the possibility that acute auditory vestibular injury may predict impending posterior circulation infarction, especially when patients have basilar artery occlusive disease on brain magnetic resonance imaging.