伴眩晕的突发性聋患者临床特征与病因分析

Clinical characteristics and etiological analysis of sudden deafness patients with vertigo

目的分析伴眩晕的突发性聋患者的临床特征和发病原因。方法2016年8月至2017年12月在中山大学附属第一医院耳鼻咽喉科住院治疗的突发性聋伴眩晕患者74例,其中男36例,女38例,年龄18~75(40.5±6.5)岁。按内耳磁共振成像(MRI)结果分为内耳出血(IEH)和非IEH(NIEH)组,比较两组患者耳聋、眩晕特征,实验室检查及随访结果。结果IEH组26例,耳聋与眩晕同时发生22例(84.6%),患侧半规管功能、颈性前庭诱发肌源性电位(C-VEMP)、眼性前庭诱发肌源性电位(O-VEMP)异常均26例(100%),伴良性阵发性位置性眩晕(BPPV)10例(38.5%)。治疗后14 d总有效率19.2%(5/26);治疗后180 d失平衡11例(42.3%),患侧半规管功能、C-VEMP、O-VEMP异常率分别为69.2%(18/26)、53.8%(14/26)、57.7%(15/26),听阈改善值为(28.6±9.7)dB。NIEH组48例,耳聋与眩晕同时发生25例(52.1%),患侧半规管功能、C-VEMP、O-VEMP异常分别为37例(77.1%)、34例(70.8%)、26例(54.2%),BPPV 6例(12.5%),治疗后14 d总有效率52.1%(25/48);治疗后180 d失平衡8例(16.7%),患侧半规管功能、C-VEMP、O-VEMP异常率分别为31.2%(15/48)、25.0%(12/48)、20.8%(10/48),听阈改善值为(42.5±10.3)dB。两组患者耳聋与眩晕同时发生率、患侧前庭功能异常率、BPPV发生率、治疗后14 d总有效率差异均有统计学意义(均P<0.05),IEH组前庭、耳蜗功能损害重于NIEH组。治疗后180 d,两组患侧前庭功能异常率、失平衡率、听阈改善值差异均有统计学意义(均P<0.05),NIEH组前庭、耳蜗功能恢复优于IEH组。结论突发性聋伴眩晕,可出现前庭、耳蜗功能损害,病因不同可出现不同临床特征及预后。内耳出血所致前庭、耳蜗功能损害更严重,恢复效果差。

Objective To explore the possible causes and mechanisms of sudden deafness with vertigo. Methods Between August 2016 and December 2017, 74 patients with sudden deafness and vertigo were hospitalized in the Department of Otolaryngology, First Affiliated Hospital of Sun Yat-sen University. Among them, 36 were male and 38 were female, aged 18-75 (40.5±6.5) years. According to the results of magnetic resonance imaging (MRI), the patients were divided into two groups: internal ear hemorrhage (IEH) and non-IEH (NIEH). The characteristics of deafness, vertigo, laboratory examination and follow-up results were compared between the two groups. Results In IEH group, deafness and vertigo occurred simultaneously in 22 cases (84.6%), abnormalities of semicircular canal function, cervical vestibular evoked myogenic potential (C-VEMP), ocular vestibular evoked myogenic potential (O-VEMP) in 26 cases (100%) and benign paroxysmal positional vertigo (BPPV) in 10 cases (38.5%). The total effective rate was 19.2%(5/26) after 14 days of treatment, and 11 cases (42.3%) appeared disturbance after 180 days of treatment. The abnormal rate of lateral vestibular function, C-VEMP and O-VEMP was 69.2%(18/26), 53.8%(14/26) and 57.7%(15/26) respectively. The improvement of hearing threshold was (28.6±9.7) dB. In NIEH group, deafness and vertigo occurred simultaneously in 25 cases (52.1%). The abnormalities of semicircular canal function, C-VEMP and O-VEMP happened in 37 cases (77.1%), 34 cases (70.8%), 26 cases (54.2%), respectively, and 6 cases (12.5%) were of BPPV. The total effective rate was 52.1%(25/48) after 14 days of treatment. After 180 days of treatment, 8 cases (16.7%) were out of balance, and the abnormal rate of lateral vestibular function, C-VEMP and O-VEMP were 31.2%(15/48), 25.0%(12/48) and 20.8%(10/48) respectively. The improvement of hearing threshold was (42.5±10.3) dB. The incidence of stimulantous deafness and vertigo, vestibular dysfunction rate, BPPV incidence rate and the total effective rate after 14 days of treatment were significantly different between the two groups (all P<0.05). The vestibular and cochlear dysfunction in IEH group was more serious than that in NIEH group. After 180 days of treatment, the vestibular dysfunction rate, imbalance rate and improvement of hearing threshold in NIEH group were significantly higher than that in IEH group (all P<0.05). The recovery of vestibular and cochlear function in NIEH group was better than that in IEH group. Conclusions Sudden deafness with vertigo can cause vestibular and cochlear dysfunction. Different etiologies may lead to different clinical features and prognosis. The vestibular and cochlear function damage caused by inner ear hemorrhage was more serious and the recovery effect was poor.