极重度突发性聋患者耳蜗和前庭功能特点及预后差异性分析

Cochleo-vestibular lesions and prognosis in patients with profound sudden sensorineural hearing loss:a comparative analysis

目的观察极重度突发性聋患者耳蜗及前庭功能变化特点,探讨内耳出血对患者预后的影响。方法2017年1月至2018年12月在中山大学附属第一医院耳鼻咽喉科住院治疗的极重度突聋患者92例,其中男47例、女45例,年龄20~78岁,平均(39.3±6.1)岁。根据内耳磁共振成像(MRI)检查结果将其分成内耳出血组和非内耳出血组,比较两组患者临床特征、前庭功能检查及听力学检查随访结果。应用SPSS 22.0软件进行统计学处理。结果92例患者中,内耳出血组32例(34.8%,32/92),其眩晕发生率为100%(32/32),眩晕与听力下降同时出现的比率为78.1%(24/32),患侧半规管功能、颈源性前庭诱发肌源性电位(cervical vestibular evoked myogenic potentials,c-VEMP)和眼源性前庭诱发肌源性电位(ocular vestibular evoked myogenic potentials,o-VEMP)异常率均为100%(32/32),良性阵发性位置性眩晕(BPPV)的发生率为37.5%(12/32),失平衡发生率为25.0%(8/32);治疗后14 d听力改善有效率为28.1%(9/32),治疗后30 d听力变化稳定。非内耳出血组60例(65.2%,60/92),眩晕发生率为58.3%(35/60),眩晕与听力下降同时出现的比率为60%(21/35),患侧半规管功能、c-VEMP、o-VEMP的异常率分别为71.6%(43/60)、78.3%(47/60)和66.7%(40/60),BPPV发生率为16.7%(10/60),失平衡发生率为8.3%(5/60);治疗后14 d有效率为58.3%(35/60),治疗后90 d听力变化稳定。两组患者在眩晕发生率、眩晕与听力下降同时出现的比率,患侧半规管功能、c-VEMP及o-VEMP异常率、BPPV发生率、失平衡发生率,治疗后14 d有效率、治疗后14 d、30 d、90 d、180 d平均听阈,差异均有统计学意义,P值均<0.05。结论内耳出血所致极重度突聋患者与非内耳出血极重度突聋患者相比,前庭和耳蜗功能损伤重,恢复效果差。

Objective To investigate the characteristics of cochleo-vestibular dysfunction in patients with profound sudden deafness,and the prognosis of inner ear hemorrhage.Methods From January 2017 to December 2018,92 inpatients with profound sudden sensorineural hearing loss were enrolled in the Department of Otorhinolaryngology,First Affiliated Hospital of Sun Yat-sen University.Our studied patients included 47 males and 45 females,aged 20-78(39.3±6.1)years.According to the results of inner ear magnetic resonance imaging(MRI),the patients were divided into two groups:inner ear hemorrhage group and non-inner ear hemorrhage group.The clinical features,vestibular tests and audiological examination results during follow up were compared between the two groups.SPSS 22.0 software was used for statistical analysis.Results The inner ear hemorrhage group consisted of 32 cases(34.8%,32/92),all of whom complained of vertigo(100%,32/32).Simultaneous vertigo attack and hearing loss occurred in 78.1%of this group(24/32).Neither semicircular canals function,nor cervical vestibular evoked myogenic potential(c-VEMP),nor ocular vestibular evoked myogenic potential(o-VEMP)in the affected side was normal(100%,32/32).The rates of benign paroxysmal positional vertigo(BPPV)and disequilibrium were 37.5%(12/32)and 25.0%(8/32)respectively.Hearing improved in 28.1%(9/32)two weeks after treatment,and became stable at one month′s follow up.In 60 cases without inner ear hemorrhage,58.3%of them(35/60)experienced vertigo,which occurred simultaneously with hearing loss in 21 patients(60%,21/35).The abnormal rates of semicircular canals function,c-VEMP and o-VEMP were 71.6%(43/60),78.3%(47/60)and 66.7%(40/60),respectively.The incidence of BPPV was 16.7%(10/60)and 8.3%(5/60)in cases with disequilibrium.Hearing improved in 58.3%(35/60)two week after treatment,and became stable at three months′follow up.Significant difference was found in either vertigo rate,or simultaneous vertigo/hearing loss rate,or abnormal c-VEMP/o-VEMP rates,or accompanying BPPV,or disequilibrium rates between the two groups(P<0.05 each).Moreover,we observed better hearing recovery in non-inner ear hemorrhage group in the two weeks,one month,three months and six months′follow up,when compared with those in inner ear hemorrhage groups(P<0.05 each).Conclusions Inner ear hemorrhage is associated with more severe cochlea-vestibular lesion and poorer prognosis,in comparison to the non-inner ear hemorrhage,in patients with profound sudden sensorineural hearing loss.