单侧突发性耳聋治疗前后言语识别能力对比分析

Analysis ofWord Recognition Score after Treatment of Idiopathic Sudden Sensorineural Hearing Loss

目的分析单侧突发性耳聋(idiopathic sudden sensorineural hearing loss,ISSNHL)患者治疗前后言语识别率(word recognition score,WRS)疗效及其影响因素。方法收集2016-2019年间在解放军总医院耳内科住院治疗的220例ISSNHL患者的资料,包括一般情况、临床表现、纯音测听、言语测听等数据,对治疗前后纯音听阈(PTA)和最大言语识别率(WRSmax)进行比较分析,采用二元Logistic回归分析多因素对于WRS预后的作用。结果相较于治疗前,ISSNHL患者治疗后患耳PTA和WRS有显著改善(P<0.001),且治疗后PTA和WRS存在显著负相关(r=-0.797,P<0.001)。单因素分析发现性别、耳别、年龄、合并症、发病诱因以及伴随症状耳鸣、耳闷、眩晕均不是WRS疗效的影响因素(P值均>0.05),病程、听力曲线类型和听力损失程度为WRS疗效的影响因素(P值均<0.05)。根据单因素分析结果,将病程、听力曲线类型和听力损失程度纳入Logistic回归模型,发现病程>2周,听力曲线为下降型和平坦型,听力损失为极重度是影响WRS疗效的危险因素(P<0.05)。结论ISSNHL患者治疗后WRS疗效为35.9%,其疗效的影响因素包括病程、治疗前听力曲线类型和听力损失程度。病程>2周患者疗效显著差于病程≤2周者;治疗前听力曲线为上升型患者,治疗后WRS疗效比下降型和平坦型患者更好;治疗前听力损失为极重度患者,治疗后WRS疗效较轻中度和重度患者更差。

Objective To statistically investigate the improvement of word recognition score(WRS)before and af-ter treatment of idiopathic sudden sensorineural hearing loss(ISSNHL)and the influencing factors of the effect of speech recognition rate.Methods The general information,clinical manifestations,pure tone audiometry,speech test and other data of 220 ISSNHL patients who hospitalized in the Department of Otology of PLA General Hospital from 2016 to 2019 were collected.The improvement of pure tone average and WRS before and after treatment was compared and analyzed.The Logistic regression was used to analyze the effect of multiple factors on the prognosis of WRS.Re-sults Compared with pre-treatment,PTA and WRS were significantly improved after-treatment(P<0.001),and there was a significant negative correlation between after-treatment PTA and WRS(r=-0.797,P<0.001).Univariate analysis showed that gender,effected ear,age,complications,causes of illness and associated symptoms such as tinnitus,tight-ness and vertigo were not the influencing factors for the efficacy of WRS(P>0.05),but the time from onset to hospital-ization,the type of hearing curve and degree of hearing loss before treatment were the influencing factors for the effica-cy of WRS(P<0.05).According to the results of univariate analysis,time from onset to hospitalization,hearing curve type and severity of hearing loss were included in Logistic regression model,and it was found that the time from onset to hospitalization was more than 2 weeks,hearing curve was descending or flat,and profound hearing loss,each was an independent risk factor affecting the efficacy of WRS(P<0.05).Conclusion The improvement rate of WRS in patients with ISSNHL after treatment was 35.9%.The influencing factors of the efficacy include the time from onset to hospital-ization of the disease,the type of hearing curve and the degree of hearing loss.The curative effect of patients with course of disease more than two weeks is significantly worse than that of patients with course of disease less than two weeks.Patients with declining or flat hearing curve before treatment had a worse prognosis than those with ascending.Patients with profound hearing loss had worst prognosis in after treatment WRS.