双侧突发性聋临床特征分析

Analysis of the Clinical Characteristics of Bilateral Sudden Hearing Loss

目的分析双侧突发性聋患者临床特征和治疗效果,探讨其发病及影响预后的因素。方法回顾性分析2018年10月至2020年12月期间诊治的713例突发性聋患者的临床资料,其中,双侧突发性聋54例,将双耳听力下降间隔≤30天者合并为双侧同时组(31例),评估双耳疗效;双耳听力下降间隔>30天者合并为双侧间隔组(23例),评估后发病耳疗效;以同期住院治疗的659例(病程≤30天)单侧突发性聋作为对照组,比较单、双侧突聋的临床特点及疗效。结果本组双侧突发性聋的发病率占同期突发性聋总数的7.57%(54/713),双侧同时组中双耳发病间隔≤3天者占双侧突发性聋的55.56%(30/54),双侧间隔组中双耳发病间隔2~5年者占52.17%(12/23)。发病前有压力或疲劳等诱因者双侧同时组明显高于单侧突聋组(P=0.014);双侧间隔组糖尿病、高血压、冠心病和脑梗塞的患病率均高于双侧同时组及单侧突聋组,但仅冠心病、脑梗塞的患病率组间比较差异有统计学意义(分别为P=0.029,P=0.002)。双侧同时组平均听力下降程度较双侧间隔组现病耳和单侧突聋组轻(分别为P=0.008,P<0.001),但治疗效果最差,其次是双侧间隔组现病耳、单侧突聋组疗效最好。结论双侧突发性聋发生率低,恢复率较单侧突发性聋低;双耳同时发病者多见且发病前有较高比例的压力或疲劳等诱发因素;伴随血管性疾病的单侧突发性聋患者对侧耳发生突聋的风险较高。

Objective To study the patient characteristics and hearing outcomes of bilateral sudden sensorineural hearing loss(BSSNHL).Methods A retrospective study was conducted on the clinical data of 713 cases of inpatient with sudden sensorineural hearing loss(SSNHL)who admitted to our hospital between October 2018 and December 2020.Fifty-four cases of BSSNHL were divided into two subgroups 31 simultaneous BSSNHL cases,whose two ears had onset of hearing loss within 30 days and 23 metachronous BSSNHL cases,whose second ear had onset of hearing loss within 30 days but the first or contralateral ear over 30 days.At the same time,659 cases of unilateral sudden sersorineural hearing loss(USSNHL)with onset of hearing loss within 30 days were compared as control.Results The incidence of BSSNHL was 7.57%(54/713)in total SSNHL patients.Among the BSSNHL group,55.56%(30/54)cases suffered from SSNHL and the onset of SNHL≤3 days between ears.52.17%(12/23)patients went through onset interval of 2 to 5 year intervals between their two ears onsets in metachronous subgroup.More patients had experienced pressure or fatigue before their hearing loss in simultaneous BSSNHL than in USSNHL(P=0.014).The incidence of diabetes,hypertension,coronary heart disease and cerebral infarction were higher in metachronous BSSNHL than in simultaneous BSSNHL and USSNHL,but only coronary heart disease and cerebral infarction were found statistical difference between metachronous BSSNHL and USSNHL(P=0.029 and P=0.002,respectively).Hearing loss was milder in simultaneous BSSNHL than in metachronous BSSNHL and USSNHL(P=0.008 and P<0.001,respectively),but the hearing recovery was much better in USSNHL,then in metachronous BSSNHL and the worst in simultaneous BSSNHL.Conclusion BSSNHL has a lower incidence rate and lower recovery rate than USSNHL.More patients with simultaneous BSSNHL experienced stress or fatigue before onset of SNHL.USSNHL patients with vascular disease is at a higher risk of SNHL in the conlaralateral ear.