单侧听力下降对前庭神经鞘瘤患者认知功能及生活质量的影响

Effect of unilateral hearing loss on cognitive function and quality of life in patients with vestibular schwannoma

目的评估单侧听力下降对前庭神经鞘瘤患者生活质量及认知功能的影响。方法前瞻性纳人2016年12月至2020年12月新疆医科大学第一附属医院神经外科中心收治的52例单侧前庭神经鞘瘤致同侧听力下降患者(前庭神经鞘瘤组),包括右侧前庭神经鞘瘤组(简称右侧组,26例)和左侧前庭神经鞘瘤组(简称左侧组,26例)。同时纳入52例年龄、性别、受教育年限相匹配的健康人群作为健康对照组。听力评估由本院耳鼻喉科同一名医生进行纯音听阈测量。采用简易智能精神状态量表(MMSE)等多种认知功能量表评估认知功能,采用宾夕法尼亚大学前庭神经鞘瘤生活质量量表评价生活质量,并进行组间比较。采用Pearson相关分析评价前庭神经鞘瘤组听力下降程度与认知功能和生活质量评分的关系。结果与健康对照组比较,前庭神经鞘瘤组的波士顿命名测验、记忆与执行筛查量表、听觉词语学习测试(AVLT)-短时延迟回忆、AVLT-长时延迟回忆、词语流畅性测试、数字与符号转换测验评分均较低(均P<0.05),连线测试B的评分较高(P<0.001)。前庭神经鞘瘤组较健康对照组的生活质量评分下降(P<0.001)。与健康对照组比较,右侧组和左侧组的AVLT-短时延迟回忆、AVLT-长时延迟回忆、数字与符号转换测验、词语流畅性测试以及生活质量评分均较低,连线测试B评分较高(均P<0.05)。右侧组较健康对照组的波士顿命名测验和记忆与执行筛查量表评分均下降(均P<0.05)。Pearson相关分析结果显示,患侧平均纯音听阈与连线测试B评分呈正相关(r=0.57,P<0.001),与数字符号转换测验评分呈负相关(r=-0.79,P<0.001),与生活质量评分呈负相关(r=-0.63,P<0.001)。结论单侧听力下降的前庭神经鞘瘤患者认知功能及生活质量均下降,相较于左侧前庭神经鞘瘤,右侧前庭神经鞘瘤患者的认知功能下降更严重。

Objective To evaluate the effect unilateral hearing loss on quality of life and cognitive function in patients with vestibular schwannoma.Methods From December 2016 to December 2020,52 patients with ipsilateral hearing loss caused by unilateral vestibular schwannoma(vestibular schwannoma group),including the right vestibular schwannoma group(referred to as the right group,26 cases)and left vestibular schwannoma group(referred to as the left group,26 cases),who were admitted to the Neurosurgery Center of the First Affiliated Hospital of Xinjiang Medical University were prospectively enrolled into this study.At the same time,52 healthy people matched in age,gender,and years of education were included as healthy control groups.The hearing evaluation was performed by the same doctor in the Otolaryngology Department of the hospital to measure the pure tone hearing threshold.Cognitive function was evaluated by multiple cognitive function scales such as the Mini-Mental State Examination(MMSE),and the quality of life was evaluated by the Penn Acoustic Neuroma Quality-of-Life(PANQOL)scale,and comparisons were made between groups.Pearson correlation analysis was used to evaluate the relationship between hearing loss and cognitive function and quality of life scores in the vestibular schwannoma group.Results Compared with the healthy control group,the scores of Boston naming test,memory and execution,AVLT-short-term delayed recall,AVLT-long-term delayed recall,word fluency test,and number and symbol conversion test were lower(all P<0.05)and scores of wired test B were higher(P<0.001)in the vestibular schwannoma group.The vestibular schwannoma group had lower quality of life scores than the healthy control group(P<0.001).Compared with the healthy control group,the scores of AVLT-short-term delayed recall,AVLT-long-term delayed recall,number and symbol conversion test,word fluency test and the quality of life were lower in the right and left vestibular schwannoma groups,and the scores of wired test B were higher(all P<0.05).The scores of Boston naming test,memory and execution in the right group were lower than those in the healthy control group(all P<0.05).The results of Pearson correlation analysis showed that the mean pure tone hearing threshold on the affected side was positively correlated with the B-score of the connection test(r=0.57,P<0.001),negatively correlated with the score of the number sign conversion test(r=-0.79,P<0.001),and negatively correlated with the quality of life score(r=-0.63,P<0.001).Conclusion Patients with vestibular schwannoma with unilateral hearing loss have decreased cognitive function and quality of life,and patients with right vestibular schwannoma have more cognitive decline than those with left vestibular schwannoma.