双侧突发性聋169例临床特征及疗效分析

Analysis of clinical characteristics and curative effects of 169 patients with bilateral sudden sensorineural hearing loss

目的分析双侧突发性聋(bilateral sudden sensorineural hearing loss,BSSHL)患者的临床特征及疗效。方法回顾性总结解放军总医院第一医学中心169例(338耳)BSSHL患者临床资料,对其人口学特征、发病诱因、伴随症状及伴发疾病、听力学特征、实验室检查结果进行统计描述,并对其疗效及影响因素、预后情况进行统计分析。结果50.9%(86/169)患者至少存在一种诱因,其中上呼吸道感染(23/169)、劳累(23/169)最为多见;伴随症状中耳鸣(150/169,88.8%)、眩晕(100/169,59.2%)较高,伴发疾病中高血压(49/169,29.0%)、糖尿病(23/169,13.6%)较为常见。听力损失类型多为全频受累,平坦型和全聋型占83.1%(281/338耳);听力损失程度以全聋型最多见(86/338耳),重度及以上占60.1%(203/338耳)。治疗总有效率仅29.0%,病程≤14 d、14 d<病程≤30 d患者有效率分别为39.5%和25.5%,病程>30 d者有效率为3.6%,差异有统计学意义(χ^(2)=13.776,P<0.01);不同类型的听力曲线治疗有效率差异有统计学意义(χ^(2)=14.782,P<0.01);比较28例BSSHL患者入院至出院和出院至随访的听力提高值,发现左-250 Hz、左-500 Hz、右-125 Hz、右-250 Hz、右-500 Hz处,两组听力提高值差异有统计学上意义(Z值分别为-2.495、-3.083、-3.970、-3.388、-3.264,P值均<0.05)。患者血清IgE升高比例远高于健康人群。结论BSSHL患者听力损失严重,更多患者伴耳鸣、眩晕,疗效欠佳,发病30 d内就诊疗效优于30 d后就诊;对低频范围内听力损失,住院治疗听力提高更显著;且BSSHL的发生可能存在免疫机制。

Objective To analyze the clinical characteristics,curative effect related factors and follow-up situation of bilateral sudden sensorineural hearing loss(BSSHL).MethodsThe clinical data of 169 patients(338 ears)with BSSHL were retrospectively summarized,and the demographic characteristics,predisposing factors,concomitant symptoms and diseases,and audiological characteristics were statistically described.Additionally,influencing factors of curative effect and prognosis were statistically analyzed.ResultsAmong the 169 patients,50.9%(86/169)of patients had at least one incentive,with cold and fatigue being the most common incentives(both 23/169).There were high rates of accompanying symptoms including tinnitus(150/169,88.8%)and dizziness(100/169,59.2%).Hypertension(49/169,29.0%)and diabetes(23/169,13.6%)were the most common concomitant diseases observed.Most cases exhibited all frequencies involvement,with flat type and total deafness type accounting for 83.1%(281/338 ears).The most common degree of hearing loss was total deafness(86/338 ears),with approximately 60.1%(203/338 ears)of the cases being severe or worse.The total effective rate of treatment was only 29.0%,but it increased to 39.5%for patients with course of disease≤14 days,however,when course of disease>30 days,the effective rate decreased sharply to 3.6%,showing a significant difference between these two groups(χ^(2)=13.776,<0.01).Different types of hearing curves showed statistically significant difference in efficiency(χ^(2)=14.782,P<0.01).Comparing the hearing improvements of 28 BSSHL patients from admission to discharge and from discharge to follow-up,it was found that the hearing improvement of the two groups showed statistically significant difference at the frequencies of L-250 Hz,L-500 Hz,R-125 Hz,R-250 Hz and R-500 Hz(Z value was-2.495,-3.083,-3.970,-3.388 and-3.264 respectively,all P<0.05).The proportion of patients with elevated serum IgE was much higher than that of the normal population.ConclusionBSSHL patients suffer from serious hearing loss,and many also experience tinnitus and vertigo symptoms.Due to the poor efficiency of treatment,it is better for patients to be treated within 30 days of onset.For patients of hearing loss in the low frequency range,hearing improvement is more significant during hospitalization.And the occurrence of BSSHL may involve an immune mechanism.