尿毒症合并突发性聋患者的临床特征及预后

目的 分析尿毒症合并突发性聋（突聋）患者的临床特征及预后。方法 收集2015年1月—2019年12月在会理县人民医院治疗的尿毒症合并突聋患者29例（30耳）,平均初诊听阈值为（62.33±13.68） dB HL;17耳（56.67%）伴耳鸣,8耳（26.67%）伴眩晕;9耳（30.00%）为平坦型,13耳（43.33%）为全聋型。根据尿毒症病程长短将29例患者分为<2年组（13例,13耳）、2～4年组（8例,8耳）和>4年组（8例,9耳）,对比3组突聋患者的听力预后。结果 29例（30耳）患者治疗结束3个月后,3耳（10.00%）痊愈、5耳（16.67%）显效、6耳（20.00%）有效、16耳（53.33%）无效,平均听阈改善均值为（15.68±7.43） dB HL。根据尿毒症病程长短分组后,尽管<2年组、2～4年组和>4年组的痊愈率、显效率、有效率和无效率无统计学差异,但3组的听阈改善值分别为（20.52±7.95）、（16.30±6.27）、（7.78±9.36） dB HL,组间比较差异具有统计学意义（P<0.05）。结论 尿毒症合并突聋的患者听力损失较重,听力预后较差,尿毒症病程越长预后越差。     

儿童突发性聋的临床特征及预后相关因素分析

目的 分析儿童突发性聋的临床特征、疗效及影响预后的相关因素,为临床治疗及预后评估提供依据。 方法 收集2010年1月至2017年10月就诊的67例突发性聋患儿临床资料,对其临床特征及治疗效果进行回顾性分析,同时根据疗效将患者分为总体有效组(36例)及无效组(31例),采用单因素及多因素分析的方法分析患者的性别、年龄、病程、初诊听阈、是否伴发耳鸣、眩晕、病毒感染史、发病季节和听力曲线类型对预后的影响。 结果 儿童突聋患者中64.18%在春冬季发病,其就诊时听阈为(76.62±25.97)dB HL,耳鸣及眩晕伴发率分别为70.15%和61.19%,病毒感染率为19.40%,听力曲线中10.44%为低频下降型、2.99%为高频下降型、34.33%为平坦型及52.24%为全聋型。经治疗后,患者听阈为(60.41±31.52)dB HL,总体有效率为53.73%,其中痊愈率、显效率及有效率分别为20.90%、16.42%和16.42%。多因素分析结果显示,初诊听阈越高及听力曲线为全聋型,预后越差(P均<0.05);伴有病毒感染的非全聋型患者预后较好(P<0.05)。 结论 儿童突发性聋患者病毒感染率较高且大部分在春冬季发病,就诊时听力损失较重并常伴有耳鸣及眩晕,其听力曲线以平坦型及全聋型为主。就诊时听力损伤程度轻、伴有病毒感染的非全聋型患者预后较好。     

突发性聋的早期治疗及超氧化物歧化酶和丙二醛检测

OBJECTIVE: To explore the effect of treatment on sudden deafness at ultra-early stage and the influence on Malonyldialdehyde (MDA) and superoxide dismutase(SOD) of serum. METHODS: One hundred and forty-seven cases of sudden deafness (168 ears) from July 1995 to June 2001 were divided into three groups, 29 cases (36 ears) in group I treated within 6 hours after deafness, 55 cases(63 ears) in group II treated within 15 days after deafness, and 63 cases (69 ears) in group III treatment after 15 days after deafness. Total cases were treated with medicine and hyperbaric oxygen and the volume of SOD and MDA of serum were observed at the same time. There were 30 healthy volunteers as control group. RESULTS: In the group I, the hearing threshold was recovered in 18 ears, significant improved in 9 ears, improved in 7 ears and not changed in 2 ears after treatment. In the group II, the hearing threshold was recovered in 11 ears, significant improved in 16 ears, improved in 15 ears and no changed in 21 ears after treatment. In the group III, the hearing threshold was recovered in 14 ears, significant improved in 20 ears, improved in 13 ears and no changed in 22 ears after treatment. There was a significant difference in improved level of hearing between the group I and group II. (chi 2 = 9.90, P < 0.01) and between group I and group III (chi 2 = 9.30, P < 0.01). There was no significant difference between group II and group III (chi 2 = 0.03, P > 0.01). CONCLUSION: The treatment on sudden deafness in ultra-early stage is very important. The use of free radical scavenger early can protect audio nerve.     

病程超过3周的突发性聋患者的临床疗效分析

目的 了解对病程超过3周的突发性聋患者以糖皮质激素等药物进行治疗的意义.方法 对北京大学人民医院耳鼻咽喉科2002年11月至2010年7月住院治疗的48例(58耳)病程超过3周的突发性聋患者的临床资料进行同顾性分析.根据本次入院治疗前的听力曲线分为3组,分别采用不同的治疗方案,观察其疗效.以SPSS 17.0统计软件对数据进行分析,患者治疗前后纯音测听阈值采用t检验.结果 低频下降型(6耳)、高频下降型(22耳)、全频下降型(30耳)治疗后有效率分别为83.3%、31.8%、36.7%.病程≥1年的共12耳,其治疗有效率58.3%(7耳).全频下降型中本次治疗前气导听阈均值≥90 dB(听力级)的9耳,7耳(77.8%)治疗有效,其中3耳(33.3%)达到显效标准;本次治疗前气导听阈均值＜90 dB的患者21耳,其中3耳(14.3%)治疗有效.结论 病程超过3周的突发性聋患者仍有积极治疗的意义.其中低频下降型治疗有效率最高,高频下降型有效率最低,全频下降型有效率居中.病程≥1年的突发性聋患者经积极治疗仍有改善听力可能.全频下降型、听功能损失程度较重的患者,通过积极治疗获益较大.

Abstract：

Objective To investigate and analyze the significance of a course of glucocortieosteroids and other drugs for the treatment of patients with sudden deafness present for at least three weeks.Methods A retrospective review was done on 48 patients (58 ears) with sudden deafness present for at least three weeks or more,who were admitted to the Department of Otorhinolaryngology,Peking University People's Hospital from November 2002 to July 2010.The patients were devided into three groups by the type of hearing threshold.The different treatments were used in the three groups.The SPSS 17.0 software was used to analyze the data.Results In patients with a low tone hearing loss (6 ears) ,83.3% improved.For patients with a high tone loss (22 ears) 31.8% improved.For a flat tone hearing loss (30 ears) 36.7% improved.For patients with a hearing loss more than one year (12 ears) there was improvement in 58.3% (7 ears)of the patients.In 9 ears which had a flat tone hearing loss of 90 dB or greater before treatment,77.8% (7 ears) improved with 33.3% (3 ears) having a significant improvement.In 21 ears which had a hearing threshold was under 90 dB,14.3% (3 ears) improved.Conclusions In the treatment of patients with sudden deafness which was longer than 21 days the treatment was significant,especially for those who had a 90 dB or greater flat-tone type hearing threshold before treatment.Even though the hearing loss was more than a year in some patients there was still a benefit from treatment.     

Vestibular evoked myogenic potentials are intact after sudden deafness

OBJECTIVE: To evaluate vestibular evoked myogenic potentials (VEMPs) in cases of sudden deafness, and to confirm the noncochlear origin of the VEMPs. STUDY DESIGN: Prospective study. VEMPs, which were evoked by short tone burst (95 dB nHL) stimulation, were recorded in 20 patients with unilateral, idiopathic sudden deafness. The results of the deaf ears were compared with those of the contralateral healthy ears and the normal control ears. The relations between VEMPs and the hearing level or caloric response were then investigated. RESULTS: All 20 of the deaf ears displayed normal biphasic VEMPs. The mean latencies of p13 and n23, as well as mean amplitude p13-n23, were 15.1 +/- 2.8 msec, 20.7 +/- 3.3 msec and 25.2 +/- 12.6 microV, respectively, not significantly different to either the contralateral healthy ears (p > 0.05) or the normal control ears (p > 0.05). Five deaf ears displayed canal paresis or absent caloric response, whereas the remaining 15 ears revealed normal caloric response. CONCLUSION: All the lesioned ears of patients with idiopathic sudden deafness exhibit normal biphasic VEMPs. Neither the hearing level nor the caloric response correlated to the VEMPs.     

鼓室内注射地塞米松治疗突聋的临床研究

目的:观察鼓室内注射地塞米松治疗突聋的临床效果。方法:对21例突聋患者采用鼓膜穿刺注入5 g/L地塞米松1 ml治疗,每日1次,7 d为1个疗程。比较地塞米松鼓室内注射前后4个频率(500、1 000、2 000、4 000 Hz)气导纯音听阈均值(PTA),下降10 dB以上为有效。结果:21例患者鼓室内注射地塞米松前后PTA分别为(65.65±24.73)dB HL和(50.25±25.59)dB HL,有明显下降,P<0.01。10例有效,11例无效,总有效率为47.6%。对发病至治疗的时间短、不伴眩晕的突聋患者应用鼓室内注射地塞米松治疗效果好。本组病例未出现鼓室内感染、鼓膜穿孔和听力下降。结论:鼓室内注射地塞米松治疗突聋安全、有效,发病至治疗的时间以及是否伴有眩晕是影响预后的因素。     

细菌性脑膜炎致聋患者内耳影像学观察及人工耳蜗置入术

目的 :了解细菌性脑膜炎后内耳MRI影像学的变化 ,及对人工耳蜗置入术的影响。方法 :细菌性脑膜炎致聋患者 5例 (10耳 )行听性脑干诱发反应 (ABR)和内耳MRI检查 ,实施人工耳蜗置入术。结果 :MRI成像检查 ,耳蜗膜迷路形态异常 5耳 ,前庭形态异常 3耳 ,半规管形态异常 8耳 ;10耳的平均听阈为 (10 2 .0± 7.1)dBHL ,手术耳的平均听阈为 (98.0± 5 .7)dBHL ,非手术耳的平均听阈为 (10 6 .0± 6 .5 )dBHL ;实施人工耳蜗置入术时 3耳没能将电极全部插入 ;发病到发现听力下降平均为 (15 .8± 15 .0 )d ,小儿较成人发现听力下降时间延迟。结论 :细菌性脑膜炎可引起不同程度的内耳形态异常 ,人工耳蜗置入术前进行MRI检查可以发现内耳形态异常的程度 ,利于正确选择术耳及手术的顺利进行     

以听力突然下降为特征的分泌性中耳炎（附24例报告）

目的：提高对以听力突然下降为特征的分泌性中耳炎的确诊率。方法：回顾性分析24例（28耳）以听力突然下降为特征的分泌性中耳炎的临床资料,结果：11例患者被误诊或漏诊,各频率的平均气导阈值在60．2－66．5dBHL,平均骨导阈值在40．5－58．6dBHL,听力图示感音神经性聋9耳,混合性聋19耳,鼓室压图为B型,治疗后听力明显改善,结论,鼓室积液影响圆窗及卵圆窗间的相位差,导致听力突下降,它们的听力图无特征,并对产生误诊的原因进行了讨论。     

鼻咽癌放疗后突发性聋18例

目的 探讨鼻咽癌放疗后突发性聋(突聋)的临床特征及预后,为该类疾病的临床诊治提供依据.方法 收集并分析18例鼻咽癌放疗后突聋患者的临床资料,包括年龄、性别、耳侧、病程、伴随症状、听力曲线类型、听力损失程度、放疗后突聋发病间隔以及听力预后.结果 18例均为单侧发病,左侧10耳(55.56％),右侧8耳(44.44％);其...     

突发性聋患者内耳三维液体衰减反转恢复成像在预后评估中的价值

目的 探讨突发性聋患者内耳在三维液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)成像上的表现及其与疗效间关系.方法 23例突发性聋患者行三维FLAIR成像,观察内耳在FLAIR上的表现,并测定入院和治疗后的平均听阈,分析内耳信号与治疗结果之间关系.结果23例患者中8例患侧耳蜗在FLAIR上呈高信号,15例患侧及全部健侧耳蜗无信号.就诊时患侧耳蜗无信号组患者平均((x)±s,下同)听阈(听力级,下同)为(80±24) dB,耳蜗高信号组平均听阈为(92±18)dB,差异无统计学意义(t=1.245,P＞0.05);治疗后两组的平均听阈分别为(60±28)dB和(90±21)dB,有效率分别为60.0％和12.5％,差异均有统计学意义(P值均＜0.05).7例伴有眩晕患者中5例患侧半规管在FLAIR上呈高信号,此5例均治疗无效.结论三维FLAIR可显示突发性聋患者内耳淋巴液改变,呈高信号时疗效及预后差.