高压氧疗治疗大前庭导水管综合征患儿急性听力丧失九例

目的 目的探讨高压氧疗治疗大前庭导水管综合征患儿急性听力丧失的临床效果。 方法 对急性听力丧失的大前庭导水管综合征患者9例11耳,进行为期2周共10次高压氧治疗。 结果 患儿均耐受良好,治疗后复查纯音听阈测试,提示患耳听阈均有明显改善。 结论 9例患儿对高压氧疗耐受良好,治疗效果显著,高压氧疗可以成为大前庭导水管综合征急性听力丧失患者的治疗方法之一。     

大前庭导水管综合征

目的:探讨大前庭导水管综合征的发病、临床表现及防治措施。方法:对18例经高分辨率CT证实为双侧大前庭导水管综合征患者的诊疗过程进行回顾性分析。结果:同一患者，管径大患耳较管径小患耳的听力损失重；不同患者管径大小与听力损失程度无关。耳声发射测定结果波动大，经颞骨CT扫描证实均为大前庭导水管综合征。结论:大前庭导水管综合征是一种独立的疾病，极易误诊，对临床上有波动性进行性听力下降、轻微的头颅外伤引起严重的听力下降的患者或声发射测定结果波动较大的感音神经性聋患者,应常规进行颞骨高分辨率CT扫描,以明确诊断，对已经证实的患者应积极进行干预治疗，尽可能地保存患者的残余听力。     

鼠神经生长因子在突发性耳聋中的疗效观察

目的探讨鼠神经生长因子联合银杏叶提取物、长春西汀及激素在突发性耳聋中的治疗效果,了解鼠神经生长因子在突发性耳聋中疗效,探讨治疗突发性耳聋更加有效的方法。方法选择2013年1月至2014年6月于我科住院救治的患者84例,将所有患者随机分成实验组(鼠神经生长因子+银杏叶提取物、长春西汀及激素)及对照组(银杏叶提取物、长春西汀及激素)2组,每组42例,每组按低中频下降、中高频下降及平坦与全聋各分为三小组,对照组行银杏叶提取物、长春西汀及激素治疗,实验组在对照组基础上加用鼠神经生长因子,比较两组患者的临床疗效、受损频率听力体力提高幅度及并发耳鸣症状的改善情况。结果 1.实验组治疗的有效率80.95%,高于对照组的有效率64.28%,χ2=6.323,P=0.028,差异显著,有统计学意义(P<0.05),见表1;实验组突聋患者听力提高幅值(23.87±15.50)d B高于对照组(15.48±13.84)d B,见表2;说明鼠神经生长因子联合银杏叶提取物、长春西汀及激素在各型突发性耳聋中均有疗效;且鼠神经生长因子联合银杏叶提取物、长春西汀及激素听力提高幅度高于银杏叶提取物、长春西汀及激素,说明鼠神经生长因子治疗突聋的有效性。2.实验组及对照组组间比较低中频听力下降听力提高值均优于中高频下降及平坦及全聋,P<0.05,差异有统计学意义,而中高频下降与平坦及全聋比较,P>0.05,差异无统计学意义。说明低中频下降听力提高效果优于中高频及平坦与全聋型。实验组听力提高幅度高于对照组,说明鼠神经生长因子可以增加突聋治疗的有效性。见表3;3中高频听力下降伴耳鸣发生率最高94%,平坦及全聋伴耳鸣次之73%,低中频听力下降伴耳鸣发生率最低40%,差异显著,有统计学意义(P<0.05);经治疗后各型听力下降伴耳鸣实验组的有效率76%明显高于对照组34%,差异有统计学意义(P<0.05);说明鼠神经生长因子联合金纳多注射液、长春西汀及激素对突发性耳聋伴耳鸣疗效显著,鼠神经生长因子可以增加治疗突聋伴耳鸣的有效率。组间比较见表4。结论 1鼠神经生长因子联合银杏叶提取物、长春西汀及激素在各型突发性耳聋中均有疗效;且鼠神经生长因子联合银杏叶提取物、长春西汀及激素在突发性耳聋听力提高幅度上高于单纯银杏叶提取物、长春西汀及激素,说明鼠神经生长因子治疗突发性耳聋的有效性。2通过组间比较说明低中频下降听力提高效果优于中高频及平坦与全聋型。实验组听力提高幅度高于对照组,说明鼠神经生长因子可以增加突聋治疗的有效性。见表3;3说明鼠神经生长因子联合金纳多注射液、长春西汀及激素对突发性耳聋伴耳鸣疗效显著,鼠神经生长因子可以增加治疗突聋伴耳鸣的有效率。     

耳鸣治疗仪联合银杏叶提取物注射液治疗突聋伴耳鸣的疗效分析

目的观察耳鸣治疗仪联合银杏叶提取物注射液对突聋伴耳鸣的疗效。方法选取108例突聋伴耳鸣患者,随机数表法分为观察组与对照组,各54例。对照组应用银杏叶提取物注射液治疗,观察组联合耳鸣治疗仪。比较两组患者的听力总有效率、耳鸣总有效率、治疗前后听阈值与血液流变学指标。结果两组患者听力总有效率比较,观察组(88.89%)高于对照组(66.67%);两组患者耳鸣总有效率比较,观察组(81.48%)高于对照组(61.11%)。治疗1周、2周、4周后,观察组的听阈值均低于对照组。治疗后观察组的全血高切黏度、全血中切黏度、全血低切黏度、血浆黏度、红细胞聚集指数均低于对照组;治疗后观察组的红细胞变形指数高于对照组。结论耳鸣治疗仪联合银杏叶提取物注射液可有效改善突聋患者血液流变,缓解耳鸣症状,提高患者听力。     

8例内耳病变导致患耳气骨导差的临床分析

目的探讨内耳病变导致患耳气骨导差的临床特点。方法回顾性分析8例内耳病变导致患耳气骨导差的临床资料。所有患者行音叉、纯音测听和声反射检查,同时行颞骨CT扫描。结果5例患者颞骨CT扫描及上半规管重建提示上半规管裂孔存在,诊断为上半规管裂综合征,主诉听力下降,时间2个月到10年不等,音叉检查患耳Rinne试验阴性,Weber试验偏向患侧,纯音测听提示低频听力下降,气导平均听阈(0.5、1、2kHz)为50.25dBHL,骨导平均听阈为28.48dBHL;声反射均能引出。其中,3例患者强声能诱导出眩晕和眼震,2例患者变压试验能诱导出眩晕和眼震。其余3例患者为大前庭水管综合征,颞骨CT均证实前庭导水管扩大,中耳乳突无积液,听骨链无畸形,外耳和鼓膜正常,音叉检查患耳Rinne试验阴性,纯音测听患耳有明显的气骨导差,声反射均能引出;均采用激素和高压氧治疗,2例听力明显好转,1例听力无改善。结论上半规管裂和前庭导水管扩大等内耳疾病可导致患耳气骨导差,临床上应予以关注。     

突发听力下降的大前庭导水管综合征一例

大前庭导水管综合征发病率低 ,报道较少 ,其病史特点是自幼双耳渐进性听力下降。因无其他特征性的临床表现 ,在做适当的影像学检查之前 ,难与其他原因引起的双侧耳聋相鉴别。现报告一例病程 10年 ,2次突发听力下降的大前庭导水管综合征患者。1　　病例报告患者男性 ,15岁 ,2 0 0 1年 6月 18日因右耳听力突然下降 ,以“突发性聋”收入院。患者无眩晕、耳鸣、耳毒性药物使用、外伤及耳流脓史。家长述患者自幼听力差 ,5岁后听力下降更明显 ,曾在其它医院住院治疗 ,治疗情况不明 ,发病前左耳全聋 ,右耳听力差 ,但能与他人交流。体检 :右耳戴助听…     

铁必复颗粒治疗缺铁感音神经性聋患者的疗效分析

目的 探讨铁必复颗粒治疗有缺铁的感音神经性耳聋患者的临床疗效。 方法 收集感音神经性耳聋患者1 214例,检查血清铁蛋白,筛查出存在缺铁的患者217例,其中单侧耳聋患者54例,双侧163例,以听力较好耳为观察对象,完全随机分为两组,铁必复颗粒组109耳,西药对照组108耳,铁必复颗粒组接受铁必复颗粒冲服,西药对照组口服常规剂量新B1、敏使朗、弥可保等,两组患者均连续用药2个月以上。分别在用药前1~3 d,治疗1、2个月时测平均电测听阈值和血清铁蛋白,观察听力改变与血清铁蛋白变化是否相关。 结果 治疗1个月后铁必复颗粒组有78耳(71.6%)血清铁蛋白恢复正常值,2个月后共有97耳(89.0%)血清铁蛋白恢复正常值,对照组分别为11耳(10.2%)和15耳(13.9%),秩和检验两组有效率差异有统计学意义(P<0.001)。听力测试结果显示治疗2个月后铁必复颗粒组显效9耳,有效48耳,总有效率为52.3%;西药对照组108耳,显效2耳,有效22耳,总有效率为22.2%。铁必复颗粒组有效率高于西药对照组,经秩和检验两组总有效率差异有统计学意义(P<0.05)。铁必复颗粒组听阈提高与血清铁蛋白的上升呈正相关,西药对照组无相关性。 结论 部分感音神经性耳聋可能与缺铁有关,铁必复颗粒能有效改善人体内缺铁状况,有效改善缺铁并感音神经性耳聋患者的听力情况。     

仙璐贝滴剂治疗儿童分泌性中耳炎疗效分析

目的 探讨仙璐贝滴剂治疗儿童分泌性中耳炎的疗效.方法 儿童分泌性中耳炎患者52例(70耳)随机分为仙璐贝治疗组29例(40耳)和对照组23例(30耳),两组同时给予常规治疗,其中治疗组加用仙璐贝滴剂,疗程14天,比较两组的治疗效果.结果 治疗组显效12耳,有效21耳,总有效率为82.5%;对照组显效5耳,有效13耳,总有效率为60.0%,治疗组的总有效率明显高于对照组(P＜0.05),且无不良反应.结论 仙璐贝滴剂辅助治疗儿童分泌性中耳炎安全有效.     

银杏叶提取物治疗突发性感音神经性聋临床疗效及对血液流变学的影响

目的　探讨银杏叶提取物在突发性感音神经性聋（sudden sensorineural hearing loss,SSNHL）治疗中的应用价值。方法　将138例SSNHL患者按照数字随机表 法分为2组,每组69例;对照组给予地塞米松磷酸钠注射液、前列地尔注射液治疗,研究组在对照组用药基础上给予银杏叶提取物治疗。比较两组患者治疗前后听阈和血液流变学指标,并比较两组治愈率和总有效率。结果　治疗后研究组低频下降型、高频下降型和全频下降型患者听阈均低于对照组（t =3.194、3.847、3.516,P＜0.01）;全血高切黏度、全血中切黏度、全血低切黏度、血浆黏度和红细胞聚集指数均低于对照组（t =4.405、3.356、8.910、4.608、3.356,P＜0.01）,红细胞变形指数高于对照组（t =2.937,P＜0.01）,治愈率和总有效率高于对照组（χ2=4.739、6.824,P＜0.05）。结论　银杏叶提取物可有效帮助患者恢复听力,改善血液流变学指标,提高SSNHL治愈率和总有效率,安全性好,有临床应用价值。     

大前庭水管综合征患者听力随访观察

目的 动态观察大前庭水管综合征(large vestibular aqueduct syndrome, LVAS)患者的听力变化,为更好地保护LVAS 患者的听力提供参考.方法 选取2007年7月至2016年5月经确诊且资料完整、能够准确完成纯音听阈检测的双耳大前庭水管综合征患者21例为研究对象,年龄5~29岁,中位年龄11岁,其中男12例,女9例;12例患者行单侧人工耳蜗植入手术,另一耳佩戴助听器,其余患者均双耳佩戴助听器.动态观察非耳蜗植入耳听力2~7年,中位数3年4个月;在随访期间发现患者听力下降就诊,及时给予扩血管改善循环、营养神经等药物保守治疗1~2周,比较用药前后的听力变化;病情稳定者一年复查一次纯音听阈,动态观察听力变化.结果 21例(30耳)中随访期间有15例发生过听力波动(下降),治疗前500、1 000、2 000、4 000 Hz平均纯音听阈分别为85.3±4.4、91.5±4.3、95.9±5.7、99.1±6.6 dB HL,治疗后分别为66.5±4.1、74.4±4.1、76.8±5.0、80±5.9 dB HL,各频率治疗前后比较差异均有统计学意义(均为P<0.05).结论 大前庭水管综合征患者可表现为波动性或进行性感音神经性听力损失;早期发现、及时治疗,可使LVAS患者的听力维持在一定的水平或使之听力下降的速度明显减缓.     

前庭诱发肌源性电位结合纯音测听在大前庭水管综合征患者的临床应用

目的 通过记录、分析大前庭水管综合征（LVAS）患者的前庭诱发的肌源性电位(VEMP) 和纯音测听（PTA）状况,了解其球囊及前庭下神经功能和纯音听力特征,探讨其在LVAS患者的临床应用及意义。方法 对22例（42耳）LVAS患者行内耳高分辨率CT扫描、纯音测听和VEMP检查,对检查结果结合其临床症状进行总结、分析。结果 双侧短声刺激42患耳中25耳（占59.5%）VEMP表现为高振幅和（或）低阈值;42患耳纯音测听有30耳（占71.4%）表现为低中频（2KHz以下）存在明显气骨导差的混合性聋。VEMP低阈值组,前庭水管内径平均值为（4.30±0.53）mm,纯音听力低中频平均气骨导差值为（36±17）dB HL, 19耳主观听力易受外界原因或发热致颅内压改变而波动;VEMP非低阈值组前庭水管内径平均值为（2.80±0.67）mm,纯音听力低中频平均气骨导差值为（32±15）dB HL,4耳主观听力易受外界原因或发热致颅内压改变而波动。结论 VEMP阈值较低者,其前庭水管平均内径值较大,主观听力也易受外界原因或发热致颅内压增高的改变而波动。而纯音听力损失程度与前庭水管内径平均值无相关性,与VEMP振幅的大小及阈值的高低亦无相关性。     

伴有大前庭水管的突发性聋(附病例报告及文献复习)

目的:探讨不伴耳蜗畸形的大前庭水管综合征的临床表现和高分辨率CT对大前庭管的诊断。方法:报告1例18岁男性患者从2岁时开始患双耳感音神经性听力损失,2001年1月和11月两耳先后出现突发性聋;颞骨轴位高分辨率CT扫描示双侧前庭水管扩大,不伴耳蜗畸形。此外并进行了文献复习。结果:不伴耳蜗畸形的大前庭水管综合征可出现后天性感音神经性听力损失,并有突发性聋的危险。结论:对儿童时期发生的不明原因的感音神经性听力损失或(和)突发性聋,应行高分辨率CT扫描,以了解是否存在不伴耳蜗畸形的大前庭水管综合征。     

双侧大前庭导水管综合征7例报告

目的：探讨双耳均为大前庭导水管综合征病例的ＣＴ和听力改变特征。方法：对７例经高分辨率ＣＴ证实为双耳大前庭导水管综合征病例的导水管管径和听阈改变进行分析。结果：ＣＴ示扩大的前庭导水管的管径两耳不对称,管径较大侧耳的听力损失重,差异有显著性意义（Ｐ〈０．０５）。结论：测量前庭导水管的管径对估计听力损失的程度和预后有重要意义。     

大前庭水管综合征与波动性听力损失

目的 分析波动性听力损失在大前庭水管综合征（large vestibular aqueduct syndrome,LVAS）中的特征。方法 总结LVAS13例（23耳）的临床资料，对其波动性听力损失的机理、LVAS诊断及治疗作一讨论。结果 LVAS13例（23耳）中双侧10例，单侧3例，平均年龄7.9岁。多幼年起病，呈缓慢进行性听力减退，波动性突然加重12耳，并伴发作性眩晕3例。6例有提重物、运动、乘飞机、感冒史。3例有遗传性家庭史。纯音听力多呈高频下降型感音神经性聋。眼震电图12耳6耳一侧半规管麻痹。高分辨率CT显示大前庭水管扩大2.5-8mm，有的深达前庭总脚。结论 LAVS多于幼年时出现缓慢进行性听力减退，可伴波动性突发性听力下降、眩晕，常与增加颅内压的活动有关，故应注意预防和避免。     

中西医结合治疗突发性聋120例疗效观察

本文报告中西医结合治疗突发性聋120例效果明显优于对照组（P＜0．05）。治愈58例（48％），显著好转20例（17％），好转32例（27％），无效10例（8．3％），总有效率达92％。笔者认为活血化瘀，改善内耳微循环在治疗突发性聋中有比较满意的效果。并对所用药物的药理作用做了初步探讨。     

Correlation of semi-quantitative findings of endolymphatic hydrops in MRI with the audiometric findings in patients with Meniere's disease

Purpose: To investigate the correlation between vestibular hydrops (VH), cochlearhydrops (CH), vestibular aqueduct non-visibility (VANV), and visually increased perilymphatic enhancement (VIPE) with the findings of pure-tone audiometry (PTA) in Meniere’s disease (MD) patients.Methods: In this cross-sectional study, 53 ears belonging to 48 patients were divided into two groups and evaluated. In group “MD patients,” there were 24 ears of 19 patients diagnosed with the definite MD (14 patients with unilateral and 5 patients withbilateral involvements). The “control group” consisted of 29 non-symptomatic ears belonging to patients diagnosed with unilateral sudden sensory-neural hearing loss or unilateral schwannoma. All the patients underwent 2 sessions of temporal bone MRI using the same 3T system: an unenhanced axial T1, T2, and 3D-FLAIR MRI, an intravenous gadolinium-enhanced axial T1 fat-sat, and 4 h after the injection, an axial 3D-T2 cube and 3D-FLAIR session. VH, CH, VANV, and VIPE were assessed. Subsequently, the correlation between EH indices and PTA findings (in three frequency domains of low, middle, and high) were evaluated, and the predictive value of MRI was calculated.Results: VH was significantly correlated with the hearing threshold in the low, middle, and high-frequency domains. CH was also correlated with the hearing threshold in the low and middle domains. Contrarily, VIPE was not associated with hearing thresholds, and VANV was only correlated with the hearing threshold in low frequencies.Conclusion: The grade of VH, CH, and VANV were significantly correlated with the hearing thresholds in PTA.     

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.     

The remediation of hearing deterioration in children with large vestibular aqueduct syndrome

Based on imaging findings, large vestibular aqueduct syndrome (LVAS) in early childhood is the most common cause of sensorineural hearing loss. Children with LVAS are at a high risk of suffering sudden deteriorations in hearing. This study was to review treatment of sudden hearing deterioration in children with LVAS who underwent corticosteroid therapy. We conducted a retrospective study of patients presenting to an academic tertiary medical center. Sixteen children of LVAS were evaluated. Corticosteroid therapy (prednisolone 1-2 mg/(kg day) or equal titer's dexamethasone) was administered as soon as sudden hearing loss developed. The pure tone audiometric result improved more than 10dB at two or more consecutive frequencies and was regarded as a significant response to corticosteroid therapy. Sixteen cases comprising 12 boys and 4 girls were retrospectively analyzed in this study. The mean age at which LVAS was diagnosed was 2.3 years. Mean follow-up for the 16 cases from the first clinic visit to November 2003 was 4.2 years. The initial audiograms varied from down-sloping, valve or rising patterns. In addition, bilateral enlargement of the vestibular aqueduct was found to all children and the mean diameter of right and left ears were 7.23 and 6.83 mm, respectively. Seven children had totally experienced 13 episodes of sudden hearing deterioration. After receiving corticosteroid therapy in time, 11 of 13 episodes had indicated significant responses to treatment, a response rate of 85%. Early detection of LVAS and the timing of treatment are crucial for preventing the residual hearing from deteriorating. As soon as the hearing deterioration of a child with LVAS is recognized, aggressive intervention such as corticosteroid therapy should be performed in no time.     

三磷酸胞苷加地塞米松等综合治疗突发性聋的临床观察

OBJECTIVE: To investigate the effect of application of cytridini triphosphatis (CTP) combined with dexamethasone on sudden deafness. METHODS: Two-hundred and seven patients (312 ears) with sudden deafness were randomly divided into CTP group (n = 159 ears) and control group (n = 153 ears). Besides intravenous administration of CTP, another treatments in CTP group were the same as that in control group including hyperbaric oxygen, vasodilator, energy preparation such as ATP, CoA and dexamethasone (DXM). RESULTS: The hearing threshold was (75.56 +/- 30.24) dB HL in CTP group and (72.50 +/- 40.50)dB HL in control group (P > 0.05) before treatment. The average value of the hearing threshold after treatment was decreased by (50.08 +/- 21.47) dB HL in CTP group and (19.45 +/- 19.12) dB in control group(P < 0.05), respectively. CONCLUSION: The application of CTP combined with DXM can significantly improve the effect of treatment on sudden deafness and CTP may enhance the recovery rate in the patients with sudden deafness, which was much higher than that treated by the traditional methods. However, the mechanism of the effect of CTP coupled with DXM is still unknown and further study is necessary.