噪音性内耳损伤的前庭病理分析  

Vestibular Pathology Associated with Noise-induced Inner Ear Impairment

作　　者：徐进[1] 黄魏宁[1] 高波[1] 周金梅[1] 

机构地区：[1]卫生部北京医院耳鼻咽喉科,北京100730

出　　处：《中国医学科学院学报》2008年第6期639-642,共4页Acta Academiae Medicinae Sinicae

摘　　要：目的探讨噪音致内耳损伤后前庭系统的病理状态。方法回顾性分析68例具有噪音性听力损失(NIHL)的眩晕或平衡障碍患者的传统前庭功能检查及高频前庭自旋转试验结果。结果469例眩晕患者中合并NIHL者68例(14.5%);NIHL眩晕患者4000Hz纯音阈值在30～80dBHL,4000Hz平均阈值左耳(46.7±17.6)dBHL,右耳(37.3±16.7)dBHL,4000Hz听力损失双耳对称占41.7%,非对称占58.3%;前庭病理类型表现为良性阵发性位置性眩晕45.7%,单侧外周前庭功能损害20.0%,双侧外周前庭功能低下26.7%,前庭脊髓反射功能异常28.6%,前庭功能反应亢进3.0%和高频前庭眼反射异常97.0%。结论强声刺激能引起内耳听、前庭感受器损伤,合并前庭症状的NIHL患者均显示出一种或多种前庭病理。前庭病理与听力损失程度及是否左右对称无相关性,但与前庭系统主观症状有一致性。Objective To evaluate the pathological status of the vestibular system associated with noise-induced inner ear impairment. Methods Totally 68 patients with noise-induced hearing loss （NIHL） who presented with vestibular symptoms including vertigo, dizziness, and chronic disequilibrium were screened. All patients underwent a series of conventional vestibular function tests and vestibular autorotation test and the results were retrospectively reviewed and evaluated. Results Sixty-eight （ 14.5% ） patients with NIHL were identified among 469 patients with vertigo, dizziness, or imbalance. A pure tone hearing threshold of patients with vertigo and NIHL at 4 000 Hz were between 30dB HL and 80dB HL with an average threshold of （46.7 ±17.6） dB HL in left ear and （37.3 ±16.7） dB HL in right ear. Patients with symmetrical hearing loss at 4 000 Hz accounted for 41.7% and those with asymmetrical loss accounted for 58.3%. Vestibular pathologies included benign positional paroxysmal vertigo （45.7%）, unilateral decreased caloric responses （20.0%）, bilateral decreased caloric responses （26.7%）, abnormal vestibulo-spinal reflex function （28.6%）, vestibular function response hyperactivity （3.0%）, and abnormal vestibulo-ocular reflex presentation at high frequencies （97.0%）. Conclusions Loud acoustic stimulation not only damages the cochlea but also causes clear functional impairment to the vestibular end organs. Although the vestibular pathology is not correlated with the severity of the hearing loss, it correlates with the subjective symptoms of the vestibular system.

关 键 词：前庭 病理 噪音性听力损失 前庭自旋转试验 

分 类 号：R76[医药卫生—耳鼻咽喉科]