双侧突发性耳聋患者临床特征与预后分析  

A clinical and prognosis analysis for bilateral sudden sensorineural hearing loss

作　　者：王秋菊[1] 兰兰[1] 韩冰[1] 王大勇[1] 李倩[1] 丁海娜[1] 李娜[1] 赵阳[1] 韩东一[1] 杨伟炎[1] 

机构地区：[1]解放军总医院耳鼻咽喉-头颈外科解放军耳鼻咽喉研究所耳内科及临床听力医学中心,北京100853

出　　处：《中华耳科学杂志》2010年第2期119-128,共10页Chinese Journal of Otology

基　　金：国家自然基金重点项目(30830104);国家自然基金面上项目(30672310&30771203);北京市自然科学基金重大项目(7070002);国家"十一五"科技支撑计划(2006BAI02B06&2007BAI18B12)联合资助

摘　　要：目的分析双侧突发性耳聋患者的临床特征及预后效果,了解与该病发生及影响预后的相关因素。方法对12例双侧突发性耳聋患者的临床资料进行系统性分析,包括临床表现、听力学检查、血液学、影像学检查、治疗方法和疗效评估等,分析致病和影响预后的危险因素,总结该病发生发展及转归的特点。结果 12例患者痊愈2耳,有效1耳,总有效率为12.5%。患者双耳同时发病7例,相继发病5例。可明确突聋诱因的6例,首发症状为听力下降21耳、耳鸣17耳,眩晕8耳。12耳既往有听力损失和耳鸣病史,发病后≤7天治疗者20耳,>7天4耳。12例患者听力损失呈下降型听力曲线15耳,治疗有效1例;全聋型5耳,切迹型2耳,治疗无效;山型1耳,平坦型1耳,痊愈。白细胞计数异常8例,在听力损失程度、耳鸣评价方面,外周血白细胞计数异常与正常患者间差异有统计学意义(P<0.05)。免疫抗体检查异常3例;IgE异常增高3例;血清促甲状腺激素测定异常增高1例;葡萄糖增高3例、血清脂质和脂蛋白异常7例,脂类代谢功能异常4例。结论双侧突发性聋的病情复杂,预后较差,详细分析病史、临床表现和特异性的血液及免疫学系统检查,有助于制定个性化诊疗方案。Objective To analyze the clinical characteristics and prognosis, impact factors of patients with bilateral sudden sensorineural hearing loss （BSSHL）. Methods Clinical data of 12 cases of patients with BSSHL were analyzed systematically, including all the clinical manifestations, audiologic characteristics, hematology, iconography, treatment methods and effect assessment. Base on those, we summarized comprehensively the development and prognosis characteristics of the disease. Results The total effective rate was 12.5%, 2 ears in 12 patients cured, effective one ear. In 12 patients, 7 cases with simultaneous BSSHL, 5 cases with sequential BSSHL, and 6 cases with clear incentives.Initial symptoms showed hearing loss in 21 ears, tinnitus in 17 ears and vertigo in 8 ears. Hearing curve of 15 ears showed decline type, treatment is effective in 1 case, others void; full deaf type 5 ears, notch type 2 ears, treatment fails; hill type 1 ear, flat 1 ears, both were healed. 8 cases had abnormal white blood cell count. The degree of hearing loss, tinnitus evaluation between patients with abnormal and normal white blood cell count was statistically significant difference （P 0.05）. Abnormal antibodies and IgE abnormally increased in 3 cases separately. Serum thyroid stimulating hormone abnormally increased in one case; glucose increased in 3 cases. There were 7 cases with serum lipid and lipoprotein abnormalities, and 4 cases with abnormal lipid metabolism. Conclusion BSSHL has complex condition; the prognosis for improvement is poor, so it helps to develop individualized treatment programs by detailed analysis of the history, clinical characteristics and specific examination of blood and immune system.

关 键 词：耳聋 突发性 听力损失 耳鸣 眩晕 

分 类 号：R764.437[医药卫生—耳鼻咽喉科]