以突聋为首发症状的颅内感染性疾病的临床特征分析  

Intracranical infections presented with sudden sensorineural hearing loss

作　　者：叶星[1] 王晓宇[1] 

机构地区：[1]北京军区总医院耳鼻咽喉头颈外科,北京100700

出　　处：《中华耳科学杂志》2011年第3期296-299,共4页Chinese Journal of Otology

摘　　要：目的探讨以突发性耳聋为首发症状的颅内感染性疾病的临床特点、听力学及影像学表现,以减少误诊。方法对5例以突发性耳聋为首发症状的颅内感染性疾病患者的临床资料、诊断过程以及疾病转归进行分析。结果 5例患者中男4例,女1例,临床表现:听力下降5例,眩晕伴走路不稳3例,头痛伴恶心呕吐4例,发热3例。纯音测听5例均为感音神经性耳聋,双耳3例,单耳2例;声导抗测听鼓室曲线A型5例,声反射不能引出4例;DPOAE检查4例不能引出,前庭功能检查半规管功能低下3例。ABR检查2例为蜗后性改变,影像学检查CT无特殊表现;MRI检查未见明显异常1例,呈现炎症性改变4例。腰穿正常2例,脑脊液压力增高、细胞数高3例。最后确诊疾病:急性小脑炎1例,病毒性脑炎2例,结核性脑膜炎2例。结论临床上在诊治突发性耳聋的患者时应考虑到有颅内病变的可能,尤其对听力损失重度,且为双侧性以及有发热、头痛、眩晕等症状重者需进MRI、ABR、腰穿等检查明确诊断。Objective To characterize clinical, auditory and imaging teatures of patients who present with sudden sensorineural hearing loss as the prodrome of an intracranial infection, in order to improve diagnosis. Methods Five cases of intracranial infection that were initially diagnosed as sudden sensorineural bearing loss were revisited. Results Four of these patients were males and 1 was female. All 5 patients presented with heating loss. Vertigo or vestibular dysfunction, headaches and nausea/vomiting were seen in 4 cases, and fever in 3 cases. Audiological tests showed severe sensorineural heating loss in all cases, bilateral in 3 and unilateral in 2 cases, with absent acoustic stapedial reflex. ABR and I）POAEs were also abnormal in all cases. MRI studies showed signs of infection changes in the brain. Final diagnoses included acute cerebellitis,viral encephalitis and tuberculous meningitis. Conclusions Clinicians should consider the possibility of intracranial lesions when facing a patient with sudden hearing loss, especially when symptoms include headaches, vertigo and fever. MRI, ABR and lumbar puncture may help avoid misdiagnosis.

关 键 词：突聋:颅内感染 眩晕 

分 类 号：R512.3[医药卫生—内科学] R764.43[医药卫生—临床医学]