甲状腺功能异常导致恐声症——对《恐声症鉴别和患病率》一文的验证  

A Case Study of Hyperacusis Caused by Thyroid Dysfunction in Support of the Paper Hyperacusis： Differentiation and Prevalence＂

作　　者：柴福[1] 靳玲[1] 张艳红[1] 

机构地区：[1]山西医科大学第二医院耳鼻咽喉头颈外科,太原030001

出　　处：《中国听力语言康复科学杂志》2012年第1期49-52,共4页Chinese Scientific Journal of Hearing and Speech Rehabilitation

摘　　要：目的分析1例甲状腺功能异常导致恐声症患者的病因机制、临床特征和听力学特点。方法对患者连续1年的甲状腺功能及听力学检查结果（包括纯音昕阈及不舒适阈、声导抗、耳声发射．听性脑干反应）进行分析，观察患者恐声症与甲状腺功能变化的相关性，并进行颞骨CT、耳蜗内听道水成像核磁共振．甲状腺彩超、心脏彩超及生化检查。结果甲状腺功能亢进（血清游离甲状腺素FT4升高、高灵敏度血清促甲状腺素3rd--TSH降低）时，听阈正常，但听觉过敏发生，不舒适阈降低，双耳各个频率受累，尤其不舒适阈4000和8000 Hz分别为30和35dB HL（右耳），30和25dB HL（左耳），最少相差仅10dB。而当甲状腺功能减低（3rd-TSH降低）时。同样出现听觉过敏，不舒适阈也很接近正常听阈。而镫骨肌反射阈无降低。与听阈之差〉60dB。耳声发射、电反应测听未见异常。结论患者连续1年的听力学检测结果证明患者甲状腺功能异常是发生恐声症的原因之一，提示甲状腺功能异常与听觉不舒适阈降低具有相关性。甲状腺功能异常可能导致内耳微循环缺血而诱发恐声症。Objective To analyze the etiological mechanism,clinical symptoms and audiological characteristics of a hyperacusis patient with thyroid dysfunction. Methods A series of examinations were performed to the patient, including thyroid function test once a month and audiology tests （pure-tone audiometry, acoustic immittance, otoacoustic emission and auditory brainstem response） to assess the relationship between thyroid functions and hyperacusis. The temporal bone CT, magnetic resonance liquid imaging and measurement for inner ear canal, thyroid ultrasound, cardiac ultrasound and biochemical examination were performed to the patient. Results The patient suffered from hyperacusis when she had thyroid dysfunction.When hyperthyroid happened, the hearing thresholds were normal but the uncomfortable loudness levels（ULL） of both ears decreased at all frequencies, especially at 4000 Hz with 30 dB HL（right） and 30 dB HL（left） and at 8000 Hz with 35 dB HL（right） and 25 dB HL（left）. When hypothyroid occurred, the hyperacusis was noted. The acoustic reflex threshold didn＇t decrease and was 60 dB higher than the hearing thresholds. The results of OAE and ABR were normal. Conclusion The hearing examination results indicate that the thyroid dysfunction is one of the causes for hyperacusis, which implies there is a correlation between thyroid dysfunction and ULL reduction. The possible reason may be the ischemia in the inner ear microcirculation caused by thyroid dysfunction.

关 键 词：恐声症 甲状腺功能异常 不舒适阈 听阈 

分 类 号：R581[医药卫生—内分泌]