鼻咽癌患者放化疗后听力下降的远期临床分析  

Hearing Loss after Chemoradiotherapy Treatment on Nasopharyngeal Carcinoma: a Longitudinal Analysis

作　　者：冯韶燕[1] 樊韵平[1] 吕明慧[1] 米姣平[1] 王静清[1] 

机构地区：[1]中山大学附属第五医院耳鼻咽喉头颈外科,广东省珠海519020

出　　处：《中国慢性病预防与控制》2012年第5期543-546,共4页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：珠海市科技局基金(01337411140530024)

摘　　要：目的研究鼻咽癌患者放化疗后远期的听力变化规律及其影响因素,为制定鼻咽癌治疗方案提供依据。方法 22名鼻咽癌患者在放疗前及放疗中、放疗结束时及放疗后3、6、24个月接受耳内镜检查、纯音测听以及声导抗检查,对数据进行统计分析得出鼻咽癌放化疗后听力改变的规律。结果放疗后24个月内,共有18耳发生分泌性中耳炎。随着放化疗后时间的推移,纯音测听中各频率气骨导差值总体呈逐渐上升趋势;而鼓室声导抗中鼓室图梯度(GRAD)值呈逐渐下降趋势,放疗后24个月该下降趋势逐渐平缓;鼓室图宽度(TW)值开始呈逐渐上升趋势,放疗后24个月上升趋势渐趋平缓。放疗后24个月时,44耳中有5耳发生低频感音神经性耳聋,有17耳发生高频感音神经性耳聋。应用logistic回归分析筛选出放疗后24个月感音神经性听力下降的影响因素包括:年龄、放疗后发生分泌性中耳炎以及应用顺铂。结论鼻咽癌患者放化疗后发生以高频下降为主的感音神经性听力下降。年龄、放疗后发生分泌性中耳炎以及应用顺铂均为感音性听力损害的影响因素。放疗后分泌性中耳炎的发展在放疗后24个月开始有所好转。Objective To investigate the long-term alterations of hearing in the patients with nasopharyngeal carcinoma（NPC） after radiotherapy（RT） and chemotherapy including Cisplatin（CDDP）,and its influential factors.Methods Twenty-two NPC patients after radiotherapy and chemotherapy were studied.They had to receive a serial assessment of hearing status,including endoscopy examination for ear,pure-tone audiography and impedance audiometry,at six regular intervals（before,during and at the end of RT,and in the 3rd,6th and 24th month after RT as well）.Statistical analysis was carried out by using SPSS 13.0.The potentially contributory influences on the sensorineural hearing loss（SNHL） after treatment were analyzed by Binary Logistic Regression.Results Of the 44 eligible ears,5 ears resulted in low-frequency SNHL and 17 ears resulted in high-frequency SNHL,after a follow-up of 2 years.Multivariate analysis by the Binary logistic regression revealed that the patient＇s age,occurrence of otitis media with effusion（OME） after radiotherapy,and adjuvant chemotherapy including CDDP were important determinants of SNHL.In the 2 years after radiotherapy,18 ears resulted in OME.The air-bone gap at the different frequencies got the widest in the 2nd year after radiotherapy,and tympanogram gradient（GRAD） got the lowest and tympanogram width（TW） got the highest in the acoustic immittance tests.Conclusion High-frequency SNHL in NPC patients after radiotherapy and chemotherapy is common.The risk of SNHL may be correlated with the patient＇s age,OME and adjuvant chemotherapy including CDDP.The development of OME in NPC patients in the 2nd year after treatment declined.

关 键 词：鼻咽肿瘤 放射疗法 听力损失 

分 类 号：R739.6[医药卫生—肿瘤]