突然发生的双耳感音神经性听力损失病因及临床表现特征分析  

Bilateral Sudden Sensorineural Hearing Loss: an Analysis of Etiologies and Clinical Characteristics

作　　者：曾祥丽[1] 李鹏[1] 李永奇[1] 陈愈彬[1] 岑锦添[1] 黎志成[1] 尹根蒂[1] 黄子真[1] 

机构地区：[1]中山大学附属第三医院耳鼻咽喉一头颈外科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2014年第6期956-960,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2012B061700073)

摘　　要：【目的】分析突发双耳感音神经性听力损失的病因及临床表现特征,为进一步提高诊疗质量提供数据支持。【方法】因突发双耳感音神经性听力损失入院,最终病因明确的病例19例,分析其临床表现特征。【结果】按照发病率高低依次为:1双侧内耳畸形10例。其中前庭扩大5例,前庭导水管扩大3例,前庭及前庭导水管均扩大1例,前庭扩大伴耳蜗发育不全1例。单纯前庭扩大畸形,初次发作感音神经性听力损失时程度为中度,经治疗并积极控制诱因,2例恢复正常,随访3年无复发;3例听力较发病时好转,纯音听阈在中度以内波动。其他类型畸形5例听力逐渐下降至重度以上。2癔症性听力损失8例,其中学龄儿童及青少年共6例,均可查及特殊的生活背景;中年女性2例,发病前有特殊的情感经历。8例患者经积极治疗后听力恢复。3肺癌颅内及左侧内听道转移1例,左耳全聋、右耳轻度听力损失,虽经及时治疗,双耳听力均无改善。【结论】儿童突发双侧感音神经性听力损失患者易误诊,双侧前庭、前庭导水管扩大或合并其他畸形听力预后较差,有必要于首诊时完善影像学检查。癔症性听力损失发病率近年有升高趋势,仍以儿童患者为主(6/8)应对其诱因进行关注并给予及时有效的处理。肺癌内听道转移则极为罕见,对中老年双侧感音神经性听力损失患者建议必要的影像学检查。[Objectives] To analyze the etiologies and clinical characteristics of bilateral sudden sensorineural hearing loss, in order to avoid misdiagnose and missed diagnose. [ Methods ] 19 bilateral sudden sensorineural hearing loss suffers whose etiologies could be determined eventually were included. The authors analyzed the etiologies and the clinical characteristics. [Results] According to the rank of morbidity rate ： ①Bilateral inner ear malformation 10 cases, including bilateral enlarged vestibule 5 cases; enlarged vestibular aqueduct 3 cases, enlarged vestibule and vestibular aqueduct 1 case, enlarged vestibule and cochlear hypoplasia 1 case. For the 5 enlarged vestibule malformation cases ,the first attack of sensorineural hearing loss showed moderate deafness , and 2 cases got and kept normal hearing after iniervention and avoided incentives; 3 cases got better hearing than the attack ,the hearing level fluctuated within 60 dB HL. Hearing deteriorated gradually to sever-to-profound loss in the other 5 cases with other type of malformations. ②Psychogenic hearing loss 8 cases, including school children and teen-agers 6 cases with special life background and experience ;mid-aged women 2 cases with special sensibility experience. All 8 cases got hearing rehabilitation after effective cure. ③Lung cancer with brain and internal acoustic meatus metastasis 1 case, whose hearing loss was mild in right ear and profound in left ear. The bilateral hearing loss got no improvement. [ Conclusions ] Bilateral sudden sensorineural hearing loss of children are prone to be misdiagnosed usually. For enlarged bilateral vestibule, vestibular aqueduct and other types of malformation often lead to sever-to-profound hearing loss, the image scan is necessary when the first visitation. Psychogenic hearing loss showed increasing morbidity, and the major suffers were still children. The inducement should be pay close attention to. Lung cancer with internal acoustic meatus metastasis was very rare , and image scan should be proposed

关 键 词：突发性感音神经性听力损失 双耳 病因 

分 类 号：R76[医药卫生—耳鼻咽喉科]