突发性聋预后相关因素分析  

Analyses prognostic factors relevant to sudden sensorineural hearing loss

作　　者：王军[1] 肖水芳[1] 曾镇罡[1] 甄甄[1] 张雪溪[1] 林枫[1] 董明敏[2] 卢伟[2] 秦兆冰[2] 左彬[2] 白险峰[2] 

机构地区：[1]北京大学第一医院耳鼻咽喉科头颈外科,100034 [2]郑州大学第一附属医院耳科

出　　处：《中华耳鼻咽喉头颈外科杂志》2015年第6期448-452,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨突发性聋预后的相关因素。方法采用国际通用的标准化临床研究方法，统一设计、统一方案进行前瞻性临床多中心研究。2007年8月至2011年10月全国33家医院共收集符合入组条件（年龄在18～65周岁之间，病程在2周以内，未经任何相关医疗处理）的单侧突发性聋患者1024例，其中男性492例（48．05％），女性532例（51．95％）；年龄为19-65岁，平均（41．2±12．8）岁。将患者按照听力曲线分为低中频下降型、中高频下降型、平坦下降型和全聋型四种类型并分别给予相应治疗。分析发病年龄、发病时间、听力下降程度、听力下降特点等因素对听力预后的影响。结果各种类型突发性聋药物治疗的总有效率：低中频下降型最高，为90．73％；平坦下降型次之，为82．59％；全聋型为70．29％；中高频下降型为65．96％；各型之间总有效率比较，差异具有统计学意义（X^2=231．58，P=0．000）。痊愈患者的平均年龄为（39．0±12．4）岁；显效患者的平均年龄为（40．8±12．9）岁；有效患者的平均年龄为（43．2±12．7）岁；无效患者的平均年龄为（43．5±13．2）岁；不同疗效患者之间平均年龄比较，差异具有统计学意义（F=8．08，P=0．000）。从发病到开始接受治疗的时间，痊愈患者平均为（3．0±2．4）d，显效患者为（3．7±3．0）d，有效患者为（3．9±3．4）d，无效患者为（4．2±3．6）d；不同疗效患者之间比较，差异具有统计学意义（F=5．33，P=0．001）。全频下降型（平坦下降型与全聋型）中治疗前平均听阈〉80dBHL者痊愈率低（15．36％）、无效率高（26．68％）。结论不同听力曲线类型的突发性聋患者预后差异较大，低中频下降型疗效最好，平坦下降型次之，中高频下降型和全聋型效果不佳。发病年龄越轻，预后越好；发病后越早接受治疗，预后越好。Objective To investigate the prognostic factors relevant to sudden sensorineural hearing loss. Methods The internationally accepted standardized clinical research methods, unified design, and unified program were adopted to conduct the prospective clinical multi-center study. The sudden deafness patients between 18 to 65 years old, with the course of this disorder less than two weeks, and without any medical treatments were collected, and then, divided into four types according to the hearing curve： type A, acute sensorineural hearing loss in low tone frequencies; type B, acute sensorineural hearing loss in high tone frequencies; type C, acute sensorineural hearing loss in all frequencies; and type D, total deafness. The factors, in terms of age, gender, type of initial audiogram, time delay before the first visit, and severity of hearing loss, were included in the analyses. Results A total of 1 024 cases with single side sudden deafness were collected in the study from 33 hospitals in China from August 2007 to October 2011, inclusive of for 492 males （48.05%） and 532 females （51.95%）. The average age was （41.2 ± 12. 8）years old. There were 553 cases（54.00% ） in left ear, and 471 cases（46. 00% ） in right ear. The curative effects of different types were shown as follows ： the type in low tone frequencies had the highest rate of 90. 73% , the type in all frequencies was 82. 59% ; the type of total deafness was 70. 29% ; and the type in high tone frequencies had the lowest rate of 65.96%. It had significant difference of the effective rate between different types （X^2=231.58 ,P =0. 000）. Age, time delay before first visit, and severity of initial hearing loss were significantly correlated with hearing improvement. Conclusions Initial audiogram of SSNHL might predict hearing recovery. The young in age and a short time delay before starting treatment are positive prognostic factors for hearing recovery in SSNHL. The initial severity of hearing loss is negative prognostic factor of hearin~

关 键 词：听觉丧失 突发性 随机对照实验 药物疗法 预后 

分 类 号：R764.437[医药卫生—耳鼻咽喉科]