突发性耳聋八例误诊临床讨论  

Clinical Analysis of 8 Misdiagnosed Patients with Sudden Deafness

作　　者：张焱 ZHANG Yan(Department of Otorhinolaryngology, Fengtai Hospital of Traditional Chinese and Western Medicine, Beijing 100072, China)

机构地区：[1]北京市丰台中西医结合医院耳鼻喉科,北京100072

出　　处：《临床误诊误治》2017年第3期44-47,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析突发性耳聋的临床特点及误诊原因。方法回顾性分析2013年1月—2015年1月我院收治并误诊的突发性耳聋8例的临床资料。结果 8例均因眩晕、耳鸣就诊,其中伴视物旋转3例,恶心2例;6例听力持续性下降;5例耳聋突发;3例耳聋与耳鸣同时出现。首诊均误诊,误诊时间为3~15 d,误诊为眩晕症4例,梅尼埃病、椎基底动脉供血不足各2例。听力检查显示听力曲线呈高频下降型6例,全频下降型2例;音叉试验显示为中度感音神经性耳聋1例,重度感音神经性耳聋7例;声导抗检测显示镫骨肌反射阈值下降6例;耳声发射及耳蜗点图提示蜗性损害2例。前庭功能正常2例,减退、消失各3例。均确诊为突发性耳聋,予糖皮质激素、溶栓与抗凝药物、营养神经及高压氧治疗,听力均恢复正常,痊愈出院。结论突发性耳聋临床症状无特异性,医师应提高对该病的认知及诊断水平,及时行相关检查,减少误诊误治。Objective To analyze clinical characteristics and misdiagnosed causes of sudden deafness. Methods Clinical data of 8 misdiagnosed patients with sudden deafness admitted between January 2013 and January 2015 was retrospec tively analyzed. Results All the 8 patients visited doctors for vertigo and tinnitus, among whom 3 patients had complicated with visual rotation, 2 patients with nausea, 6 patients with persistent hearing decline, 5 patients with sudden deafness and 3 patients with deafness and tinnitus at the same time. All patients were misdiagnosed at the first diagnosis, and misdiagnosed time was 3-15d. Among them, 4 patients were misdiagnosed as having staggers, 2 patients as Meniere~ disease and 2 patients as vertebrobasilar insufficiency. Listening examination showed that 6 patients with high frequency descent type and 2 patients with full frequency descent type in audiometric curve. Tuning fork test showed that moderate sensorineural hearing loss was found in 1 patient, and severe sensorineural hearing loss in 7 patients. Acoustic immittance measurement showed decreased stapedius reflex threshold value in 6 patients, and 2 patients had cochlear impairment by otoacoustic emission and cochlea point diagram. Vestibular function was normal in 2 patients, decreased in 3 patients and disappeared in 3 patients. All pa- tients were confirmed as having sudden deafness, and were treated with glucocorticoid, thrombolysis, anticoagulation drugs, neurotrophic drugs and hyperbaric oxygen therapy. All patients were cured and discharged after hearing had been returned to normal by treatments. Conclusion Clinical symptoms of sudden deafness are non-specific. Clinicians should improve cognition and diagnosis of the disease, and give related examinations in time to avoid misdiagnosis and mistreatment.

关 键 词：突发性耳聋 误诊 眩晕 梅尼埃病 椎底动脉供血不足 

分 类 号：R764.437[医药卫生—耳鼻咽喉科]