妊娠期突发性聋的临床特点及预后分析
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摘要
目的分析妊娠期突发性聋(简称突聋)患者的临床特点及预后,为该病的临床诊治提供参考。方法收集2010年1月到2017年1月24例(24耳)妊娠期突发性聋患者(妊娠组)的临床资料,对所有患者的年龄、耳侧、病程、双耳发病比例、孕周期、初诊听阈、耳鸣和眩晕及耳闷胀感伴发率、听力曲线类型、治疗效果进行统计分析,并与同期72例(76耳)孕龄期非妊娠女性突聋患者(非妊娠组)进行对比。妊娠组患者均给予低分子右旋糖酐-40治疗,其中13例给予鼓室注射地塞米松治疗。结果 24例妊娠期突聋患者均为单侧发病,4例(16.67%,4/24)发病于妊娠早期,9例(37.50%,9/24)发病于妊娠中期,11例(45.83%,11/24)发病于妊娠晚期;妊娠组患者病程(4.83±3.83天)短于非妊娠组(11.20±14.50天),差异有统计学意义(P<0.05);妊娠组初诊平均听阈(71.83±21.10 dB HL)及全聋型比例(58.33%)均高于非妊娠组(分别为60.52±23.97 dB HL,32.89%),差异有统计学意义(P<0.05);妊娠组治疗及随访期间未见明显不良反应,治疗后妊娠组总有效率为75.00%,痊愈率为33.33%,均高于非妊娠组(分别为50.00%和13.16%),差异有统计学意义(P<0.05);妊娠组中鼓室注射的患者总有效率(84.62%)高于未行鼓室注射的患者(63.64%),但差异无统计学意义(P>0.05)。结论妊娠期突发性聋常发病于妊娠中晚期,一旦发病听力损失往往较重,听力曲线以全聋型为主,低分子右旋糖酐-40静脉滴注疗效显著,联合鼓室注射激素的疗效有待进一步验证。
Objective To analyze the clinical characteristics and prognosis of sudden sensorineural hearing loss(SSNHL) during pregnancy, and provide guidelines for clinical practice.Methods We collected the clinical data of 24 SSNHL patients in pregnancy from January 2010 to January 2017. Comparatively we investigated those related factors: age, ear side, duration from onset to treatment, the rate of bilateral hearing loss, gestation period, initial hearing threshold, presence of tinnitus, vertigo, ear fullness, treatment and outcome, between the pregnant and non-pregnant groups.Results For the 24 patients with unilateral hearing loss, 4 patients(16.67%) were in the first trimester, 9 patients(37.50%) in the second trimester and 11 patients(45.83%) in the last trimester. For the pregnant group, the duration from onset to treatment(4.83±3.83 d) was shorter than that in non-pregnant group(11.20±14.50 d)(P<0.05). The initial hearing threshold(71.83±21.10 dB HL) and rate of total deafness(58.33%) were higher than those in non-pregnant group(P<0.05). All the patients were treated with dextran-40 and 13 patients were treated with adjunct intratympanic corticosteroids. After positive treatment, the overall recovery(31.25%) and complete recovery were higher than those in the non-pregnant group(P<0.05). The overall recovery of patients treated with adjunct intratympanic corticosteroids was higher than those without adjunct intratympanic corticosteroids, but the difference was not statistically significant(P>0.05).Conclusion SSNHL in pregnancy often occurred in the second trimester or the last trimester. The hearing loss was severe, and most were complete deafness. Dextran-40 was effective to treat these patients without adverse reactions during the follow-up period, but the effect of adjunct intratympanic corticosteroids was unknown.
Objective To analyze the clinical characteristics and prognosis of sudden sensorineural hearing loss(SSNHL) during pregnancy, and provide guidelines for clinical practice.Methods We collected the clinical data of 24 SSNHL patients in pregnancy from January 2010 to January 2017. Comparatively we investigated those related factors: age, ear side, duration from onset to treatment, the rate of bilateral hearing loss, gestation period, initial hearing threshold, presence of tinnitus, vertigo, ear fullness, treatment and outcome, between the pregnant and non-pregnant groups.Results For the 24 patients with unilateral hearing loss, 4 patients(16.67%) were in the first trimester, 9 patients(37.50%) in the second trimester and 11 patients(45.83%) in the last trimester. For the pregnant group, the duration from onset to treatment(4.83±3.83 d) was shorter than that in non-pregnant group(11.20±14.50 d)(P<0.05). The initial hearing threshold(71.83±21.10 dB HL) and rate of total deafness(58.33%) were higher than those in non-pregnant group(P<0.05). All the patients were treated with dextran-40 and 13 patients were treated with adjunct intratympanic corticosteroids. After positive treatment, the overall recovery(31.25%) and complete recovery were higher than those in the non-pregnant group(P<0.05). The overall recovery of patients treated with adjunct intratympanic corticosteroids was higher than those without adjunct intratympanic corticosteroids, but the difference was not statistically significant(P>0.05).Conclusion SSNHL in pregnancy often occurred in the second trimester or the last trimester. The hearing loss was severe, and most were complete deafness. Dextran-40 was effective to treat these patients without adverse reactions during the follow-up period, but the effect of adjunct intratympanic corticosteroids was unknown.
引文
1 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.突发性聋诊断和治疗指南[J].中华耳鼻咽喉头颈外科杂志,2015,50:443.
2 侯志强,王秋菊.不同年龄段突聋患者的临床特点及预后研究进展[J]. 听力学及言语疾病杂志,2013,21:418.
3 Yen TT, Lin CH, Shiao JY, et al. Pregnancy is not a risk factor for idiopathic sudden sensorineural hearing loss: a nationwide population-based study[J]. Acta Otolaryngol,2016,136:446.
4 Sharma K, Sharma S, Chander D. Evaluation of audio-rhinological changes during pregnancy[J]. Indian J Otolaryngol Head Neck Surg, 2011,63:74.
5 Pawlak-Osinska K, Burduk PK, Kopczynski A. Episodes of repeated sudden deafness following pregnancies[J]. Am J Obstet Gynecol, 2009,200:e7.
6 Stenberg AE, Wang H, Fish J, et al. Estrogen receptors in the normal adult and developing human inner ear and in Turner’s syndrome[J]. Hear Res, 2001,157:87.
7 Lavy JA. Sudden onset deafness: two cases associated with pregnancy[J]. Int J Clin Pract, 1998,52:129.
8 Wiles NM, Hunt BJ, Callanan V. et al. Sudden sensorineural hearing loss and antiphospholipid syndrome[J]. Haematologica, 2006,91:124.
9 Goh AY, Hussain SS. Sudden hearing loss and pregnancy: a review[J]. J Laryngol Otol, 2012,126:337.
10 曾祥丽,何建成,李鹏,等.妊娠期突发性感音神经性聋21例报道[J].中华耳科学杂志,2014,12:207.
11 Butte NF. Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus[J]. Am J Clin Nutr, 2000,71:1256S.
12 何慧,张世科,刘勇,等.电项针加电耳周针治疗妊娠期突发性聋22例[J].中华耳科学杂志,2018,16:107.
13 Wang YP, Young YH. Experience in the treatment of sudden deafness during pregnancy[J].Acta Otolaryngol, 2006,126:271.
14 Qiang Q, Wu X, Yang T, et al. A comparison between systemic and intratympanic steroid therapies as initial therapy for idiopathic sudden sensorineural hearing loss: a meta-analysis[J]. Acta Otolaryngol, 2017,137:598.
15 Chen Y, Wen L, Hu P, et al. Endoscopic intratympanic methylprednisolone injection for treatment of refractory sudden sensorineural hearing loss and one case in pregnancy[J]. J Otolaryngol Head Neck Surg, 2010,39:640.
16 Chung JH, Cho SH, Jeong JH, et al. Multivariate analysis of prognostic factors for idiopathic sudden sensorineural hearing loss in children[J]. Laryngoscope, 2015,125:2209.
2 侯志强,王秋菊.不同年龄段突聋患者的临床特点及预后研究进展[J]. 听力学及言语疾病杂志,2013,21:418.
3 Yen TT, Lin CH, Shiao JY, et al. Pregnancy is not a risk factor for idiopathic sudden sensorineural hearing loss: a nationwide population-based study[J]. Acta Otolaryngol,2016,136:446.
4 Sharma K, Sharma S, Chander D. Evaluation of audio-rhinological changes during pregnancy[J]. Indian J Otolaryngol Head Neck Surg, 2011,63:74.
5 Pawlak-Osinska K, Burduk PK, Kopczynski A. Episodes of repeated sudden deafness following pregnancies[J]. Am J Obstet Gynecol, 2009,200:e7.
6 Stenberg AE, Wang H, Fish J, et al. Estrogen receptors in the normal adult and developing human inner ear and in Turner’s syndrome[J]. Hear Res, 2001,157:87.
7 Lavy JA. Sudden onset deafness: two cases associated with pregnancy[J]. Int J Clin Pract, 1998,52:129.
8 Wiles NM, Hunt BJ, Callanan V. et al. Sudden sensorineural hearing loss and antiphospholipid syndrome[J]. Haematologica, 2006,91:124.
9 Goh AY, Hussain SS. Sudden hearing loss and pregnancy: a review[J]. J Laryngol Otol, 2012,126:337.
10 曾祥丽,何建成,李鹏,等.妊娠期突发性感音神经性聋21例报道[J].中华耳科学杂志,2014,12:207.
11 Butte NF. Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus[J]. Am J Clin Nutr, 2000,71:1256S.
12 何慧,张世科,刘勇,等.电项针加电耳周针治疗妊娠期突发性聋22例[J].中华耳科学杂志,2018,16:107.
13 Wang YP, Young YH. Experience in the treatment of sudden deafness during pregnancy[J].Acta Otolaryngol, 2006,126:271.
14 Qiang Q, Wu X, Yang T, et al. A comparison between systemic and intratympanic steroid therapies as initial therapy for idiopathic sudden sensorineural hearing loss: a meta-analysis[J]. Acta Otolaryngol, 2017,137:598.
15 Chen Y, Wen L, Hu P, et al. Endoscopic intratympanic methylprednisolone injection for treatment of refractory sudden sensorineural hearing loss and one case in pregnancy[J]. J Otolaryngol Head Neck Surg, 2010,39:640.
16 Chung JH, Cho SH, Jeong JH, et al. Multivariate analysis of prognostic factors for idiopathic sudden sensorineural hearing loss in children[J]. Laryngoscope, 2015,125:2209.