老年突发性聋的临床特征分析
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摘要
目的分析老年性突发性耳聋的流行病学特征及其预后关系,为提高疗效提供临床思路。方法回顾性分析2015年1月～2018年12月重庆医科大学附属第一医院突发性聋患者中≥65岁的临床病例229例(241耳),描述其流行病学特征,并探讨其与疗效的相关性。结果老年突发性聋占所有突发性聋患者的10.7%。229例老年突发性聋患者中,初诊时间≤14d的172例、>14d的57例;听力下降前后出现耳鸣者189例,以持续性嗡嗡声为主;有耳闷者85例;有眩晕或者头晕者80例;无明显诱因者占91.3%、有感冒病史者占4.4%、有劳累、压力大、情绪波动因素者占3%、其他因素占1.3%;伴高血压病者121例;伴糖尿病者65例;伴冠心病者42例;伴高血压、糖尿病、冠心病任一基础疾病者146例,占63.8%。241例患耳中,按耳聋程度分级:轻度27耳、中度44耳、重度67耳、极重度103耳;按听力曲线类型分类:低频下降型6耳、高频下降型24耳、平坦型111耳和全聋型100耳。老年突发性聋患者的性别、是否伴耳鸣、耳闷、头晕或眩晕对临床总有效率的影响不具有统计学意义(P>0.05);不同初诊时间、不同听力曲线类型与患者的临床总有效率比较,差异有统计学意义(P<0.05),即初诊时间越长,疗效越差。高频听力损失患者的疗效较全聋型差。结论老年突发性聋患者虽多伴有基础疾病,但是否伴基础疾病与疗效无明显相关性,在就诊及时的情况下,临床总有效率较高,且高频听力损失患者的预后较全聋型差。
Objective To provide clinical evidence for improving treatment effect through investigating the clinical epidemiological features and prognasis of sudden deafness in the elderly. Methods The clinical data of all patients with sudden deafness of 65 or above from January 2015 to December 2018 were retrospectively analyzed. Results Sudden deafness in the elderly accounted for 10.7% of all the sudden deafness patients. Out of 229 elderly patients with sudden deafness, 172 cases with the first diagnosis time less than or equal to 14 days and 57 cases with the first diagnosis time more than 14 days. There were 189 cases with tinnitus before and after hearing loss. Among 229 cases of sudden deafness,the rate of no causative factor accounted for 91.3%. 4.4% with history of colds, 3% with fatigue, stress, mood swings, 1.3%for other factors. There were 121 patients with hypertension; 65 patients with diabetes; 42 patients with coronary heart disease; 146 patients with hypertension or diabetes or coronary heart disease, accounting for 63.8%. Among the 241 cases,27 ears were classified as mild, 44 ears, moderate 67 ears sevelre and 103 ears profound.The hearing curves were classified as follows: 6 ears at low frequency, 24 ears at high frequency, 111 ears as flat and 100 ears as total deafness. There was no statistically significant difference in the clinical total effective rate among the patients of different genders, or accompanied by tinnitus, or accompanied by ear tightness, whether they were accompanied by dizziness or vertigo(P>0.05). Comparison of the clinical total effective rate of patients with different first diagnosis times and hearing curve types, the difference was statistically significant(P<0.05). The longer the initial diagnosis was, the worse the curative effect. The effect of highfrequency hearing loss was worse than that of total deafness. Conclusion Although the elderly patients with sudden deafness are often accompanied by basic diseases, if treated early enougn, the total effective rate can be high, and the prognosis of patients with high-frequency hearing loss is worse than that of patients with total deafness.
Objective To provide clinical evidence for improving treatment effect through investigating the clinical epidemiological features and prognasis of sudden deafness in the elderly. Methods The clinical data of all patients with sudden deafness of 65 or above from January 2015 to December 2018 were retrospectively analyzed. Results Sudden deafness in the elderly accounted for 10.7% of all the sudden deafness patients. Out of 229 elderly patients with sudden deafness, 172 cases with the first diagnosis time less than or equal to 14 days and 57 cases with the first diagnosis time more than 14 days. There were 189 cases with tinnitus before and after hearing loss. Among 229 cases of sudden deafness,the rate of no causative factor accounted for 91.3%. 4.4% with history of colds, 3% with fatigue, stress, mood swings, 1.3%for other factors. There were 121 patients with hypertension; 65 patients with diabetes; 42 patients with coronary heart disease; 146 patients with hypertension or diabetes or coronary heart disease, accounting for 63.8%. Among the 241 cases,27 ears were classified as mild, 44 ears, moderate 67 ears sevelre and 103 ears profound.The hearing curves were classified as follows: 6 ears at low frequency, 24 ears at high frequency, 111 ears as flat and 100 ears as total deafness. There was no statistically significant difference in the clinical total effective rate among the patients of different genders, or accompanied by tinnitus, or accompanied by ear tightness, whether they were accompanied by dizziness or vertigo(P>0.05). Comparison of the clinical total effective rate of patients with different first diagnosis times and hearing curve types, the difference was statistically significant(P<0.05). The longer the initial diagnosis was, the worse the curative effect. The effect of highfrequency hearing loss was worse than that of total deafness. Conclusion Although the elderly patients with sudden deafness are often accompanied by basic diseases, if treated early enougn, the total effective rate can be high, and the prognosis of patients with high-frequency hearing loss is worse than that of patients with total deafness.
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(2015)[J].中华耳鼻咽喉头颈外科杂志,2015,50(6):443-447.
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[5]李倩,马晓娟,王大勇,等.突发性聋伴耳鸣患者的临床特征分析[J].临床耳鼻咽喉头颈外科杂志,2015,29(1):57-60.
[6]psifidis AD,psillas GK.Sudden sensorineural hearing loss:long-term follow-up results[J].Otolaryngol Head Neck Surg,2006,134(5):809-815.
[7]Mamak A,Yilmaz S,Cansiz H,et al.A study of prognostic factors in sudden hearing loss[J].Ear Nose throat J,2005,84(10):641-644.
[8]Wallh?usser-Franke E,Brade J,Balkenhol t,et al.tinnitus:distinguishing between subjectively perceived loudness and tinnitus-related distress[J].pLoS One,2012,7:e34583.
[9]郑亿庆,区永康,许耀东,等.低中频下降型突发性聋药物治疗的多中心研究[J].中华耳鼻咽喉头颈外科杂志,2013,48(5):362-367.
[10]侯志强,王秋菊,韩东一,等.老年突发性耳聋的临床特征和转归[C].2010全国耳鼻咽喉头颈外科中青年学术会议论文集.2010.17-18.
[11]王明明,樊兆民,罗建芬,等.中高频下降型突发性聋药物治疗的多中心研究[J].中华耳鼻咽喉头颈外科杂志,2013,48(5):368-373.
[12]Schreiber BE,Agrup C,Haskard DO.Sudden sensorineural hearing loss[J].Lancet,2010,375(9721):1203-1212.
[2]teranishi M,Katayama N,Uchida Y,et al.thirty-year trends in sudden deafness from four nationwide epidemiological surveys in Japan[J].Acta Otolaryngol,2007,127(12):1259-1265.
[3]卜行宽,刘铤.世界卫生组织预防聋和听力减退工作情况介绍[J].中华耳鼻咽喉头颈外科杂志,2000,35(3):78-80.
[4]汪琼,陈其国,胡福云,等.突发性耳聋的流行病学调查[J].中外医学研究,2016,14(33):55-57.
[5]李倩,马晓娟,王大勇,等.突发性聋伴耳鸣患者的临床特征分析[J].临床耳鼻咽喉头颈外科杂志,2015,29(1):57-60.
[6]psifidis AD,psillas GK.Sudden sensorineural hearing loss:long-term follow-up results[J].Otolaryngol Head Neck Surg,2006,134(5):809-815.
[7]Mamak A,Yilmaz S,Cansiz H,et al.A study of prognostic factors in sudden hearing loss[J].Ear Nose throat J,2005,84(10):641-644.
[8]Wallh?usser-Franke E,Brade J,Balkenhol t,et al.tinnitus:distinguishing between subjectively perceived loudness and tinnitus-related distress[J].pLoS One,2012,7:e34583.
[9]郑亿庆,区永康,许耀东,等.低中频下降型突发性聋药物治疗的多中心研究[J].中华耳鼻咽喉头颈外科杂志,2013,48(5):362-367.
[10]侯志强,王秋菊,韩东一,等.老年突发性耳聋的临床特征和转归[C].2010全国耳鼻咽喉头颈外科中青年学术会议论文集.2010.17-18.
[11]王明明,樊兆民,罗建芬,等.中高频下降型突发性聋药物治疗的多中心研究[J].中华耳鼻咽喉头颈外科杂志,2013,48(5):368-373.
[12]Schreiber BE,Agrup C,Haskard DO.Sudden sensorineural hearing loss[J].Lancet,2010,375(9721):1203-1212.