突发性聋并发良性阵发性位置性眩晕的临床特征和近期疗效分析

发布时间：2018-04-29 22:36

本文选题：突发性聋 + 眩晕　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:分析突发性聋(简称突聋)并发良性阵发性位置性眩晕(BPPV)患者的临床特征和治疗效果,并进一步探讨其可能的致病因素和适宜的治疗方案。方法:选取2015.1-2016.6期间就诊于天津市人民医院耳鼻咽喉科,并确诊为单侧突聋且资料完整的患者260例,根据是否伴发有BPPV,将突聋患者分为突聋伴BPPV组和突聋不伴BPPV组,分析总结突聋伴BPPV组患者的临床特征;所有突聋患者病程均1-10d,根据突聋患者听力损失的频率和程度,将听力曲线分为低频下降型、高频下降型、平坦下降型及全聋型(含极重度聋),并依据不同听力曲线类型分型治疗,疗程均14d,以疗程结束后的纯音测听结果判定疗效,统计分析伴BPPV和不伴BPPV两组突聋患者的治疗有效率。另选取同期就诊于我科确诊为原发性BPPV且资料完整的患者100例,作为突聋伴BPPV组之对照组,两组BPPV患者依据受累半规管的不同,采用G-force眩晕诊疗系统行相应复位方法的复位治疗,治疗后判定疗效,并于治疗后1周复查变位试验(G-force眩晕诊疗系统辅助下Dix-Hallpike试验及滚转试验),对未治愈的患者再次复位治疗,统计分析两组BPPV患者的治愈次数和治疗有效率。所有BPPV患者复位治疗结束后随访时间为3月,随访方式为门诊复查或电话随访,记录复发例数,并对复发BPPV者行相应复位治疗。应用SPSS21.0统计软件进行统计学分析。结果:1.突聋伴BPPV患者的发病率约占突聋患者的14.62%,约占突聋伴眩晕患者的38.38%,女性发病多于男性,男:女比例为1:1.92,平均发病年龄为(49.18±9.78)岁,受累半规管均与突聋患耳同侧,后半规管受累最多见,约55.26%,其次为水平半规管BPPV(31.58%),BPPV发病时间晚于突聋(1周内:81.58%,2周内:18.42%);伴BPPV的突聋患者全聋型听力曲线比例最高,约为42.11%,低频下降型所占比例最小2.63%。2.突聋伴BPPV患者经1-4次G-force眩晕诊疗系统复位治疗后均治愈,与原发性BPPV组相比,突聋伴BPPV组的1次治愈率(44.74%)低于原发性BPPV组(72%),差异有统计学意义(P0.05);原发性BPPV组和突聋伴BPPV组的总治愈率均为100%,无差异。3.突聋伴BPPV患者的听力疗效总有效率(52.63%)低于突聋不伴BPPV组(71.62%),经卡方检验,差别有统计学意义(P0.05);伴BPPV和不伴BPPV的两组突聋患者,经治疗后,其平均听阈水平均较前有所恢复,且不伴BPPV的突聋患者治疗后平均听阈略高于突聋伴BPPV组患者,差异均有统计学意义(P均0.05)。4.突聋伴BPPV组和原发性BPPV组治疗后随访3月,其BPPV复发率分别为5.26%、2%,两组患者复发率差异无统计学意义(P0.05)。结论:1.突聋伴BPPV患者平均发病年龄为(49.18±9.78)岁,女性发病多于男性,受累半规管均与突聋患耳同侧,后半规管受累多见,BPPV发病时间晚于突聋(1周内:81.58%,2周内:18.42%);四种听力曲线中全聋型所占比例最高。2.突聋伴BPPV患者和原发性BPPV患者经耳石复位治疗后总治愈率为100%,但1次治愈率低于原发性BPPV组,两组患者BPPV复发率无差异;突聋伴BPPV患者听力治疗的总有效率低于突聋不伴BPPV组。3.突聋伴BPPV的病因同突聋和BPPV一样,目前尚无定论;其可能之病因是能够作用于耳蜗和前庭系统的共同因素所致,国内外较公认的致病因素有内耳血管因素和病毒感染。4.积极予突聋并发BPPV患者改善内耳微循环、营养神经及口服激素治疗,同时予耳石复位和心理干预治疗,绝大部分患者有较满意的治疗效果。
[Abstract]:Objective: to analyze the clinical features and therapeutic effects of sudden deafness (sudden deafness) complicated with benign paroxysmal positional vertigo (BPPV), and to further explore the possible pathogeny factors and appropriate treatment schemes. Methods: selecting 2015.1-2016.6 during the diagnosis of the Department of otorhinolaryngology in Tianjin People's Hospital, and diagnosed as unilateral sudden deafness and complete data. 260 cases of total deafness were divided into two groups: deafness with BPPV group and group of sudden deafness without BPPV. The clinical characteristics of the patients with sudden deafness and BPPV were analyzed. All the patients with sudden deafness were 1-10d. According to the frequency and degree of hearing loss in the patients with sudden deafness, the hearing loss was divided into low frequency descent type, high frequency descending type and flat under the level of hearing loss. The treatment of descending and fully deafness type (containing very severe deafness), and according to different types of hearing curve type, was treated with 14d. The curative effect was determined by pure tone audiometry after the end of the course. The treatment efficiency of the patients with BPPV and no two groups of sudden deafness were statistically analyzed, and 100 cases of the patients diagnosed as primary and complete data in our department at the same time were selected. As the control group of the group of sudden deafness with the BPPV group, the two groups of BPPV patients were treated with the G-force vertigo treatment system according to the difference of the affected semicircular canals. After treatment, the curative effect was judged, and the reexamination (Dix-Hallpike test and rolling test aided by the G-force vertigo diagnosis and treatment system) was rechecked after the treatment (G-force vertigo diagnosis and treatment system), and the patients who had not been cured were treated. The reposition treatment of the two groups of BPPV patients was statistically analyzed and the curative efficiency was statistically analyzed. All BPPV patients were followed up in March after the end of the reposition treatment. The follow-up was the outpatient reexamination or telephone follow-up, the number of recurrent cases was recorded, and the recurrent BPPV patients were treated with corresponding reduction treatment. The statistical analysis should be made with the SPSS21.0 software. The results were as follows: 1. the incidence of sudden deafness accompanied by BPPV was about 14.62% of the patients with sudden deafness, about 38.38% of sudden deafness and vertigo. The incidence of women was more than that of men. The female ratio was 1:1.92, the average age was (49.18 + 9.78) years, the affected semicircular canals were the same side with the sudden deafness, the posterior semicircular canal was the most common, and the second was the horizontal semicircular canal BPPV (31.58%). The onset time of BPPV was later than sudden deafness (1 weeks: 81.58%, 2 weeks: 18.42%); the proportion of all deafness hearing curves in patients with BPPV was the highest, about 42.11%, and the lowest 2.63%.2. sudden deafness and BPPV patients were cured after 1-4 G-force vertigo treatment system, and 1 times compared with the primary BPPV group, the sudden deafness group with the BPPV group. The cure rate (44.74%) was lower than that of the primary BPPV group (72%), the difference was statistically significant (P0.05), the total cure rate of the primary BPPV group and the sudden deafness with the BPPV group was 100%, and the total effective rate of hearing loss in the patients with.3. sudden deafness with BPPV (52.63%) was lower than that of the sudden deafness without the BPPV group (71.62%), and the difference was statistically significant (P0.05) with the chi square test; with BPPV and no. The average hearing threshold level of two group of sudden deafness patients with BPPV was recovered after treatment, and the average hearing threshold was slightly higher than that of sudden deafness patients with BPPV group without BPPV. The difference was statistically significant (P 0.05).4. sudden deafness with BPPV group and primary BPPV group after treatment in March, and the recurrence rate of BPPV was 5.26%, 2%, two, respectively. There was no statistically significant difference in the recurrence rate of the patients in the group (P0.05). Conclusion: the average age of onset of 1. sudden deafness with BPPV was (49.18 + 9.78) years, female was more than male, the affected semicircular canal was identical with the ear of sudden deafness, and the posterior semicircular canal was more common. The onset time of BPPV was later than sudden deafness (1 weeks: 81.58%, 2 weeks: 18.42%); all hearing curves were completely deafness. The total cure rate of the patients with the highest proportion of.2. sudden deafness with BPPV and primary BPPV after otolith reduction was 100%, but the 1 cure rate was lower than that of the primary BPPV group. The recurrence rate of BPPV in the two groups was no difference, and the total effective rate of hearing treatment in the sudden deafness and BPPV patients was lower than that of the.3. sudden deafness with BPPV without the.3. sudden deafness and BPPV in the BPPV group. There is no final conclusion; the possible cause is the common factors that can function in the cochlea and the vestibule system. The more recognized pathogenic factors at home and abroad are internal ear vascular factors and virus infection.4. actively giving sudden deafness complicated with BPPV patients to improve inner ear microcirculation, nutritional nerve and oral hormone treatment, otolith reduction and psychological intervention treatment, Most patients have a satisfactory therapeutic effect.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.437

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