急性低频感音神经性听力损失的临床观察

发布时间：2018-02-02 08:59

本文关键词： 低频听力损失糖皮质激素血管扩张剂　出处：《大连医科大学》2011年硕士论文　论文类型：学位论文

【摘要】：背景介绍:急性低频感音神经性听力损失( ALHL)于1982年由Abe首先报道。患者急性起病,以低频听力损失为主,高频听力基本正常,听力损失大多程度不重,且随频率升高听力损失逐渐减轻并恢复至正常,经过临床总结和研究,目前倾向于认为是一种独立的疾病。由于该病病因未明,目前尚无统一治疗方案。糖皮质激素、血管扩张剂及神经营养剂等常被用于该病的治疗,愈后良好。目的:探讨急性低频感音神经性听力损失的临床特征、诊断、治疗方法及效果,以提高临床医师对该疾病的认识及治疗,减少误诊和漏诊,为患者减少痛苦,减轻经济负担。方法:2009年4月-2010年10月因急性低频感音神经性听力损失于大连医科大学附属第一医院耳鼻咽喉科门诊和住院进行治疗的患者40例(41耳),均予大剂量强的松晨起空腹顿服,强的松的初始用量为lmg/Kg体重/天,连用3天后逐渐减量,用药总计为6天,同时予一种血管扩张剂静脉输液,口服神经营养药维生素B1及维生素B12(腺苷钴胺),连续用药7天,为一个疗程。全部患者于治疗前、治疗7天后,进行纯音听阈测定,每次均包括0.125、0.250、0.500、l、2、4、8kHz频率。观察患者听力恢复情况。以SPSS11.5统计软件对所有结果进行统计学分析,相关数据采用t检验或卡方检验。回顾性分析这40例(41耳)急性低频感音神经性听力损失患者的临床表现、听力学检测结果、治疗效果及3月～22月的随访情况。总结ALHL的临床发病特点及治疗情况。结果:本组40例(41耳)急性低频感音神经性听力损失患者均呈急性发病,年龄17～51岁,平均(31.48±7.78)岁。男13例(14耳)(32.50%),女27例(27耳)(67.50%)。其中29例(29耳)伴低调耳鸣,26例(27耳)伴耳部闷胀及堵塞感,18例(18耳)自觉听力下降,9例(9耳)伴有头昏感,6例(6耳)伴听觉过敏现象,3例(3耳)伴自听增强。治疗后33例(34耳)听力完全恢复,5例(5耳)部分恢复,2例(2耳)无变化,听力恢复多发生于治疗后5日以内,0.125,0.250及0.500 kHz治疗前的纯音测听平均听阈为(42.03±9.28)dB HL,2,4及8 kHz平均听阈为(16.59±3.43)dB HL,治疗后上述平均听阈分别为(20.45±8.66)dB HL和(15.81±2.94)dB HL,短期治疗有效率达95.12%,治愈率82.93%。27例(27耳)女性治疗有效率96.30%(26/27),其中治愈率达85.19%(23/27);男性治疗有效率92.86%(13/14),治愈率为78.57%(11/14)。男性与女性患者治疗有效率差异无统计学意义(P 0.05)。结论:ALHL多见于青年女性,以单侧发病为主,常伴低调耳鸣、耳部闷胀及堵塞感。纯音听阈测定以低频听阈升高为特征,应用糖皮质激素及血管扩张剂治疗效果好。
[Abstract]:Background: acute low frequency sensorineural hearing loss (ALHLL) was first reported by Abe in 1982. Most of the hearing loss is not heavy, and with the increase of the frequency of hearing loss gradually alleviated and returned to normal, after clinical summary and research, it tends to be considered as an independent disease, because the etiology of the disease is not clear. Glucocorticoids vasodilators and neurotrophic agents are often used in the treatment of the disease. Objective: to explore the clinical features, diagnosis, treatment and effect of acute low frequency sensorineural hearing loss in order to improve the understanding and treatment of the disease, reduce misdiagnosis and missed diagnosis, and reduce the pain for the patients. Lighten the economic burden. Methods: from April 2009 to October 2010, 40 patients with acute low frequency sensorineural hearing loss were treated in Department of Otolaryngology, Department of Otolaryngology, first affiliated Hospital of Dalian Medical University. 41 ears). The initial dose of prednisone was lmg/Kg body weight / day. After 3 days, the dosage decreased gradually, and the total dosage was 6 days. At the same time, a vasodilator was given intravenously. Oral neurotrophic drugs vitamin B1 and vitamin B12 (Cobalamin adenosine) for 7 days as a course of treatment. The pure tone audiometry was performed in all patients before and after 7 days of treatment. The hearing recovery was observed at 8 kHz frequency. All the results were analyzed by SPSS11.5 software, and the related data were analyzed by t test or chi-square test. The clinical manifestations and audiological results of 40 patients with acute low frequency sensorineural hearing loss were analyzed retrospectively. The clinical features and treatment of ALHL were summarized. Results: all the 40 patients with acute low frequency sensorineural hearing loss presented acute onset, aged 17 to 51 years. The mean age was 31.48 卤7.78 years old. There were 13 cases of male with 14 ears and 32.50 cases of female, 27 cases of female with 27 ears and 67.50% of them, 29 cases with 29 ears) with low-key tinnitus. 26 cases (27 ears) with stuffiness and clogging (18 ears) and 9 ears with conscious hearing loss (9 ears) with dizziness in 6 ears (6 ears) with auditory hypersensitivity. After treatment, 33 cases (34 ears) had complete recovery of hearing, 5 cases had partial recovery, 2 cases had no change, and the recovery of hearing occurred within 5th. The mean threshold of pure tone audiometry before 0.125 and 0.500 kHz treatment was 42.03 卤9.28 dB HL2. The average hearing threshold of 4 and 8 kHz was 16.59 卤3.43 dB HL. The average hearing threshold after treatment was 20.45 卤8.66 dB HL and 15.81 卤2.94 dB HL respectively. The short-term effective rate was 95.12%. The effective rate of female treatment was 96.30 / 26 / 27, of which the cure rate was 85.199.23 / 27; The effective rate of treatment was 92.866.13 / 14%, and the cure rate was 78.57 / 14 / 14. There was no significant difference in the effective rate of treatment between male and female patients (P 0.05). ConclusionTwo one ALHL is more common in young women, with unilateral onset, often accompanied by low-key tinnitus, stuffy ear distention and clogging. Pure tone audiometry is characterized by the increase of low frequency hearing threshold. The effect of glucocorticoid and vasodilator was good.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764

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