单侧突发性聋预后影响因素研究

发布时间：2018-03-04 13:14

本文选题：突发性聋　切入点：预后　出处：《安徽医科大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的突发性聋常单侧发病,患者听力有不同程度损害,影响其预后的因素尚未明确。本课题将探讨影响单侧突发性聋预后的相关因素;并探索单侧突发性聋患者内耳在3D FLAIR上的表现,及其与预后的关系。方法1.回顾性分析2004.01—2009.12在安徽医科大学第一附属医院耳鼻咽喉头颈外科住院接受规范综合治疗的单侧突发性聋患者的临床资料。结合本研究的目的,确定排除标准和入组标准。对入选的339例患者的年龄、初次就诊时间、就诊时听力图形状、是否伴有眩晕或(和)耳鸣等症状、是否有糖尿病或(和)高血压等因素和预后之间的关系进行分组统计分析,统计方法为秩和检验。 2.选取自2010.4—2010.10在安徽医科大学第一附属医院耳鼻咽喉头颈外科住院接受规范综合治疗,自愿行头颅MRI检查的单侧突发性聋患者30名,用GE 3.0T MR仪行3D FLAIR成像,探索患者的听觉通路有无异常信号,观察内耳在FLAIR上的表现。患者入院后皆进行规范综合治疗,疗程至少在7天以上,或者患者疗程虽未及7天但已经痊愈出院。所有患者入院时及出院前均给予纯音测听检查,对内耳信号和患者的预后之间的关系进行统计分析,统计方法主要有t检验和卡方检验。结果1. 339例单侧突发性聋患者有55例痊愈(16.2%),85例显效(25.1%),56例有效(16.5%),143例无效(42.2%)。患者的性别、初次就诊时间、患病耳侧、耳闷症状与患者的预后无相关性。而患者的年龄、伴眩晕或(和)耳鸣症状、伴有高血压等基础疾病、入院初始听力图形状等与患者的预后存在相关性。伴有眩晕症状的患者预后差,不伴有耳鸣的患者预后差。高龄患者的预后比中年人和青年患者差。伴有高血压或者糖尿病的患者预后较差,同时伴有高血压和糖尿病的患者预后最差。听力图形状呈凹陷型和上升型的患者预后较好,总有效率分别为83.8%和78.2%。听力图形状呈下坡型,平坦型,极重度聋的患者预后较差。全聋患者的总有效率仅为30.6%,预后最差。 2. 30例经MR检查的患者中,有12例患侧耳蜗在FLAIR上呈高信号,另外18例患侧耳蜗及所有健侧耳蜗均无异常信号。12例内耳有高信号的患者仅有1例治疗有效,其余11均无效;18例内耳未见异常信号的患者有2例痊愈,并且总有效率为61.1%,差异有统计学意义。结论1.听力图形状呈凹陷型和上升型的患者预后较好,全聋型最差。高龄患者的预后较差。伴有眩晕症状的患者预后差,不伴耳鸣症状的患者预后差。伴有糖尿病和高血压的患者预后差。 2. 3D FLAIR可显示突发性聋患者内耳淋巴液改变,呈高信号时患者疗效较差。这种内耳高信号可以作为预测突发性聋预后的一个新因素。
[Abstract]:Objective to explore the related factors influencing the prognosis of paroxysmal deafness. To explore the features of the inner ear of unilateral sudden deafness patients on 3D FLAIR and its relationship with prognosis. Methods 1. The clinical data of patients with unilateral sudden deafness who were admitted to the department of otolaryngology and head and neck surgery in the first affiliated Hospital of Anhui Medical University from January to December 2004.The purpose of this study was to analyze the clinical data of patients with unilateral sudden deafness. Determine exclusion criteria and admission criteria. For 339 selected patients, the age, the first visit time, the shape of the auditory effort at the time of the visit, whether there were symptoms such as vertigo or / and tinnitus, were determined. The relationship between diabetes and / or hypertension and prognosis was analyzed by rank sum test. 2. Thirty patients with unilateral sudden deafness, who were admitted to the Department of Otorhinolaryngology and head and neck surgery in the first affiliated Hospital of Anhui Medical University from April to October 2014.30 patients with unilateral sudden deafness who voluntarily underwent cranial MRI, were examined by 3D FLAIR imaging with GE 3.0T Mr instrument. To explore the abnormal signal of auditory pathway and observe the appearance of inner ear on FLAIR. The patients were treated with standard comprehensive therapy after admission, the course of treatment was at least more than 7 days. All patients were given pure tone audiometry on admission and before discharge. The relationship between the inner ear signal and the prognosis of the patients was statistically analyzed. Statistical methods include t test and chi-square test. Results 1.55 out of 339 patients with unilateral sudden deafness recovered 16.2% of 85 cases with remarkable effect and 56 cases with effective 16.5%. The sex of the patient, the time of the first visit, the side of the diseased ear and the symptoms of stuffy ear were not related to the prognosis of the patient, but the age of the patient was not related to the age of the patient, but the age of the patient was not correlated with the age of the patient. Patients with vertigo or / and tinnitus, basic diseases such as hypertension, and the shape of initial audiogram were associated with the prognosis of the patients. The prognosis of patients without tinnitus is poor. The prognosis of elderly patients is worse than that of middle-aged and young patients. The prognosis of patients with hypertension or diabetes is worse. The prognosis of the patients with hypertension and diabetes was the worst. The patients with concave shape and ascending shape had better prognosis, the total effective rates were 83.8% and 78.2, respectively. The shape of hearing graph was downhill and flat. The prognosis of patients with extremely severe deafness was poor, the total effective rate of total deafness patients was only 30.6 and the prognosis was the worst. 2.Among 30 cases of Mr examination, 12 cases of affected cochlea showed high signal on FLAIR, the other 18 cases of affected cochlea and all healthy cochlea showed no abnormal signal. 12 cases of patients with high signal in inner ear were effective. Of the 18 patients with no abnormal signal in the inner ear, 2 were cured, and the total effective rate was 61.1. The difference was statistically significant. Conclusion 1. The prognosis of the patients with concave and ascending shape of audiogram is better, the type of total deafness is the worst, the prognosis of the elderly patients is poor, the prognosis of the patients with vertigo symptoms is poor, the prognosis of the patients with vertigo symptoms is poor. 2. Patients without tinnitus had poor prognosis. Patients with diabetes and hypertension had poor prognosis. 2. 3D FLAIR can show the changes of lymphatic fluid in the inner ear of the patients with sudden deafness, which can be used as a new factor to predict the prognosis of sudden deafness.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764.43

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