突发性耳聋76例回顾性病例分析

发布时间：2018-06-01 02:51

本文选题：突发性耳聋 + 疗效　；参考：《河北医科大学》2010年硕士论文

【摘要】： 目的:突发性耳聋(Sudden deafness,SD )是指突然发生的原因不明的感音神经性听力损失,听力一般在72小时内下降到最低点,其发病为10万分之5到7。关于其病因及发病机制目前一直未明,目前存在多种学说,包括微循环障碍、感染、自身免疫、窗膜破裂和代谢障碍等,(1)微循环障碍学说:认为内耳血栓形成、栓子栓塞、血流量下降、血管痉挛等引起耳蜗血流灌流减少,使内耳缺血、缺氧,最终导致内耳毛胞坏死和退行性改变;(2)感染学说:直接和间接的证据证明突聋和病毒感染相关,部分突聋患者有上呼吸道感染病史,突聋患者的血液中发现病毒抗体,病毒原体可通过不同的作用方式直接或间接引起内耳损伤;(3)免疫学说:认为原发性免疫病局限于内耳或是继发于全身性的自身免疫性疾病可引起内耳的损伤;(4)窗膜破裂学说:认为气压伤、外伤、跳水等原因引起的内耳压强改变可以导致窗膜破裂,表现为突发性耳聋。突发性耳聋的治疗方法有多种,包括扩血管药物、抗病毒药物、吸入混合氧、维生素类、口服或鼓室注射糖皮质激素等,但是目前何种治疗最有效果尚不明确,尚无直接证据。因此探讨突发性耳聋的病因、临床特点及影响突发性耳聋患者预后的因素有一定意义,并可指导临床治疗。方法:选择我院2007.9—2010.2收治的有详细病史资料的76例突发性耳聋患者进行回顾性分析,入院时对病人进行详细查体,仔细询问病史,全部病人均行纯音测听、声导抗检查,部分患者脑干诱发电位、眼震电图检查、必要的放射学检查(头颅及内听道CT、MRI等)检查,排除相关疾病。把患者的年龄、性别、耳别、就诊时间、耳聋程度、耳聋类型、眩晕、耳鸣、全身疾病情况、疗效进行列表,分析突聋的病因、临床特点,并采用x2检验,探讨年龄、性别、耳别、就诊时间、耳聋程度、耳聋类型、眩晕、耳鸣、全身疾病情况与预后的关系。结果:突聋患者发病率较高,男女性别无明显差异,年龄以40—60岁为多(47例,占61.84% ),单侧聋为主(72例占94.74%),4例表现为双侧聋,52例患者(68.4%)伴耳鸣,18例患者(23.7%)伴眩晕。经x2检验,患者年龄、耳聋程度、耳聋类型、伴随眩晕、就诊时间与预后相关,耳别、性别、耳鸣与预后无明显关系。结论:突发性耳聋是耳鼻喉科常见病,其发病率逐年上升,对突发性耳聋患者要详细查体,治疗突聋时,应全面考虑各种影响预后的因素,针对病因进行病因及对症采取综合治疗,尽量提高治愈率。
[Abstract]:Objective: sudden deafness (Sudden deafnessle SD) refers to the sudden onset of sensorineural hearing loss of unknown origin, which generally decreases to its lowest level within 72 hours, and its incidence ranges from 5 to 7 per 100,000. There are many theories, including microcirculation disorder, infection, autoimmunity, window membrane rupture and metabolic disorder. Decreased blood flow, vasospasm and other causes of cochlear perfusion, ischemia and hypoxia in the inner ear, eventually leading to hair cell necrosis and degenerative changes in the inner ear. Infection theory: direct and indirect evidence that sudden deafness is associated with viral infection. Some patients with sudden deafness had a history of upper respiratory tract infection, and virus antibodies were found in the blood of patients with sudden deafness. Viroplasma can cause inner ear injury directly or indirectly in different ways. Immunology says: it is believed that primary immune disease is limited to the inner ear or secondary to systemic autoimmune disease can cause damage to the inner ear. The theory of membrane rupture: it is believed that air pressure injury, Trauma, diving and other causes of pressure changes in the inner ear can lead to rupture of the window membrane, showing sudden deafness. There are many treatments for sudden deafness, including vasodilators, antiviral drugs, inhaled mixed oxygen, vitamins, oral or tympanic injection of glucocorticoids, etc. Therefore, it is of significance to explore the etiology, clinical characteristics and prognostic factors of sudden deafness, and to guide clinical treatment. Methods: 76 patients with sudden deafness who were admitted to our hospital from July to February 2007.9-2010.2 were analyzed retrospectively. The patients were examined in detail on admission, and their history was inquired carefully. All patients were examined by pure tone audiometry and acoustic conductance test. Brain stem evoked potential (BAEP), electronystagmogram (ENG), and necessary radiologic examination (CT MRI, etc.) were used to exclude the related diseases in some patients. Age, sex, ear type, time of visit, degree of deafness, type of deafness, vertigo, tinnitus, disease of the whole body, curative effect were listed, the etiology and clinical characteristics of sudden deafness were analyzed, and the age and sex were studied by using x2 test. The relationship between prognosis and ear classification, time, degree of deafness, type of deafness, vertigo, tinnitus, systemic disease. Results: the incidence of sudden deafness was higher, and there was no significant difference between male and female. 47 cases (61.84%) were aged 40-60 years old, and 72 cases (94.7444%) were unilateral deafness, which showed bilateral deafness in 52 cases (68.4%) and tinnitus in 18 cases (23.7%) with vertigo. By x2 test, age, degree of deafness, type of deafness, accompanied by vertigo, the time of seeing a doctor was related to prognosis, ear type, sex, tinnitus and prognosis were not significantly related to the prognosis. Conclusion: sudden deafness is a common disease in the department of otolaryngology. The incidence of sudden deafness is increasing year by year. To improve the cure rate by comprehensive treatment for etiology and syndrome.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764

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