山东大学耳鼻喉眼学报 ›› 2024, Vol. 38 ›› Issue (4): 15-21.doi: 10.6040/j.issn.1673-3770.0.2023.083
• 论著 • 上一篇
曹影1,邱月1,陈智斌2,费兵1,李东1,张晓凤3,王惠4,康欣乐5,王海旭1,怀德1,李秀婷6,束明阳7
CAO Ying1, QIU Yue1, CHEN Zhibin2, FEI Bing1, LI Dong1, ZHANG Xiaofeng3,WANG Hui4,KANG Xinle5, WANG Haixu1,HUAI De1,LI Xiuting6, SHU Mingyang7
摘要: 目的 分析单侧难治性突发性耳聋患者耳后注射神经节苷脂联合鼓室内注射甲泼尼龙后言语识别率(word recognition score, WRS )变化及其影响因素。 方法 收集58例行耳后注射神经节苷脂联合鼓室内注射甲泼尼龙治疗的难治性突发性耳聋患者资料,包括患者年龄、性别、病程持续时间、耳别、伴随症状、纯音听力及言语测听等数据。对治疗前后患者患耳的纯音测听(pure tone audiometry, PTA)结果和最大言语识别率(maximum speech recognition rate, WRSmax )进行统计分析,Logistic回归分析分析影响WRS愈后的因素。 结果 与治疗前比较,耳后注射神经节苷酯联合鼓室内注射甲泼尼龙治疗的患者治疗后患耳PTA和WRS有显著改善(P=0.027,P=0.038),两者呈负相关(r=-0.682, P<0.05 )。同时,采用单因素分析法发现年龄、性别、诱发因素、患侧耳别、伴随症状与WRS 无明显相关性,差异无统计学意义(P=0.693、P=0.208、P=0.079、P=0.335、P=0.331),而发病至首次就诊时间、听力损害程度及听力曲线类型是影响WRS疗效的重要因素(P=0.010,P=0.033,P=0.026)。 结论 难治性突发性耳聋患者经耳后注射神经节苷脂联合鼓室内注射甲泼尼龙治疗后WRS疗效为41.38%,影响其疗效的因素包括:发病至首次就诊时间、听力损害程度及听力曲线类型。发病至首次就诊时间长者疗效显著差于病程短者,低频听力下降者经上述方法治疗后WRS疗效明显较平坦型及高频听力下降者好;听力损害程度越重,疗效越差。
中图分类号:
[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. doi:10.3760/cma.j.issn.1673-0860.2015.06.002 [2] Klemm E, Deutscher A, Mösges R. A present investigation of the epidemiology in idiopathic sudden sensorineural hearing loss[J]. Laryngo Rhino Otol, 2009, 88(8): 524-7. doi: 10.1055/s-0028-1128133 [3] 钟晓声, 杨海弟, 郑亿庆. 突发性聋伴耳鸣的治疗与转归[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 43-46. doi: 10.6040/j.issn.1673-3770.0.2018.393 ZHONG Xiaosheng, YANG Haidi, ZHENG Yiqing. Treatment and outcome of tinnitus in sudden deafness[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 43-46. doi: 10.6040/j.issn.1673-3770.0.2018.393 [4] 钟丽萍, 官希龙, 王晶晶, 等. 鼓室与全身应用激素治疗突发性耳聋的系统评价与Meta分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(5): 1-10. doi:10.6040/j.issn.1673-3770.0.2021.010 ZHONG Liping, GUAN Xilong, WANG Jingjing, et al. Intratympanic injections and systemic glucocorticoid treatment for sudden hearing loss: a systematic review and Meta-analysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(5): 1-10. doi:10.6040/j.issn.1673-3770.0.2021.010 [5] Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical practice guideline: sudden hearing loss(update)executive summary[J]. Otolaryngol Head Neck Surg, 2019, 161(2): 195-210. doi:10.1177/0194599819859883 [6] 梁思玉, 郑芸, 李刚. 言语识别率对突聋疗效评估的意义[J]. 听力学及言语疾病杂志, 2015, 23(1): 32-34. doi:10.3969/j.issn.1006-7299.2015.01.008 LIANG Siyu, ZHENG Yun, LI Gang. A preliminary study of the clinical significance of word recognition scores in evaluating the curative effects of sudden hearing loss[J]. Journal of Audiology and Speech Pathology, 2015, 23(1): 32-34. doi:10.3969/j.issn.1006-7299.2015.01.008 [7] 韩东一,翟所强,韩维举.临床听力学[M]. 北京: 中国协和医科大学出版社, 2008: 183, 198, 185~187 [8] Haynes DS, O'Malley M, Cohen S, et al. Intratympanic dexamethasone for sudden sensorineural hearing loss after failure of systemic therapy[J]. Laryngoscope, 2007, 117(1): 3-15. doi:10.1097/01.mlg.0000245058.11866.15 [9] 石安妮, 张佳佳, 白鹏, 等. 浅析 “颈部七线法” 针刺治疗突发性耳聋的内涵[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 103-107. doi:10.6040/j.issn.1673-3770.0.2021.412 SHI Anni, ZHANG Jiajia, BAI Peng, et al. Analysis of a therapeutic modality for sudden deafness utilizing neck acupuncture comprising seven lines of treatment[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 103-107. doi:10.6040/j.issn.1673-3770.0.2021.412 [10] 段新艳, 宋忠义, 王宁, 等. DPOAE与高刺激率ABR在听力正常耳鸣患者中的应用价值[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 6-10. doi:10.6040/j.issn.1673-3770.0.2021.404 DUAN Xinyan, SONG Zhongyi, WANG Ning, et al. Application value of distortion product otoacoustic emission and high stimulation rate auditory brainstem response in patients with normal hearing tinnitus[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(5): 6-10. doi:10.6040/j.issn.1673-3770.0.2021.404 [11] Kim YH, Park KT, Choi BY, et al. Early combination treatment with intratympanic steroid injection in severe to profound sudden sensorineural hearing loss improves speech discrimination performance[J]. Eur Arch Oto Rhino Laryngol, 2012, 269(10): 2173-2178. doi:10.1007/s00405-011-1874-6 [12] 乔宇斐, 郝文洋, 商莹莹, 等. 单侧耳聋病程对声源定位及噪声下言语识别的影响[J]. 听力学及言语疾病杂志, 2019, 27(2): 134-139. doi:10.3969/j.issn.1006-7299.2019.02.006 QIAO Yufei, HAO Wenyang, SHANG Yingying, et al. Effects of the duration and onset age of single sided deafness on sound localization and speech recognition in noise[J]. Journal of Audiology and Speech Pathology, 2019, 27(2): 134-139. doi:10.3969/j.issn.1006-7299.2019.02.006 [13] 孙进, 朱笛, 王璐, 等. 助听器对单侧听力损失患者噪声环境中言语识别的补偿效果[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(8): 571-575. doi:10.13201/j.issn.2096-7993.2022.08.001 SUN Jin, ZHU Di, WANG Lu, et al. Compensation effect of hearing aid on speech recognition in noise in patients with unilateral hearing loss[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2022, 36(8): 571-575. doi:10.13201/j.issn.2096-7993.2022.08.001 [14] 韩东一, 杨伟炎. 普及言语测听提高耳科学诊疗水平[J]. 中华耳科学杂志, 2008, 6(1): 7-8. doi:10.3969/j.issn.1672-2922.2008.01.002 HAN Dongyi, YANG Weiyan. Popularizing speech audiometry and improving the level of otology diagnosis and treatment[J]. Chinese Journal of Otology, 2008, 6(1): 7-8. doi:10.3969/j.issn.1672-2922.2008.01.002 [15] 侯志强, 兰兰, 王大勇, 等. 老年突发性耳聋的临床特征和转归[J]. 中华耳科学杂志, 2010, 8(2): 141-147. doi:10.3969/j.issn.1672-2922.2010.02.006 HOU Zhiqiang, LAN Lan, WANG Dayong, et al. The clinical features and prognosis of sudden deafness in the elderly[J]. Chinese Journal of Otology, 2010, 8(2): 141-147. doi:10.3969/j.issn.1672-2922.2010.02.006 [16] Pensak ML, Glasscock ME III, Josey AF, et al. Sudden hearing loss and cerebellopontine angle tumors[J]. Laryngoscope, 1985, 95(10): 1188, 1193. doi:10.1288/00005537-198510000-00007 [17] 孙渊渊, 郭洋, 夏俍, 等. 影响突发性聋患者言语识别率恢复的因素的研究进展[J]. 中华耳科学杂志, 2017, 15(6): 727-731. doi:10.3969/j.issn.1672-2922.2017.06.023 SUN Yuanyuan, GUO Yang, XIA Liang, et al. Research progress on influencing factors of the recovering of speech recognition rate in sudden sensorineural hearing loss[J]. Chinese Journal of Otology, 2017, 15(6): 727-731. doi:10.3969/j.issn.1672-2922.2017.06.023 [18] 陈琪, 郑海峰, 谌国会, 等. 单侧突发性耳聋治疗前后言语识别能力对比分析[J]. 中华耳科学杂志, 2021, 19(5): 787-792. doi: 10.3969/j.issn.1672-2922.2021.05.011 CHEN Qi, ZHENG Haifeng, CHEN Guohui, et al. analysis of word recognition score after treatment of idiopathic sudden sensorineural hearing loss[J]. Chinese Journal of Otology, 2021, 19(5): 787-792. doi: 10.3969/j.issn.1672-2922.2021.05.011 [19] Choo OS, Yang SM, Park HY, et al. Differences in clinical characteristics and prognosis of sudden low- and high-frequency hearing loss[J]. Laryngoscope, 2017, 127(8): 1878-1884. doi:10.1002/lary.26382 [20] 司建平, 姜子刚, 杨丽莉, 等. 全频下降型突发性聋患者听力初始恢复频率与预后相关性研究[J]. 中国耳鼻咽喉头颈外科, 2017, 24(10): 547-548. doi:10.16066/j.1672-7002.2017.10.015 SI Jianping, JIANG Zigang, YANG Lili, et al. Correlation between initial recovery frequency of hearing and prognosis in patients with full-frequency descending sudden deafness[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2017, 24(10): 547-548. doi:10.16066/j.1672-7002.2017.10.015 [21] Bae SC, Noh HI, Jun BC, et al. Efficacy of intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss: comparison with systemic steroid therapy and combined therapy[J]. Acta Oto Laryngol, 2013, 133(5): 428-433. doi:10.3109/00016489.2012.749520 [22] 吴悔, 梁敏, 陈建勇, 等. 全聋型突发性耳聋患者的预后与前庭症状及前庭功能关系的回顾性分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 33-38. doi: 10.6040/j.issn.1673-3770.1.2020.075 WU Hui, LIANG Min, CHEN Jianyong, et al. Relationship between prognosis and vestibular symptoms/function in patients with unilateral profound sudden sensorineural hearing loss: a retrospective analysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 33-38. doi: 10.6040/j.issn.1673-3770.1.2020.075 [23] 李国庆, 吕萍, 王秋菊. 隐性听力损失的发病机制及听力学表现[J]. 中华耳科学杂志, 2017, 15(2): 185-190. doi:10.3969/j.issn.1672-2922.2017.02.009 LI Guoqing, LV Ping, WANG Qiuju. Pathogenesis and audiologic performances in hidden hearing loss[J]. Chinese Journal of Otology, 2017, 15(2): 185-190. doi:10.3969/j.issn.1672-2922.2017.02.009 [24] 张静平, 王巍, 王悦, 等. 语后聋成人人工耳蜗植入患者术后生活质量和言语识别能力评估[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(11): 1002-1004. doi:10.13201/j.issn.2096-7993.2020.11.010 ZHANG Jingping, WANG Wei, WANG Yue, et al. Assessment of speech perception and quality of life after cochlear implant in postlingual deaf adults[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2020, 34(11): 1002-1004. doi:10.13201/j.issn.2096-7993.2020.11.010 [25] 郗昕. 成人言语测听的基本内容及其临床价值[J]. 临床耳鼻咽喉头颈外科杂志, 2013, 27(7): 337-339. doi:10.13201/j.issn.1001-1781.2013.07.004 XI Xin. The basic content and clinical value of adult speech audiometry[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2013, 27(7): 337-339. doi:10.13201/j.issn.1001-1781.2013.07.004 |
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