山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (1): 9-14.doi: 10.6040/j.issn.1673-3770.1.2019.063

• 临床研究 • 上一篇    下一篇

外伤导致听力损失的临床特点及预后

丁玉静1,2(),兰兰1(),王秋菊1,冀飞1,熊芬1,谢林怡1,丁海娜1,夏寅2,*(),赵辉1,*()   

  1. 1. 中国人民解放军总医院耳鼻咽喉头颈外科医学部/国家耳鼻咽喉疾病临床医学研究中心/聋病教育部重点实验室/聋病防治北京市重点实验室, 北京 100853
    2. 首都医科大学附属北京天坛医院 耳鼻咽喉头颈外科，北京 100070
  • 收稿日期:2019-07-24 出版日期:2020-01-20 发布日期:2020-03-06
  • 通讯作者: 夏寅,赵辉 E-mail:dyjing0830@126.com;ll-301@263.net;xiayin3@163.com;huizhao@yeah.net
  • 作者简介:丁玉静。E-mail：dyjing0830@126.com|兰兰。E-mail：ll-301@263.net|赵辉，中央军委保健专家，解放军总医院耳鼻咽喉头颈外科副主任兼五病区主任、主任医师，解放军医学院副教授、硕士研究生导师，医学博士，主要从事聋病方向的研究。奖项荣誉：曾获得北美优秀研究生论文奖(2004年)，全军优秀博士论文奖(2007年)，全国优秀博士论文奖(2007年)，北京市科技进步二等奖(2007年)，作为主要完成人获得国家科技进步二等奖(2008年)，中华医学科技奖(2008年)，总后勤部"科技新星"(2010年)，解放军总医院“十佳青年”(2012年)，解放军总医院首届“百名新秀”培育对象(2012年)，二类军队优秀专业技术人才岗位津贴(2015年)，国之名医青年新锐(2018年)。学术成果：以第一作者或者通信作者发表论文16篇，其中SCI论文5篇(最高影响因子12.34)，带教硕士生7名。先后获得国家自然科学基金2项、军队十一五课题、教育部高等学校优秀博士论文作者基金、海南省自然科学基金等科研基金等|学术兼职：任中华医学会耳鼻咽喉头颈外科分会小儿学组委员，北京医学会耳鼻咽喉头颈外科分会青年委员会副主任委员，北京医师协会耳鼻咽喉科分会总干事，全军耳鼻咽喉头颈外科分会秘书长
  • 基金资助:
    国家重点研发计划(2017YFA0104702)

Analysis of clinical characteristics and prognosis of post traumatic hearing loss

Yujing DING1,2(),Lan LAN1(),Qiuju WANG1,Fei JI1,Fen XIONG1,Linyi XIE1,Haina DING1,Yin XIA2,*(),Hui ZHAO1,*()   

  1. 1. ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital / National Clinical Research Center for Otolaryngologic Diseases / Key Lab of Hearing Science, Ministry of Education / Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing 100853, China
    2. Department of Otolaryngology Head and Neck Surgery, Beijing Tian tan Hospital, Capital Medical University, Beijing 100070, China
  • Received:2019-07-24 Online:2020-01-20 Published:2020-03-06
  • Contact: Yin XIA,Hui ZHAO E-mail:dyjing0830@126.com;ll-301@263.net;xiayin3@163.com;huizhao@yeah.net
  • Supported by:
    国家重点研发计划(2017YFA0104702)

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摘要： 目的

分析外伤所致听力损失的临床特点及预后,以便更好地指导临床诊断和医学鉴定，早期确定有效治疗方案。

方法

对外伤后主诉听力损失的84例(96耳)患者的初诊和随访临床资料进行对比分析。分别将听力损失程度和鼓膜穿孔程度进行分级，统计分析其在患耳中的分布，归纳总结其临床特点及预后。

结果

外伤后初诊听力正常34耳(35.4%)，听力下降62耳(64.6%)，其中传导性聋33耳(53.2%)，感音神经性聋25耳(40.3%)，混合性聋4耳(6.5%)。随访时传导性聋患者气导平均听阈从(45.77±4.28)dB HL降低至(34.48±4.53)dB HL(t=2.906，P < 0.05)，骨导平均听阈从(23.45±2.31)dB HL降低至(19.63±2.20)dB HL(t=2.329，P < 0.05)。感音神经性聋和混合性聋患者平均听阈变化无显著性差异(P > 0.05)。外伤后鼓膜完整39耳(40.6%)，鼓膜穿孔57耳(59.4%)。鼓膜穿孔者自愈40耳(70.2%)，鼓膜修补术后愈合12耳(21.1%)，未愈5耳(8.8%)。Ⅰ级鼓膜穿孔自愈率83.0%，Ⅱ级鼓膜穿孔自愈率16.7%，Ⅲ级、Ⅳ级鼓膜穿孔自愈率为0。

结论

外伤可引起听觉器官不同程度的损害，主要表现为传导性聋，严重者可表现为感音神经性聋、混合性聋。传导性聋患者预后好，感音神经性聋和混合性聋患者预后差。外伤可导致不同程度鼓膜穿孔，随穿孔程度加重，自愈率逐渐降低，Ⅲ级、Ⅳ级鼓膜穿孔难以自愈，需行手术治疗。

关键词: 外伤, 听力损失, 鼓膜穿孔, 预后

Abstract: Objective

The clinical characteristics and prognosis of post traumatic hearing loss were retrospectively evaluated to aid further diagnosis, medical evaluation, early identification, and effective treatment.

Methods

We recruited 84 patients (96 ears) and obtained their clinical examination findings, hearing test results, and audiograms from a single-institution otolaryngology service with comparative data generated from their first and follow-up visits.

Results

Among all the recruited patients, 34 ears (35.4%) had normal hearing, while 62 ears (64.6%) had hearing loss after trauma, at their first visit. Among 62 ears with hearing loss, 33 ears (53.2%) had conductive hearing loss, 25 ears (40.3%) had sensorineural hearing loss, and four ears (6.5%) had a mixture of conductive and sensorineural hearing loss. At the follow-up visit, the air conduction threshold of ears with conductive hearing loss had significantly decreased from 45.77±4.28 dB HL to 34.48±4.53 dB HL (t=2.906, P < 0.05), while the bone conduction threshold decreased from 23.45±2.31 dB HL to 19.63±2.20 dB HL (t=2.906, P < 0.05). However, no significant differences between the first and follow-up visits were observed in ears with sensorineural hearing loss or ears with mixed hearing loss. Of all the 96 ears, 39 (40.6%) had intact tympanic membrane, while 57 (59.4%) had traumatic tympanic membrane perforation. At follow-up, 40 ears (70.2%) with traumatic tympanic membrane perforation had healed spontaneously, while 12 ears (21.1%) had healed after tympanoplasty. However, five ears (8.8%) did not heal. Among the ears that spontaneously healed, 83.0% had grade Ⅰ and 16.7% had grade Ⅱ tympanic membrane perforation. Ears with grade Ⅲ and grade Ⅳ tympanic membrane perforations did not heal spontaneously.

Conclusions

Hearing impairment is a common clinical presentation in patients with traumatic injury. In most patients, this manifests as conductive hearing loss, while severely affected patients may have sensorineural or mixed hearing loss. Patients with conductive hearing loss have a favorable prognosis, while patients with sensorineural or mixed hearing loss have a poor prognosis. Trauma could cause different degrees of tympanic membrane perforation. With gradually aggravated tympanic membrane perforation, the spontaneous healing rate decreases. Therefore, for patients with large tympanic membrane perforations, which rarely heal spontaneously, tympanoplasty is warranted.

Key words: Trauma, Hearing loss, Tympanic membrane perforation, Prognosis

中图分类号: 

  • R764

表1

96耳外伤性听力损失患者听力恢复情况"

听力损失程度
dBHL		 初诊
[ n(%)]		 复诊
[ n(%)]
正常(0~25) 34(35.4) 56(58.3)
轻度(26~40) 29(30.2) 12(12.5)
中度(41~60) 12(12.5) 14(14.6)
重度(61~80) 10(10.4) 3(3.1)
极重度(＞80) 11(11.5) 11(11.5)
合计 96(100.0) 96(100.0)

表2

不同类型听力下降患者听力转归"

听力损失类型 平均听阈(dB HL) t P
初诊 复诊
传导性聋气导 45.77±4.28 34.48±4.53 2.906 0.007
传导性聋骨导 23.45±2.31 19.63±2.20 2.329 0.026
感音神经性聋气导 75.75±5.19 69.18±5.81 1.408 0.172
混合性聋气导 66.25±3.31 53.43±11.63 1.188 0.320
混合性聋骨导 32.38±4.03 24.14±1.90 1.805 0.169

图1

传导性聋患者听力转归"

表3

鼓膜穿孔范围及其转归"

鼓膜穿孔范围(%) 自愈 术后愈合 未愈
0~25 39 6 2
25~50 1 3 2
50~75 0 3 0
75~100 0 0 1
合计 40 12 5

图2

鼓膜穿孔愈合过程"

表4

鼓膜穿孔伴传导性聋患者鼓膜穿孔愈合与听力恢复的关系"

纯音测听 平均听阈(dB HL) t P
愈合前 愈合后
气导听阈 38.16±3.34 25.06±2.43 3.456 0.002
骨导听阈 18.35±1.70 14.91±1.34 2.007 0.056
气骨导差 19.81±2.40 10.15±1.96 2.903 0.008
1 Cvorovic L , Jovanovic MB , Markovic M , et al. Management of complication from temporal bone fractures[J]. Eur Arch Otorhinolaryngol, 2012, 269 (2): 399- 403.
doi: 10.1007/s00405-011-1641-8
2 Brusis T . Sensorineural hearing loss after dull head injury or concussion trauma[J]. Laryngorhinootologie, 2011, 90 (2): 73- 80.
doi: 10.1055/s-0030-1267938
3 兰兰, 王秋菊, 韩冰, 等. 基于医院信息化管理网络下的听力诊断系统的研发与临床应用[J]. 中华耳科学杂志, 2012, 10 (2): 164- 168.
doi: 10.3969/j.issn.1672-2922.2012.02.006
LAN Lan , WANG Qiuju , HAN Bing , et al. Development and clinical utility of an audiologic diagnosis system based on a hospital information network[J]. Chinese Journal of Otology, 2012, 10 (2): 164- 168.
doi: 10.3969/j.issn.1672-2922.2012.02.006
4 兰兰, 张超, 史伟, 等. 医院信息系统下听力学信息化平台系统的临床功能及意义[J]. 听力学及言语疾病杂志, 2013, 21 (5): 526- 530.
doi: 10.3969/j.issn.1006-7299.2013.05.023
LAN Lan , ZHANG Chao , SHI Wei , et al. The significance and structure analysis on function of an information system for medical center of clinical audiology based on hospital information system[J]. Journal of Audiology and Speech Pathology, 2013, 21 (5): 526- 530.
doi: 10.3969/j.issn.1006-7299.2013.05.023
5 World Health Organization. With adaptations from report of the first informal consultation on future organization development for the prevention of deafness and hearing impairment[S]. Geneva, 1997, WHO/PDH/97.3.
6 Saliba I . Hyaluronic acid fat graft myringoplasty: how we do it[J]. Clin Otolaryngol, 2008, 33 (6): 610- 614.
doi: 10.1111/j.1749-4486.2008.01823.x
7 de Silva MJ , Roberts I , Perel P , et al. Patient outcome after traumatic brain injury in high-, middle- and low-income countries: analysis of data on 8927 patients in 46 countries[J]. Int J Epidemiol, 2009, 38 (2): 452- 458.
doi: 10.1093/ije/dyn189
8 Eggermont JJ . Auditory brainstem response[J]. Handb Clin Neurol, 2019, 160: 451- 464.
doi: 10.1016/B978-0-444-64032-1.00030-8
9 Fligor BJ , Cox LC , Nesathurai S . Subjective hearing loss and history of traumatic brain injury exhibits abnormal brainstem auditory evoked response: a case report[J]. Arch Phys Med Rehabil, 2002, 83 (1): 141- 143.
doi: 10.1053/apmr.2002.26813
10 Munjal SK , Panda NK , Pathak A . Relationship between severity of traumatic brain injury (TBI) and extent of auditory dysfunction[J]. Brain Inj, 2010, 24 (3): 525- 532.
doi: 10.3109/02699050903516872
11 张杰, 文真, 高景娥, 等. 听性脑干反应与40Hz听觉相关电位综合评估听觉阈值[J]. 中国耳鼻咽喉头颈外科, 2007, 14 (2): 95- 97.
doi: 10.3969/j.issn.1672-7002.2007.02.008
ZHANG Jie , WEN Zhen , GAO Jinge , et al. Synthetic evaluation of hearing threshold with auditory brainstem response and 40Hz auditory event related potential[J]. Chinese Archiver of Otolaryngology-Head and Neck Surgery, 2007, 14 (2): 95- 97.
doi: 10.3969/j.issn.1672-7002.2007.02.008
12 楼正才. 掌拳击伤鼓膜损伤机制及临床特点分析[J]. 山东大学耳鼻喉眼学报, 2008, 22 (2): 188- 188, 190.
13 吴柳青, 刘红琪, 唐向荣, 等. 外伤性鼓膜穿孔265例[J]. 山东大学耳鼻喉眼学报, 2007, 21 (4): 362- 363, 367.
doi: 10.3969/j.issn.1673-3770.2007.04.027
WU Liuqing , LIU Hongqi , TANG Xiangrong , et al. Perforation of the tympanic membrane in 256 cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2007, 21 (4): 362- 363, 367.
doi: 10.3969/j.issn.1673-3770.2007.04.027
14 Park AH , Hughes CW , Jackson A , et al. Crosslinked hydrogels for tympanic membrane repair[J]. Otolaryngol Head Neck Surg, 2006, 135 (6): 877- 883.
doi: 10.1016/j.otohns.2006.02.040
15 Gaur S , Sinha ON , Bhushan A , et al. Observations on tympanic membrane perforations (safe type) and hearing loss[J]. Indian J Otolaryngol Head Neck Surg, 2017, 69 (1): 29- 34.
doi: 10.1007/s12070-016-1021-1
16 Saliba I , Abela A , Arcand P . Tympanic membrane perforation: size, site and hearing evaluation[J]. Int J Pediatr Otorhinolaryngol, 2011, 75 (4): 527- 531.
doi: 10.1016/j.ijporl.2011.01.012
17 Park H , Hong SN , Kim HS , et al. Determinants of conductive hearing loss in tympanic membrane perforation[J]. Clin Exp Otorhinolaryngol, 2015, 8 (2): 92- 96.
doi: 10.3342/ceo.2015.8.2.92
18 Güneri EA , Tekin S , Yilmaz O , et al. The effects of hyaluronic acid, epidermal growth factor, and mitomycin in an experimental model of acute traumatic tympanic membrane perforation[J]. And, 2003, 24 (3): 371- 376.
doi: 10.1097/00129492-200305000-00004
19 Dawood MR . Hearing evaluation after successful myringoplasty[J]. J Otol, 2017, 12 (4): 192- 197.
doi: 10.1016/j.joto.2017.08.005
20 Pedersen CB . Traumatic middle ear lesions. Fracture of the Malleus handle, aetiology, diagnosis and treatment[J]. J Laryngol Otol, 1989, 103 (10): 901- 903.
doi: 10.1017/s0022215100110461
21 Chen SS , Lao CB , Chiang JH , et al. High resolution computed tomography of temporal bone fracture[J]. Zhonghua Yi Xue Za Zhi (Taipei), 1998, 61: 127- 133.
22 Johnson F , Semaan MT , Megerian CA . Temporal bone fracture: evaluation and management in the modern era[J]. Otolaryngol Clin North Am, 2008, 41 (3): 597- 618.
doi: 10.1016/j.otc.2008.01.006
23 Sridhara SK , Rivera A , Littlefield P . Tympanoplasty for blast-induced perforations: the Walter Reed experience[J]. Otolaryngol Head Neck Surg, 2013, 148 (1): 103- 107.
doi: 10.1177/0194599812459326
24 Whitelaw AS , Young I . A case of perilymphatic fistula in blunt head injury[J]. Emerg Med J, 2005, 22 (12): 921.
doi: 10.1136/emj.2004.020495
25 Ulug T , Ulubil SA . Contralateral labyrinthine concussion in temporal bone fractures[J]. J Otolaryngol, 2006, 35 (6): 380- 383.
doi: 10.2310/7070.2006.0069
26 Pusz MD , Robitschek J . Traumatic hearing loss in the context of blast-related tympanic membrane perforation[J]. Mil Med, 2017, 182 (1): e1645- e1648.
doi: 10.7205/MILMED-D-15-00463
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