儿童突发性聋诊断和治疗专家共识(2026)

doi:10.6040/j.issn.1673-3770.0.2026.308

摘要/Abstract

摘要： 目的制定儿童突发性聋(pediatric sudden sensorineural hearing loss, PSSNHL)诊断和治疗专家共识,为临床规范化诊疗提供依据。方法由国内儿童耳鼻咽喉头颈外科及相关交叉学科专家共同发起,检索中英文数据库,遴选9个临床问题,经两轮改良德尔菲法形成9条推荐意见。结果共识将PSSNHL定义为72 h内发生的感音神经性听力损失,至少在相邻两个频率听力下降≥20 dB HL,年龄≤18岁。诊断需综合病史采集、体格检查及听力学、影像学、遗传学等多学科评估;检查策略按年龄制定。不推荐常规分型治疗,但可参考成人分型思路指导病因判断;鉴别诊断重点排除功能性听力下降、先天性中耳畸形、内耳解剖学异常等。治疗首选糖皮质激素(甲泼尼龙或泼尼松龙1 mg/kg,最大60 mg/d,连用5 d),初始治疗无效者可考虑鼓室内或耳后注射地塞米松作为补救治疗;可联合改善微循环药物、营养神经药物等,高压氧可作为可选辅助治疗。治疗1个月无效者需转向助听器或人工耳蜗干预。疗效评估采用2015年中国指南分级标准,预后与就诊时间、听力损失程度、双侧发病、伴发眩晕等因素密切相关。结论本共识为PSSNHL的规范化诊疗提供了临床依据,有助于实现早发现、早干预,最大程度改善或挽救患儿听力。

关键词: 儿童突发性聋, 诊断, 治疗, 专家共识, 糖皮质激素

Abstract: Objective The aim is to develop an expert consensus on the diagnosis and treatment of paediatric sudden sensorineural hearing loss(PSSNHL), and to provide evidence for standardised clinical practice. Methods This consensus was initiated by experts in paediatric otolaryngology, head and neck surgery, and related interdisciplinary fields in China. Nine clinical questions were selected through a systematic review of literature from Chinese and English databases, and nine recommendations were formulated through two rounds of the modified Delphi method. Results PSSNHL is defined as sensorineural hearing loss that occurs within 72 hours and involves a hearing threshold decrease of at least 20 dB HL in two or more adjacent frequencies in patients aged 18 years or under. A diagnosis requires a comprehensive, multidisciplinary assessment, including taking a patient's history, conducting a physical examination, and carrying out audiological, imaging, and genetic evaluations. Examination strategies are age-specific. Although routine classification-based treatment is not recommended, adult classification approaches may inform the diagnosis. The differential diagnosis should particularly exclude functional hearing loss, congenital middle ear malformations and inner ear anatomical abnormalities. The first-line treatment is corticosteroids(methylprednisolone or prednisolone at a dose of 1 mg/kg, up to a maximum of 60 mg/day for five days). Intratympanic or post-auricular dexamethasone injection may be considered as salvage therapy after initial treatment has failed. Adjuvant therapies include microcirculation-improving agents and neurotrophic drugs, and hyperbaric oxygen therapy may be used as an additional treatment. For patients with no hearing recovery after one month, hearing aids or cochlear implantation should be considered. Efficacy is evaluated according to the 2015 Chinese Guideline Grading Criteria. Prognosis is closely related to the time taken to commence treatment, the severity of hearing loss, bilateral involvement and the presence of accompanying vertigo. Conclusion This consensus provides clinical evidence for the standardised diagnosis and treatment of PSSNHL. This enables the condition to be detected and treated early, maximising the chance of preserving and recovering hearing in children.

Key words: Pediatric sudden sensorineural hearing loss, Diagnosis, Treatment, Expert consensus, Glucocorticoids

中图分类号:

R720.5

中国医师协会耳鼻咽喉头颈外科医师分会小儿学组,江苏省康复医学会听力与言语康复专业委员会,浙江省医学会听力学分会. 儿童突发性聋诊断和治疗专家共识(2026)[J]. 山东大学耳鼻喉眼学报, 2026, 40(5): 1-10.

Pediatric Group of the Otolaryngology-Head and Neck Surgery Branch of the Chinese Medical Doctor Association, Hearing and Speech Rehabilitation Professional Committee of Jiangsu Association of Rehabilitation Medicine, Audiology Branch of Zhejiang Medical Association. Expert consensus on the diagnosis and treatment of sudden sensorineural hearing loss in children(2026)[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2026, 40(5): 1-10.

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