刁桐湘; 静媛媛; 张季蕾; 王宜旭; 余力生; 马鑫

doi:10.3760/cma.j.cn115330-20220406-00171

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平坦型突发性聋再分型

中华耳鼻咽喉头颈外科杂志, 2023,58(2) : 111-116. DOI: 10.3760/cma.j.cn115330-20220406-00171

摘要

目的

探讨可否依据听力曲线类型对突发性聋（突聋）中的平坦型突聋进一步分型，明确不同听力曲线类型与突聋预后的相关性。

方法

本研究为回顾性队列研究。依据2015年突聋诊断和治疗指南将2007年8月至2011年10月全国33家医院收治的1 024例（其中男492例，女532例；年龄19~65岁，平均年龄41.2岁）单侧突聋患者分为低频、高频、平坦及全聋型突聋4型；将其中402例平坦型突聋患者依据听力曲线类型进一步分为：平坦上升型、平坦下降型、平坦一致型3组。比较3组间的临床特点及预后，比较平坦上升型与低频下降型突聋、平坦下降型与高频下降型突聋、平坦一致型与全聋型突聋的临床特点及预后，探讨影响平坦型突聋预后的相关因素。采用SPSS 21.0软件对数据进行分析，应用方差分析、 $χ^{2}$ 检验、t检验及Logistic回归对数据进行分析。

结果

平坦上升、平坦下降、平坦一致型突聋3组的痊愈率分别为70.7%、17.1%、34.0%，差异有统计学意义（ $χ^{2}$ =33.984，P<0.001）；而年龄、性别、发病侧别差异无统计学意义（P值均>0.05）。平坦型突聋痊愈的影响因素为：是否伴有头晕［OR=0.459，95%可信区间（CI）：0.271~0.777］、听力曲线类型（OR=0.721，95%CI：0.530~0.981）和发病至就诊天数（OR=0.903，95%CI：0.835~0.978），P值均<0.05。平坦上升型与低频下降型突聋、平坦下降型与高频下降型突聋的痊愈率差异均无统计学意义（P值均>0.05）。平坦一致型与全聋型突聋的平均纯音听阈（pure tone average，PTA）为（69.1±18.9）dB HL和（101.7±17.7）dB HL，差异有统计学意义（t=20.890，P<0.001），痊愈率分别为34.0%和14.5%，差异有统计学意义（ $χ^{2}$ =29.012，P<0.001）。

结论

可对平坦型突聋进一步分为平坦上升型、平坦下降型、平坦一致型。其中平坦上升型痊愈率与低频下降型突聋相似，预后较好；平坦下降型痊愈率与高频下降型突聋相似，预后较差；平坦一致型痊愈率高于全聋型突聋，PTA在平坦一致型和全聋型突聋的预后中起重要作用。

引用本文: 刁桐湘, 静媛媛, 张季蕾, 等. 平坦型突发性聋再分型 [J] . 中华耳鼻咽喉头颈外科杂志, 2023, 58(2) : 111-116. DOI: 10.3760/cma.j.cn115330-20220406-00171.

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

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未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

突发性感音神经性聋（sudden sensorineural hearing loss，SSNHL）的概念于1944年被提出，又称突发性聋（突聋）^［1］，是指72 h内突然发生的、原因不明的，至少相邻3个频率听力下降≥30 dB（美国指南）^［2］，或相邻2个频率听力下降≥20 dB（中国指南）的感音神经性听力损失^［3］。突聋的发病率为5/10万~20/10万，新的流行病学数据显示突聋的发生率可高达400/10万。由于发病率逐渐升高^［4］，且病因不明，突聋一直是耳科界最富挑战的研究热点之一。

贡献者信息

刁桐湘

北京大学人民医院耳鼻咽喉科，北京100044

静媛媛

北京大学人民医院耳鼻咽喉科，北京100044

张季蕾

北京大学人民医院耳鼻咽喉科，北京100044

王宜旭

北京大学人民医院耳鼻咽喉科，北京100044

余力生

北京大学人民医院耳鼻咽喉科，北京100044

马鑫

北京大学人民医院耳鼻咽喉科，北京100044

通信作者

马鑫

北京大学人民医院耳鼻咽喉科，北京100044

Email：13581709195@163.com

关键词

听觉丧失，突发性; 平坦型突发性聋; 痊愈率; 再分型;

基金项目

北京大学人民医院研究与发展基金（RDL2021-14）

作者声明

作者贡献声明

刁桐湘：数据分析、解释、文章撰写；静媛媛、张季蕾、王宜旭：课题构思、设计、数据采集；余力生：课题构思、设计、数据分析、解释、文章审阅修改；马鑫：课题构思、设计、数据分析、解释、文章撰写、文章审阅修改

利益冲突

利益冲突：

所有作者声明无利益冲突

历史

出版日期：2023-02-07

收稿日期：2022-04-06

本文编辑

房玉新

Original Article

Reclassification of flat type sudden deafness

Diao Tongxiang, Jing Yuanyuan, Zhang Jilei, Wang Yixu, Yu Lisheng, Ma Xin

Published 2023-02-07

Cite as Chin J Otorhinolaryngol Head Neck Surg, 2023, 58(2): 111-116. DOI: 10.3760/cma.j.cn115330-20220406-00171

Abstract

Objective

To reclassify the flat type sudden deafness according to the types of audiogram shape, and to explore the correlation between different pattern of hearing loss and prognosis.

Methods

All of 1 024 patients with unilateral sudden deafness (492 males and 532 females, aged from 19 to 65 years, with an average age of 41.2 years old) admitted to 33 hospitals nationwide from August 2007 to October 2011 were divided into four types according to Chinese Guideline of Sudden Deafness(2015): low-frequency, high-frequency, flat and total deafness. Then, 402 patients with flat type sudden deafness were further divided into ascending type, descending type and consistent type according to the audiogram shapes. First, we compared the clinical characteristics and prognosis among these three subtypes of flat deafness, then compared the clinical characteristics and prognosis between ascending flat deafness and low-frequency deafness, descending flat deafness and high-frequency deafness, consistent flat deafness and total deafness, explored the factors related to the prognosis of flat deafness. SPSS 21.0 software, ANOVA, $χ^{2}$ test, t-test and Logistic regression were used to analyze the data.

Results

The cure rates of flat ascending, flat descending and flat consistent sudden deafness groups were 70.7%, 17.1% and 34.0% respectively, with a statistically significant difference ( $χ^{2}$ =33.984, P<0.001); However, there was no significant difference in age, sex and affected side (all P>0.05). The independent related factors for the recovery of flat type sudden deafness were as follows: whether there was dizziness [OR=0.459; 95% confidence interval (CI): 0.271-0.777], the type of audiogram shape (OR=0.721; 95%CI: 0.530-0.981), and days from onset to therapy (OR=0.903, 95%CI: 0.835-0.978), all of which had P values<0.05. There was no significant difference in the cure rates between ascending flat sudden deafness and low-frequency descending sudden deafness, descending flat sudden deafness and high-frequency descending sudden deafness (all P>0.05). The pure tone average(PTA) of flat consistent sudden deafness and total deafness were (69.1±18.9) and (101.7±17.7) dB HL, respectively, with a statistically significant difference (t=20.890, P<0.001), and the cure rates were 34.0% and 14.5%, respectively, with a statistically significant difference ( $χ^{2}$ =29.012, P<0.001).

Conclusion

According to the audiogram shape, the flat type sudden deafness can be further divided into ascending flat sudden deafness, descending flat sudden deafness and consistent flat sudden deafness, which can more effectively evaluate the prognosis. The cure rate of ascending flat sudden deafness is similar to that of low-frequency sudden deafness, and the prognosis is well; The cure rate of descending flat sudden deafness is similar to that of high-frequency descending sudden deafness, and the prognosis is poor. The cure rate of consistent flat sudden deafness is higher than that of total deafness. PTA plays an important role in the prognosis of consistent flat sudden deafness and total deafness. Total deafness can be regarded as a single type of sudden deafness.

Key words:

Hearing loss, sudden; Flat type sudden deafness; Recovery rate; Reclassification

Contributor Information

Diao Tongxiang