突發感音神經性聽力損失治療預後及其相關因子分析

Analysis of Prognostic and Related Factors in the Treatment of Sudden Sensorineural Hearing Loss

程淑珠(Shu-Chu Cheng) ； 陳宜湧(Yi-Yung Chen) ； 施政坪(Cheng-Ping Shih) ； 高玉純(Yu-Chun Kao) ； 林原永(Yuan-Yung Lin) ； 郭昭吟(Chao-Yin Kuo) ； 葉文英(Wen-Ying Yeh) ； 王智弘(Chih-Hung Wang) ； 陳信傑(Hsin-Chien Chen)

《台灣耳鼻喉頭頸外科雜誌》 57卷3期 (2022/09) Pp. 175-186

https://doi.org/10.6286/jtohns.202209_57(3).175

摘要

背景：探討突發感音神經性聽力損失病患，其住院治療後聽力恢復和發生聽力損失時各項因子的相關性，著重於個人屬性、聽力損失時程度、聽力恢復及眩暈有無之相關比較。蒐集北部某醫學中心於105－108年因突發感音神經性聽力損失住院病患共225位。方法：採用Sudden Deafness Research Group（SDRG）criteria聽力損失以250 Hz、500 Hz、1 kHz、2 kHz、4 kHz共五個頻率平均數。聽力恢復分為四類：完全恢復、部份恢復、輕微恢復及無恢復。前庭誘發肌源性電位雙側振幅差異40%以上異常；溫差試驗雙側管性麻痺差異25%以上異常。結果：年齡45歲以下、聽力損失未滿90 dB、溫差結果正常者聽力恢復較佳。有眩暈、年齡65歲以上、溫差結果超過40%者聽力損失較嚴重。女性、聽力損失90 dB以上、溫差結果異常或超過40%者有眩暈情形較多。結論：突發性聽力損失患者年齡越大聽力恢復越差，尤其是65歲以上；聽力損失90 dB以上及溫差結果異常或超過40%，聽力恢復預後也不佳。突發性聽力損失合併眩暈患者，溫差試驗在上前庭神經功能的辨別具有其意義，溫差試驗結果正常者其聽力恢復的預後也較佳。

關鍵字

caloric test ； hearing recovery ； sudden sensorineural hearing loss ； vertigo ； vestibular evoked myogenic potential（溫差試驗 ； 聽力恢復 ； 突發感音神經性聽力損失 ； 眩暈 ； 前庭神經誘發肌源性電位）

並列摘要

BACKGROUND: The study aimed to investigate the relationship between the hearing recovery of patients with sudden sensorineural hearing loss (SSNHL) after hospitalization and various related factors in hearing loss, focusing on the correlation between personal attributes, the degree of hearing loss, hearing recovery, and the presence of vertigo. Our study population consisted of 225 patients who were diagnosed with SSNHL from 2016-2019 in a medical center located in northern Taiwan. METHODS: According to the Sudden Deafness Research Group (SDRG) criteria, hearing level was the average of 250 Hz, 500 Hz, 1 kHz, 2 kHz, and 4 kHz, whereas hearing recovery was graded as complete, partial, slight, or no recovery. An amplitude asymmetry ratio of ＞40% in cervical vestibular-evoked myogenic potentials (cVEMPs) testing and a canal paresis (CP) value of ＞25% in caloric testing were regarded as abnormal results. RESULTS: Our study showed that patients ＜45 years of age, a degree of hearing loss ＜90 dB HL, or a normal caloric test result have better prognosis. In contrast, patients ＞65 years of age, with vertigo, or with a CP value ＞40% have a higher degree of hearing loss. Moreover, vertigo is more likely to occur in patients with the following factors: female sex, a degree of hearing loss ＞90 dB HL, and an abnormal caloric test or CP value ＞40%. CONCLUSIONS: Hearing recovery in sudden hearing loss is related to the following factors: older age (＞65 years), degree of hearing loss ＞90 dB, and an abnormal caloric test result or CP value ＞40% are poor prognostic factors. Among patients with SSNHL and vertigo, the caloric test is meaningful for assessing superior vestibular nerve function, wherein patients with a normal CP value are more likely to have a better prognosis.

並列關鍵字

caloric test ； hearing recovery ； sudden sensorineural hearing loss ； vertigo ； vestibular evoked myogenic potential