单侧全聋型突发性聋患者临床特征及预后分析

Clinical characteristics and prognosis analysis of patients with unilateral total sudden deafness

摘要:

目的 分析单侧全聋型突发性聋的一般临床特征，探讨影响预后的相关因素。方法 回顾2019年9月—2021年5月收治住院治疗的127例单侧全聋型突发性聋患者的临床资料，包括一般情况、伴随症状、伴发疾病、实验室检查、治疗效果等，采用χ²检验及二元Logistic回归分析患者性别、年龄、患耳侧别、发病至就诊时间、伴发疾病（高血压、糖尿病、心脏病）、伴随症状（耳鸣、眩晕/头晕）、实验室检查（叶酸、维生素B12、同型半胱氨酸）对预后的影响。结果 127例单侧全聋型突发性聋患者，伴耳鸣者113例（88.98%），伴眩晕/头晕者91例（71.65%），总有效率为41.73%。单因素分析显示患者的年龄（P=0.016）、发病至就诊时间（P=0.003）及是否伴眩晕/头晕（P=0.017）与预后相关，差异均具有统计学意义。患者的性别、患耳侧别、伴发基础疾病（高血压、糖尿病、心脏病）、耳鸣、实验室检查（叶酸、维生素B12、高同型半胱氨酸）对预后影响差异无统计学意义。多因素分析显示患者发病至就诊时间（P=0.006）、是否伴眩晕/头晕（P=0.037）为预后的独立危险因素，发病至就诊时间≥3 d组是<3 d组有效率的0.311倍（OR=0.311，95%CI为0.134~0.720，P=0.006），伴眩晕/头晕者有效率是不伴者有效率的0.385倍（OR=0.385，95%CI为0.157~0.944，P=0.037）。结论 单侧全聋型突发性聋常伴耳鸣、眩晕/头晕，年龄≥40岁、发病至就诊时间≥3 d、伴眩晕/头晕提示预后不佳，其中发病至就诊时间≥3 d以及伴发眩晕/头晕为其独立危险因素，可为临床预后评判及治疗提供理论依据。

Abstract:

Objective To explore the prognostic factors via analyzing the general clinical features of unilateral total sudden deafness.Methods Clinical data of 127 patients with unilateral total sudden deafness treated in our department from Sept 2019 to May 2021 were analyzed retrospectively. The studied data included general conditions, concomitant symptoms and diseases, hearing characteristics, laboratory examinations, treatment effect, etc. Chi-square test and multivariate binary Logistic regression were used to analyze the influences of patients' gender and age, affected ear side, the time before treatment, concomitant diseases (hypertension, diabetes, heart disease), accompanying symptoms (tinnitus, vertigo/dizziness), and laboratory tests (folic acid, vitamin B12, homocysteine) on prognosis.Results The total effective rate of the 127 cases was 41.73%. Among them, 113 (88.98%) were accompanied by tinnitus, 91(71.65%) by vertigo. Univariate analyses revealed that patients' age (P=0.016), the time before treatment (P=0.003), and accompanied vertigo/dizziness (P=0.017) were significantly associated with the prognosis. However, there were no statistical significances in the influences of patients' gender, affected ear side, concomitant basic diseases (hypertension, diabetes, heart disease), tinnitus and laboratory tests (folic acid, vitamin B12, high homocysteine) on prognosis. Multivariate analyses showed that the time before treatment (P=0.006) and concomitant vertigo/dizziness (P=0.037) were independent risk factors for prognosis. The group with the time before treatment ≥ 3 days had an odds ratio of 0.311 in effective rate compared with the group with the time before treatment<3 days (OR=0.311, 95%CI=0.134-0.720, P=0.006). The odds ratio of effective rate between the group with vertigo/dizziness and that without vertigo/dizziness was 0.385 (OR=0.385, 95%CI=0.157-0.944, P=0.037).Conclusions Unilateral total sudden deafness is often accompanied by tinnitus and vertigo/dizziness. The age ≥ 40 years, the time before treatment ≥ 3 days and concomitant vertigo/dizziness suggest poor prognosis. And the latter two are independent risk factors, which can provide theoretical basis for clinical prognosis evaluation and treatment of unilateral total sudden deafness.