中耳积液对分泌性中耳炎患者内耳功能影响的研究

Effect of middle ear effusion on inner ear function in patients with otitis media with effusion

摘要:

目的 探讨中耳积液对分泌性中耳炎(OME)患者内耳功能的影响。方法 回顾性分析2022年1月—2024年1月于华东师范大学附属芜湖医院就诊的39例单侧OME合并骨导听阈升高患者(病例组)及50例无骨导听阈改变OME患者(对照组)的临床资料，对比病例组患侧耳、健侧耳以及患侧耳治疗后3组听力指标的变化，分析相关临床变量对患侧耳治疗前后骨导听力的影响。结果 病例组头晕/眩晕发生率显著高于对照组(P=0.002)，且初次临床干预时间较对照组延迟(P=0.008)。病例组以高频骨导听力损伤为主要表现，患侧耳2、4 kHz骨导听阈[(34.10±13.27)dB、(29.49±15.04)dB]显著高于健侧耳[(20.26±11.00)dB、(19.87±12.59)dB，P＜0.001]，积液解除后，患侧耳2、4 kHz骨导听阈与健侧耳之间差异具有统计学意义(P=0.003)。多元线性回归显示：黏液型积液是2 kHz骨导听力恢复的不利影响因素(β=0.39,P=0.009)，而早期干预(β=-0.402,P=0.024)、无眩晕症状(β=-0.413,P=0.007)是4 kHz骨导听力恢复的保护因素。结论 中耳积液可能影响OME患者的内耳功能，部分患者可出现头晕/眩晕症状，并出现高频骨导听力不可逆下降；早期临床干预，准确辨识中耳的积液性质，对改善OME患者远期听力预后具有重要临床意义。

Abstract:

Objective To investigate the impact of middle ear effusion on inner ear function in patients with otitis media with effusion (OME). Methods A retrospective analysis was conducted on the clinical data of 39 patients with unilateral OME accompanied by elevated bone conduction thresholds (case group) and 50 OME patients without bone conduction changes (control group) who were treated at Wuhu Hospital Affiliated to East China Normal University between January 2022 and January 2024. Hearing changes were compared among the affected ears, healthy-side ears, and post-treatment affected ears in the case group. The influence of relevant variables on bone conduction hearing of the affected ear before and after treatment was analyzed. Results The incidence of dizziness/vertigo in the case group was significantly higher than that in the control group (P=0.002), and the initial clinical intervention time was delayed compared with the control group (P=0.008). The case group mainly presented with high-frequency bone conduction hearing impairment, and the bone conduction thresholds at 2 kHz and 4 kHz of the affected ear [(34.10±13.27)dB, (29.49±15.04)dB]were significantly higher than those of the healthy-side ear [(20.26±11.00)dB, (19.87±12.59)dB, P<0.001]. After the effusion was relieved, the differences in bone conduction thresholds at 2 kHz and 4 kHz between the affected ear and the healthy-side ear were statistically significant (P=0.003). Multiple linear regression showed that mucous effusion was an unfavorable factor for the recovery of bone conduction hearing at 2 kHz (β=0.39, P=0.009), while early intervention (β=-0.402, P=0.024) and no dizziness symptoms (β=-0.413, P=0.007) were protective factors for the recovery of bone conduction hearing at 4 kHz. Conclusions Middle ear effusion may affect the inner ear function of OME patients, and some patients may experience dizziness/vertigo symptoms and irreversible decline in high-frequency bone conduction hearing. Early clinical intervention and accurate identification of the nature of middle ear effusion are of great clinical significance for improving the long-term hearing prognosis of OME patients.