本文選題：突發(fā)性聾 + 眩暈　； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:分析突發(fā)性聾(簡(jiǎn)稱突聾)并發(fā)良性陣發(fā)性位置性眩暈(BPPV)患者的臨床特征和治療效果,并進(jìn)一步探討其可能的致病因素和適宜的治療方案。方法:選取2015.1-2016.6期間就診于天津市人民醫(yī)院耳鼻咽喉科,并確診為單側(cè)突聾且資料完整的患者260例,根據(jù)是否伴發(fā)有BPPV,將突聾患者分為突聾伴BPPV組和突聾不伴BPPV組,分析總結(jié)突聾伴BPPV組患者的臨床特征;所有突聾患者病程均1-10d,根據(jù)突聾患者聽(tīng)力損失的頻率和程度,將聽(tīng)力曲線分為低頻下降型、高頻下降型、平坦下降型及全聾型(含極重度聾),并依據(jù)不同聽(tīng)力曲線類型分型治療,療程均14d,以療程結(jié)束后的純音測(cè)聽(tīng)結(jié)果判定療效,統(tǒng)計(jì)分析伴BPPV和不伴BPPV兩組突聾患者的治療有效率。另選取同期就診于我科確診為原發(fā)性BPPV且資料完整的患者100例,作為突聾伴BPPV組之對(duì)照組,兩組BPPV患者依據(jù)受累半規(guī)管的不同,采用G-force眩暈診療系統(tǒng)行相應(yīng)復(fù)位方法的復(fù)位治療,治療后判定療效,并于治療后1周復(fù)查變位試驗(yàn)(G-force眩暈診療系統(tǒng)輔助下Dix-Hallpike試驗(yàn)及滾轉(zhuǎn)試驗(yàn)),對(duì)未治愈的患者再次復(fù)位治療,統(tǒng)計(jì)分析兩組BPPV患者的治愈次數(shù)和治療有效率。所有BPPV患者復(fù)位治療結(jié)束后隨訪時(shí)間為3月,隨訪方式為門(mén)診復(fù)查或電話隨訪,記錄復(fù)發(fā)例數(shù),并對(duì)復(fù)發(fā)BPPV者行相應(yīng)復(fù)位治療。應(yīng)用SPSS21.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.突聾伴BPPV患者的發(fā)病率約占突聾患者的14.62%,約占突聾伴眩暈患者的38.38%,女性發(fā)病多于男性,男:女比例為1:1.92,平均發(fā)病年齡為(49.18±9.78)歲,受累半規(guī)管均與突聾患耳同側(cè),后半規(guī)管受累最多見(jiàn),約55.26%,其次為水平半規(guī)管BPPV(31.58%),BPPV發(fā)病時(shí)間晚于突聾(1周內(nèi):81.58%,2周內(nèi):18.42%);伴BPPV的突聾患者全聾型聽(tīng)力曲線比例最高,約為42.11%,低頻下降型所占比例最小2.63%。2.突聾伴BPPV患者經(jīng)1-4次G-force眩暈診療系統(tǒng)復(fù)位治療后均治愈,與原發(fā)性BPPV組相比,突聾伴BPPV組的1次治愈率(44.74%)低于原發(fā)性BPPV組(72%),差異有統(tǒng)計(jì)學(xué)意義(P0.05);原發(fā)性BPPV組和突聾伴BPPV組的總治愈率均為100%,無(wú)差異。3.突聾伴BPPV患者的聽(tīng)力療效總有效率(52.63%)低于突聾不伴BPPV組(71.62%),經(jīng)卡方檢驗(yàn),差別有統(tǒng)計(jì)學(xué)意義(P0.05);伴BPPV和不伴BPPV的兩組突聾患者,經(jīng)治療后,其平均聽(tīng)閾水平均較前有所恢復(fù),且不伴BPPV的突聾患者治療后平均聽(tīng)閾略高于突聾伴BPPV組患者,差異均有統(tǒng)計(jì)學(xué)意義(P均0.05)。4.突聾伴BPPV組和原發(fā)性BPPV組治療后隨訪3月,其BPPV復(fù)發(fā)率分別為5.26%、2%,兩組患者復(fù)發(fā)率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.突聾伴BPPV患者平均發(fā)病年齡為(49.18±9.78)歲,女性發(fā)病多于男性,受累半規(guī)管均與突聾患耳同側(cè),后半規(guī)管受累多見(jiàn),BPPV發(fā)病時(shí)間晚于突聾(1周內(nèi):81.58%,2周內(nèi):18.42%);四種聽(tīng)力曲線中全聾型所占比例最高。2.突聾伴BPPV患者和原發(fā)性BPPV患者經(jīng)耳石復(fù)位治療后總治愈率為100%,但1次治愈率低于原發(fā)性BPPV組,兩組患者BPPV復(fù)發(fā)率無(wú)差異;突聾伴BPPV患者聽(tīng)力治療的總有效率低于突聾不伴BPPV組。3.突聾伴BPPV的病因同突聾和BPPV一樣,目前尚無(wú)定論;其可能之病因是能夠作用于耳蝸和前庭系統(tǒng)的共同因素所致,國(guó)內(nèi)外較公認(rèn)的致病因素有內(nèi)耳血管因素和病毒感染。4.積極予突聾并發(fā)BPPV患者改善內(nèi)耳微循環(huán)、營(yíng)養(yǎng)神經(jīng)及口服激素治療,同時(shí)予耳石復(fù)位和心理干預(yù)治療,絕大部分患者有較滿意的治療效果。
[Abstract]:Objective: to analyze the clinical features and therapeutic effects of sudden deafness (sudden deafness) complicated with benign paroxysmal positional vertigo (BPPV), and to further explore the possible pathogeny factors and appropriate treatment schemes. Methods: selecting 2015.1-2016.6 during the diagnosis of the Department of otorhinolaryngology in Tianjin People's Hospital, and diagnosed as unilateral sudden deafness and complete data. 260 cases of total deafness were divided into two groups: deafness with BPPV group and group of sudden deafness without BPPV. The clinical characteristics of the patients with sudden deafness and BPPV were analyzed. All the patients with sudden deafness were 1-10d. According to the frequency and degree of hearing loss in the patients with sudden deafness, the hearing loss was divided into low frequency descent type, high frequency descending type and flat under the level of hearing loss. The treatment of descending and fully deafness type (containing very severe deafness), and according to different types of hearing curve type, was treated with 14d. The curative effect was determined by pure tone audiometry after the end of the course. The treatment efficiency of the patients with BPPV and no two groups of sudden deafness were statistically analyzed, and 100 cases of the patients diagnosed as primary and complete data in our department at the same time were selected. As the control group of the group of sudden deafness with the BPPV group, the two groups of BPPV patients were treated with the G-force vertigo treatment system according to the difference of the affected semicircular canals. After treatment, the curative effect was judged, and the reexamination (Dix-Hallpike test and rolling test aided by the G-force vertigo diagnosis and treatment system) was rechecked after the treatment (G-force vertigo diagnosis and treatment system), and the patients who had not been cured were treated. The reposition treatment of the two groups of BPPV patients was statistically analyzed and the curative efficiency was statistically analyzed. All BPPV patients were followed up in March after the end of the reposition treatment. The follow-up was the outpatient reexamination or telephone follow-up, the number of recurrent cases was recorded, and the recurrent BPPV patients were treated with corresponding reduction treatment. The statistical analysis should be made with the SPSS21.0 software. The results were as follows: 1. the incidence of sudden deafness accompanied by BPPV was about 14.62% of the patients with sudden deafness, about 38.38% of sudden deafness and vertigo. The incidence of women was more than that of men. The female ratio was 1:1.92, the average age was (49.18 + 9.78) years, the affected semicircular canals were the same side with the sudden deafness, the posterior semicircular canal was the most common, and the second was the horizontal semicircular canal BPPV (31.58%). The onset time of BPPV was later than sudden deafness (1 weeks: 81.58%, 2 weeks: 18.42%); the proportion of all deafness hearing curves in patients with BPPV was the highest, about 42.11%, and the lowest 2.63%.2. sudden deafness and BPPV patients were cured after 1-4 G-force vertigo treatment system, and 1 times compared with the primary BPPV group, the sudden deafness group with the BPPV group. The cure rate (44.74%) was lower than that of the primary BPPV group (72%), the difference was statistically significant (P0.05), the total cure rate of the primary BPPV group and the sudden deafness with the BPPV group was 100%, and the total effective rate of hearing loss in the patients with.3. sudden deafness with BPPV (52.63%) was lower than that of the sudden deafness without the BPPV group (71.62%), and the difference was statistically significant (P0.05) with the chi square test; with BPPV and no. The average hearing threshold level of two group of sudden deafness patients with BPPV was recovered after treatment, and the average hearing threshold was slightly higher than that of sudden deafness patients with BPPV group without BPPV. The difference was statistically significant (P 0.05).4. sudden deafness with BPPV group and primary BPPV group after treatment in March, and the recurrence rate of BPPV was 5.26%, 2%, two, respectively. There was no statistically significant difference in the recurrence rate of the patients in the group (P0.05). Conclusion: the average age of onset of 1. sudden deafness with BPPV was (49.18 + 9.78) years, female was more than male, the affected semicircular canal was identical with the ear of sudden deafness, and the posterior semicircular canal was more common. The onset time of BPPV was later than sudden deafness (1 weeks: 81.58%, 2 weeks: 18.42%); all hearing curves were completely deafness. The total cure rate of the patients with the highest proportion of.2. sudden deafness with BPPV and primary BPPV after otolith reduction was 100%, but the 1 cure rate was lower than that of the primary BPPV group. The recurrence rate of BPPV in the two groups was no difference, and the total effective rate of hearing treatment in the sudden deafness and BPPV patients was lower than that of the.3. sudden deafness with BPPV without the.3. sudden deafness and BPPV in the BPPV group. There is no final conclusion; the possible cause is the common factors that can function in the cochlea and the vestibule system. The more recognized pathogenic factors at home and abroad are internal ear vascular factors and virus infection.4. actively giving sudden deafness complicated with BPPV patients to improve inner ear microcirculation, nutritional nerve and oral hormone treatment, otolith reduction and psychological intervention treatment, Most patients have a satisfactory therapeutic effect.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R764.437

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