本文選題：突發(fā)性聾　切入點(diǎn)：預(yù)后　出處：《安徽醫(yī)科大學(xué)》2011年碩士論文　論文類型：學(xué)位論文

【摘要】：目的突發(fā)性聾常單側(cè)發(fā)病,患者聽(tīng)力有不同程度損害,影響其預(yù)后的因素尚未明確。本課題將探討影響單側(cè)突發(fā)性聾預(yù)后的相關(guān)因素;并探索單側(cè)突發(fā)性聾患者內(nèi)耳在3D FLAIR上的表現(xiàn),及其與預(yù)后的關(guān)系。 方法1.回顧性分析2004.01—2009.12在安徽醫(yī)科大學(xué)第一附屬醫(yī)院耳鼻咽喉頭頸外科住院接受規(guī)范綜合治療的單側(cè)突發(fā)性聾患者的臨床資料。結(jié)合本研究的目的,確定排除標(biāo)準(zhǔn)和入組標(biāo)準(zhǔn)。對(duì)入選的339例患者的年齡、初次就診時(shí)間、就診時(shí)聽(tīng)力圖形狀、是否伴有眩暈或(和)耳鳴等癥狀、是否有糖尿病或(和)高血壓等因素和預(yù)后之間的關(guān)系進(jìn)行分組統(tǒng)計(jì)分析,統(tǒng)計(jì)方法為秩和檢驗(yàn)。 2.選取自2010.4—2010.10在安徽醫(yī)科大學(xué)第一附屬醫(yī)院耳鼻咽喉頭頸外科住院接受規(guī)范綜合治療,自愿行頭顱MRI檢查的單側(cè)突發(fā)性聾患者30名,用GE 3.0T MR儀行3D FLAIR成像,探索患者的聽(tīng)覺(jué)通路有無(wú)異常信號(hào),觀察內(nèi)耳在FLAIR上的表現(xiàn)�；颊呷朐汉蠼赃M(jìn)行規(guī)范綜合治療,療程至少在7天以上,或者患者療程雖未及7天但已經(jīng)痊愈出院。所有患者入院時(shí)及出院前均給予純音測(cè)聽(tīng)檢查,對(duì)內(nèi)耳信號(hào)和患者的預(yù)后之間的關(guān)系進(jìn)行統(tǒng)計(jì)分析,統(tǒng)計(jì)方法主要有t檢驗(yàn)和卡方檢驗(yàn)。 結(jié)果1. 339例單側(cè)突發(fā)性聾患者有55例痊愈(16.2%),85例顯效(25.1%),56例有效(16.5%),143例無(wú)效(42.2%)�；颊叩男詣e、初次就診時(shí)間、患病耳側(cè)、耳悶癥狀與患者的預(yù)后無(wú)相關(guān)性。而患者的年齡、伴眩暈或(和)耳鳴癥狀、伴有高血壓等基礎(chǔ)疾病、入院初始聽(tīng)力圖形狀等與患者的預(yù)后存在相關(guān)性。伴有眩暈癥狀的患者預(yù)后差,不伴有耳鳴的患者預(yù)后差。高齡患者的預(yù)后比中年人和青年患者差。伴有高血壓或者糖尿病的患者預(yù)后較差,同時(shí)伴有高血壓和糖尿病的患者預(yù)后最差。聽(tīng)力圖形狀呈凹陷型和上升型的患者預(yù)后較好,總有效率分別為83.8%和78.2%。聽(tīng)力圖形狀呈下坡型,平坦型,極重度聾的患者預(yù)后較差。全聾患者的總有效率僅為30.6%,預(yù)后最差。 2. 30例經(jīng)MR檢查的患者中,有12例患側(cè)耳蝸在FLAIR上呈高信號(hào),另外18例患側(cè)耳蝸及所有健側(cè)耳蝸均無(wú)異常信號(hào)。12例內(nèi)耳有高信號(hào)的患者僅有1例治療有效,其余11均無(wú)效;18例內(nèi)耳未見(jiàn)異常信號(hào)的患者有2例痊愈,并且總有效率為61.1%,差異有統(tǒng)計(jì)學(xué)意義。 結(jié)論1.聽(tīng)力圖形狀呈凹陷型和上升型的患者預(yù)后較好,全聾型最差。高齡患者的預(yù)后較差。伴有眩暈癥狀的患者預(yù)后差,不伴耳鳴癥狀的患者預(yù)后差。伴有糖尿病和高血壓的患者預(yù)后差。 2. 3D FLAIR可顯示突發(fā)性聾患者內(nèi)耳淋巴液改變,呈高信號(hào)時(shí)患者療效較差。這種內(nèi)耳高信號(hào)可以作為預(yù)測(cè)突發(fā)性聾預(yù)后的一個(gè)新因素。
[Abstract]:Objective to explore the related factors influencing the prognosis of paroxysmal deafness. To explore the features of the inner ear of unilateral sudden deafness patients on 3D FLAIR and its relationship with prognosis. Methods 1. The clinical data of patients with unilateral sudden deafness who were admitted to the department of otolaryngology and head and neck surgery in the first affiliated Hospital of Anhui Medical University from January to December 2004.The purpose of this study was to analyze the clinical data of patients with unilateral sudden deafness. Determine exclusion criteria and admission criteria. For 339 selected patients, the age, the first visit time, the shape of the auditory effort at the time of the visit, whether there were symptoms such as vertigo or / and tinnitus, were determined. The relationship between diabetes and / or hypertension and prognosis was analyzed by rank sum test. 2. Thirty patients with unilateral sudden deafness, who were admitted to the Department of Otorhinolaryngology and head and neck surgery in the first affiliated Hospital of Anhui Medical University from April to October 2014.30 patients with unilateral sudden deafness who voluntarily underwent cranial MRI, were examined by 3D FLAIR imaging with GE 3.0T Mr instrument. To explore the abnormal signal of auditory pathway and observe the appearance of inner ear on FLAIR. The patients were treated with standard comprehensive therapy after admission, the course of treatment was at least more than 7 days. All patients were given pure tone audiometry on admission and before discharge. The relationship between the inner ear signal and the prognosis of the patients was statistically analyzed. Statistical methods include t test and chi-square test. Results 1.55 out of 339 patients with unilateral sudden deafness recovered 16.2% of 85 cases with remarkable effect and 56 cases with effective 16.5%. The sex of the patient, the time of the first visit, the side of the diseased ear and the symptoms of stuffy ear were not related to the prognosis of the patient, but the age of the patient was not related to the age of the patient, but the age of the patient was not correlated with the age of the patient. Patients with vertigo or / and tinnitus, basic diseases such as hypertension, and the shape of initial audiogram were associated with the prognosis of the patients. The prognosis of patients without tinnitus is poor. The prognosis of elderly patients is worse than that of middle-aged and young patients. The prognosis of patients with hypertension or diabetes is worse. The prognosis of the patients with hypertension and diabetes was the worst. The patients with concave shape and ascending shape had better prognosis, the total effective rates were 83.8% and 78.2, respectively. The shape of hearing graph was downhill and flat. The prognosis of patients with extremely severe deafness was poor, the total effective rate of total deafness patients was only 30.6 and the prognosis was the worst. 2.Among 30 cases of Mr examination, 12 cases of affected cochlea showed high signal on FLAIR, the other 18 cases of affected cochlea and all healthy cochlea showed no abnormal signal. 12 cases of patients with high signal in inner ear were effective. Of the 18 patients with no abnormal signal in the inner ear, 2 were cured, and the total effective rate was 61.1. The difference was statistically significant. Conclusion 1. The prognosis of the patients with concave and ascending shape of audiogram is better, the type of total deafness is the worst, the prognosis of the elderly patients is poor, the prognosis of the patients with vertigo symptoms is poor, the prognosis of the patients with vertigo symptoms is poor. 2. Patients without tinnitus had poor prognosis. Patients with diabetes and hypertension had poor prognosis. 2. 3D FLAIR can show the changes of lymphatic fluid in the inner ear of the patients with sudden deafness, which can be used as a new factor to predict the prognosis of sudden deafness.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R764.43

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