| Background:Sudden Sensorineural Hearing Loss which be shorted for Sudden Deafness, is a common emergency in Otolaryngology that deafness mostly sensorineural. Its pathogenesis is not clear, and the general clinical common possible causes include:viral infections, ear microcirculation, metabolic disorders, immune factors, psychological factors and so on, Sudden deafness caused by the rupture of cochlear window has been used as a single disease, it is no longer included in the sudden deafness. Since the disease was first proposed in 1944 by DeKleyn, scholars pathogenic mechanism of sudden hearing loss, clinical treatment and prognostic factors has been engaged in active exploration and research. Vasospasm theory was made by Sheehy in 1960, now generally considered to be a sudden deafness lighter type of vascular event, so you can infer positive thrombolysis within a certain time window, recanalization prognosis of sudden deafnesslt has a positive meaning. In the past, the earlier the treatment, the better the effect, the course was positively correlated with prognosis, best effect is the course of 2 weeks. However, with further research, more and more scholars are concerned about the need of its treatment for the patients with the longer course or period of treatment is not satisfactory acute,.Objectives:Analyze patients’ audiological features and efficacy of the course of more than 30 days, to provide reference of diagnosis and treatment for patients with longer duration.Methods:Collect the inpatients of Sudden sensorineural hearing loss with over 30 days who treated in The PLA General Hospital from August 2012 to November 2013 as the research object, according to the treatment time is divided into four groups of 30～61～91～,181 to a total, comparative analysis of efficacy in patients with sudden deafness different course groups.Results:170 cases (179 ears) were selected in line with sudden deafness were included in the standard course of more than 30 days, including 8 cases were never had been treated before admitted to hospital and 162 cases were poor treated. The mean age was 43.3±16.4 years old, the range of age is between 6 to 79 years, the male are 89 cases (52.4%), the female are 81 cases (47.6%), male to female ratio 1.1: 1.Bilateral disease is 9 cases (5.3%), the left side is 74 cases (43.5%), the right side is 87 cases (51.2%).The shortest duration is 30 days, the longest is 210 days, the average is 50.1±33.6 days, of which 132 cases were 30-60 days,22 cases are 61-90 days,8 cases are 91-180 days,≥181 days are 8 cases. The 170 patients met the inclusion criteria were divided into four groups of 30～61～91～,181 to a total according to the duration of time. According to the degree of hearing loss:extremely severe ear are 69 (38.5%), severe ear are 48 (26.8%), moderate ear are 34 (19.0%), mild ear are 23 (12.8%), speech frequency area normal are 5 ears (2.9%).Compare the degree of hearing loss of 30-before and after treatment through Rank sum test. P= 0.007 <0.05, statistically significant, The other three groups showed no significant difference in the group.The improvement in the average hearing threshold of each group with a separate sample t test for pairwise comparison, the difference was not statistically significant, the average hearing threshold by paired sample t test, t value is 42.16, P<0.05, there were significant differences between before and after treatment, and the remaining three groups with no difference. According to the audiology performance of 170 patients before and after treatment, the total efficiency is 19.7%,16.0%,11.1%,12.5% in the four groups, there are two cases of 30-cure ear, the case is a 2 sided deafness, left and right ears are cured, each group there was no significant difference by rank sum test. In the standard 170 cases 19 ears are low-IF descending ear,28 ears are high frequency descending,63 ears are flattened,69 ears are deaf ear type (Table 3), the treatment efficiency respectively are 57.9%,,14.3%, 19.0%,8.7%,decline in the low-IF type are more efficient than other three types, the difference was statistically significant (low-IF descending compared with other three types, both P=0.021<0.05). After hospital system treatment,30-group speech recognition rate was significantly higher than the course of more than 60 days. No significant difference whether get treatment prior to admission.Conclusion:Significance of the patients with sudden deafness were more than 30 days of active treatment.30 to group therapy in which there is the most efficient, speech recognition rate maximum, maximum benefit by treatment, the treatment efficiency of 61 to the group, followed by 91 to less efficient group and 180 to the group. Have prehospital treatment had no obvious effect on prognosis, patients with normal speech frequency area with no difference in the prognosis of patients with abnormal. Hearing curve type low-IF descending better prognosis. The duration within 60 days of sudden deafness get most benefit by treatment. Speech recognition can be the supplement to pure tone threshold, it can auxiliary assess the efficacy of sudden deafness. |
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