| ObjectionTo analyze the prognostic factors of unilateral SSNHL in adults.And to further understand the pathogenesis and clinical characteristics of SSNHL,the relationship between vertigo,vestibular function,inner ear imaging and prognosis of SSNHL was investigated.MethodsThe clinical and follow-up data were collected and analyzed retrospectively.All patients received diagnosis and treatment from January,2018 to December,2018,in Shandong ENT Hospital.They were all unilateral SSNHL patients aged 18 to 70.The clinical information included gender,age,the side of disease,the inducements of disease,the course of disease,SSNHL types,the levels of hearing impairment,the associated symptoms(vertigo,tinnitus,aural fullness),the basic diseases,audiological assessment(the hearing curve of pure tone test before and after receiving treatment,the results of the Auditory Brainstem Response(ABR),the results of Distortion Product Otoacoustic Emission(DPOAE),the results of tympanogram),image data of inner ear(MRI),vestibular function(the results of Caloric test,the results of video head impulse test(vHIT),the rusults of vestibular evoked myogenic potentials(VEMP)).Additionally,to analyze the correlation between these factors and prognosis of SSNHL,the study grouped all data on these factors respectively.According to the age of patients,the patients were divided into five age groups:18-29,30-39,40-49,50-59,60-70 years old.According to the course of the disease,the patients were divided into three groups:0-3 d,4-7 d and 8-14 d.According to the basic diseases,the patients were divided into the group without basic diseases and the group with basic diseases(diabetes,hypertension,coronary heart disease and other subgroups).According to the inducements of disease,the patients were divided into the group without inducement and the group with inducement(noise,fatigue,infection of the upper respiratory tract,drinking,emotional disturbance,sleep disorder and other causes).According to the results of pure tone test before treatment,the degree of deafness was divided into four groups:mild deafness,moderate deafness,severe deafness and extremely severe deafness.According to the curve types of pure tone test,hearing loss can be divided into four groups:high frequency type,low frequency type,flat type and total deafness type.According to the accompanying symptoms,the patients were divided into non-vertigo group and vertigo group,non-tinnitus group and tinnitus group,and non-ear tightness group and ear tightness group.The diagnosis and treatment of all patients followed the guidelines for the diagnosis and treatment of sudcden.sensorineural hearing loss(2015)published in the Chinese Journal of Otorhinolaryngology Head and Neck Surgery in 2015.SPSS 20.0 was used for statistical analysis.P<0.05 meant that the difference was statistically significant.ResultsA total of 238 cases of SSNHL were collected.There were 115 male patients(48.3%),and 123 female patients(51.7%).116 cases(48.7%)were left side,122 cases(51.2%)were right side.There were 26 patients aged 18-29 years old(10.9%),57 patients aged 30-39 years old(23.9%),50 patients aged 40-49 years old(21%),70 patients aged 50-59 years old(29.4%),and 35 patients aged 60-70 years old(14.7%).The course of 102 patients were 0-3 d(42.9%),87 patients were 4-7 d(36.6%),and 49 patients were 8-14 d(20.6%).165 cases were without inducement(69.3%),the inducements of 4 cases were noise(1.7%),30 cases were fatigue(12.6%),10 cases were infection of the upper respiratory tract(4.2%),3 cases were drinking(1.3%),4 cases were emotional disturbance(1.7%),12 cases were sleep disorders(5.1%,1 case was with drinking),9 cases were other inducements(3.8%).176 cases were without basic diseases(73.9%),24 cases with type 2 diabetes(10.1%),22 cases with primary hypertension(9.2%),4 cases with coronary heart disease(CHD)(1.7%),1 case with coronary heart disease and diabetes(0.4%),4 cases with diabetes and hypertension(1.7%),6 cases with coronary heart disease and hypertension(2.5%),1 case with coronary heart disease associated with diabetes and hypertension(0.4%).After treatment,31 cases were cured(13%).57 cases were significantly effective(23.9%).61 cases were effective(25.6%).89 cases were ineffective(37.4%).There were no significant differences in therapy results among different gender(P=0.284),age(P=0.326),side of disease(P=0.429),course of disease(P=0.102),and basic disease(P=0.952).There were statistically significant differences in therapy results between the patients without inducement and those induced by emotion(P=0.023)and noise(P=0.023).In total patients,there was no significant correlation between therapy results and tinnitus(P=0.126)or ear tightness(P=0.088).While in patients without vertigo,therapy results were related to tinnitus and ear tightness.(P=0.009,P=0.030)The therapy results of SSNHL was significantly different among SSNHL types(P<0.001),among which the low-frequency type had the best curative effect,the total effective rate was 85.2%.There was a significant difference in the therapy results between the flat type and the complete deafness type(P=0.001),the total effective rate was 57.7%and 64.9%respectively.High-frequency type of SSNHL had the worst curative effect and the total effective rate was 38.5%.The therapy results of SSNHL was related to the level of hearing impairment before treatment(P<0.001).The patients with mild deafness had the best curative effect,with the total effective rate of 68.6%.The therapy results of the moderate deafness(P=0.001),severe deafness(P<0.001)and extremely severe deafness(P<0.001)were all worse than mild deafness,with the total effective rate of 50.9%,66.0%and 65.3%respectively.There was no statistically significant difference in the therapy results between moderate deafness and severe deafness(P=0.064),while between severe and extremely severe deafness,there was a significant difference(P= 0.029).The therapy results of SSNHL were related to whether the patients were accompanied with vertigo or not(P<0.001).Among the vertigo group,6 patients were cured(4.6%),30 patients were significantly effective(22.9%),43 patients were effective(32.8%),52 patients were ineffective(39.7%).In the group without vertigo,25 patients were cured(23.4%),27 patients were significantly effective(25.2%),18 patients were effective(16.8%),37 patients were ineffective(34.6%).There was no statistical difference in the total effective rate between two groups(P=0.417),with 60.3%in the vertigo group and 65.4%in the non-vertigo group relatively.The types of SSNHL was related to vertigo(P<0.001).In the vertigo group,5 cases were low-frequency type(3.8%),3 cases were high-frequency type(2.3%),54 cases were flat type(41.2%),and 69 cases were complete deafness type(52.7%).In the group without vertigo,22 cases were low-frequency type(20.6%),10 cases were high-frequency type(9.3%),50 cases were flat type(46.7%),and 25 cases were complete deafness type(23.4%).MRI abnormality in the inner ear had a certain relationship with vertigo.The protein deposition in the inner ear had no significant correlation with the presence of vertigo(P= 0.059),and had a certain correlation with the effect of therapy(P= 0.016).The destruction of the blood-labyrinth barrier in the inner ear was associated with vertigo(P=0.004),but not with the effect of therapy(P=0.610).Bleeding in the inner ear was associated with vertigo(P=0.001),and was also associated with the effect of therapy(P= 0.018).Vertigo in patients was related to the results of the Caloric test(P=0.019).In the group without vertigo,68 patients had normal horizontal semicircular reaction on the affected side(69.4%),while 30 patients had weakened reaction(30.6%).In vertigo group,67 patients had normal horizontal semicircular reaction on the affected side(54.0%),while 57 patients had weakened reaction(46.0%).The curative effect of SSNHL was independent of Caloric test on the affected side(P=0.475).Vertigo was associated with bilateral cVEMP abnormality(P=0.043),and poor therapy effect of SSNHL had been find in bilateral cVEMP abnormality group(P=0.028).In patients without vertigo,the curative effect of SSNHL with abnormal cVEMP on the affected side was less effective(P=0.025).The vHIT results of horizontal semicircular canal,posterior semicircular canal,and anterior semicircular canal were significantly different(P<0.001),the abnormal function of anterior semicircular canal was less happened in unilateral SSNHL adult patients(6.1%).Meanwhile in unilateral SSNHL adult patients,the vertigo was related to vHIT results(P<0.001),the therapy effect of SSNHL was related to the vHIT results of the horizontal semicircular canal as well(P=0.029).ConclusionsIn adult unilateral SSNHL patients,the prognosis has no significant correlation with gender,age,side of disease,course of disease(?2 weeks)and basic disease(type 2 diabetes,essential hypertension and coronary heart disease).It has a certain correlation with the inducements of the disease.The prognosis of SSNHL is related to vertigo,type of SSNHL and degree of hearing impairment.In adult patients with unilateral SSNHL,bilateral vestibular saccule function decrease and abnormal high-frequency function of lateral horizontal semicircular canal may be the reasons for poor prognosis.In patients without vertigo,decreased vestibular saccule function on the affected side may be the reason for poor prognosis.Vestibular injury caused by inner ear hemorrhage may be one of the causes of vertigo in adult patients with unilateral SSNHL.Patients with internal ear hemorrhage prompted by MRI show poor prognosis. |
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