| Part 1:Extended high frequency clinical study of patients with sudden tinnitus Objective To explore the diagnostic significance of extended high-frequency audiometry for early hearing impairment in patients with sudden tinnitus.Methods Twenty-six patients(39 ears)with sudden onset of tinnitus between the ages of 20 and39 were enrolled as the experimental group.At the same time,16 cases(32 ears)with normal hearing and no tinnitus were selected as healthy controls.Results The frequency thresholds of the experimental group at 0.125 k Hz and 20 k Hz were significantly higher than those in the control group(P < 0.05).The undetected rate at 16 to 20 k Hz increased,and the difference in undetected rate at 20 k Hz was significant(P < 0.05).Conclusion Extended high-frequency audiometry can be used as a basis for the diagnosis of early hearing loss in patients with sudden tinnitus.Sudden tinnitus with normal conventional frequency may be an early reminder to extended high-frequency sudden deafness.Part 2:Extended high frequency clinical study of patients with sudden high-frequency drop-type deafnessObjective This study intends to Compare the high-frequency difference between patients with sudden high-frequency drop-type sensorineural deafness and patients with sudden tinnitus and normal people,to further explore the significance of the diagnosis of sudden deafness by extended high-frequency audiometry.Methods Pure tone audiometry and extended high-frequency(9k~20k Hz)audiometry for 71 patients(91ears)with sudden high-frequency drop-type sensorineural deafness and sudden tinnitus.Divided into four groups according to the degree of high frequency hearing impairment:Group I:(32 ears)sudden tinnitus patients(conventional pure tone hearing threshold below 25 decibels,but sudden subjective tinnitus);Group II:(20 ears)patientswith mild(26 ~ 40 d BHL)sudden high-frequency drop-type sensorineural deafness;Group Ⅲ :(22 ears)patients with middle,severe(41 ~ 70 d B HL)sudden high-frequency drop-type sensorineural deafness;Group Ⅳ :(17 ears)patients with Severe or more(71 decibels or more)sudden high-frequency drop-type sensorineural deafness,compared with 16 case(32 ears)healthy controls.Results There is no significant change in the normal frequency listening threshold(7 ~ 10 d B HL);The threshold of 0.125 k Hz in group I was significantly higher than that in normal control group,and the difference was statistically significant(P <0.05).The threshold of 1 k Hz in group II-IV was no different from that in normal control group(P > 0.05).The standard deviation of the conventional frequency average hearing threshold of the normal group is small(3.837~7.351 d B HL),which is smooth,extended high-frequency variability increases(9.161 ~ 23.517 d B HL).The frequency deviation of the frequency thresholds of each group gradually increases with the increase of the frequency.As the frequency increases,the extended high-frequency hearing threshold increases;the frequency increases to a certain extent,the hearing threshold detection rate decreases,and the sensitivity decreases.There was a statistically significant difference between the normal control group and the I group at 20 k Hz(P < 0.05).The hearing threshold of the normal group(9k~18k Hz)was significantly lower than that of the group II-IV(both P<0.001),and the difference is ≥20 d B HL at 9-16 k Hz;In the normal group,16 k Hz,18 k Hz and 20 k Hz,the maximum sound intensity is unresponsive(the hearing threshold cannot be detected),and the undetected rate in the group I-IV was significantly higher than that in the normal group(all P < 0.05).Conclusion(1).Sudden high-frequency drop-type sensorineural deafness patients,the more the high frequency decline,the more serious the extended high-frequency damage is.From the conventional pure tone perspective,these patients may have only 1 to 2 frequency damage,but the damage is as high as 2/3 or more from the full frequency perspective.(2).For patients with mild(26to 40 d B HL)sudden high-frequency drop-type sensorineural deafness patients,especially for patients with hearing loss at only 8k Hz,it is essential to perform extended high-frequency examinations,and their extended high-frequency hearing loss mayexceed 20 d B HL,this may actually be an extended high-frequency sudden deafness that has not been recognized before.It is easy to be ignored by doctors.The discovery of this sudden deafness is great significance for people to re-recognize sudden deafness.Part 3:The clinical observation of extended high-frequency hearing threshold loss of the healthy side ear of patients with unilateral deafnessObjective The extended high-frequency pure tone hearing threshold of the healthy side ear of patients with unilateral deafness was analyzed.Methods Pure tone audiometry and extended high-frequency audiometry were performed on 76 patients,Age 20-39 years old,the average age was 29.37±4.741 years(46males,29.17±4.454 years,30 females,29.67±5.215 years)with unilateral deafness.The air conduction frequency ranges from 125 Hz to 20 k Hz,and compared with 30 healthy controls(60 ears),Age 20-39 years old,the average age of 26.20±4.513 years(male 14 ears 27.33±2.251 years,female 46 ears 26.07±4.694 years).At the same time,the patients with unilateral deafness were divided into 60 patients with a course of disease Less than half a year,with an average age of 29.32±4.883 years old(37 males,29.16±4.598 years old,23 females,29.57±5.409 years old).And 16 patients with a course of more than half a year,the average age was 31.00±5.376 years(11 males,30.82±5.076 years old,5 females,31.39± 5.595 years old)and compared between groups.Results Compared with the normal hearing group,the extended highfrequency hearing threshold of the unilateral deafness group was reduced at 9k,10 k,11.2k,12.5k,14 k,16k,18 k,20k Hz,and the difference was statistically significant(P<0.05).The constant frequency hearing threshold decreased at 0.125 k and 0.25 k Hz,and the difference was statistically significant(P<0.05).Compared with the normal hearing group,the full-frequency of the affected side of patients with unilateral deafness decreased at 0.125-20 k Hz,and the difference was statistically significant(P<0.05).Compared with the group with a course of less than half a year,the group with a course of more than half a year,the extended high-frequency hearing threshold was worse in 14 k,16k,18 k,20k,however,all frequency differences were not statistically significant(P>0.05).Conclusion Patients with unilateral deafness may have hiddenhearing loss in the healthy ear,which provides another new theoretical and experimental basis for early intervention of unilateral deafness。It is recommended to perform extended high-frequency routine testing on the healthy ear of patients with unilateral deafness.Part 4:The clinical characteristics and prognosis analysis of hearing in patients with sudden deafnessObjective Retrospective analysis of the clinical features and efficacy of hearing in patients with sudden deafness,providing a basis for disease prevention,diagnosis and treatment.Methods A total of 56 patients with sudden deafness of 16-85 years old who were admitted to the Department of Otorhinolaryngology,General Hospital of Chinese People’s Liberation Army from November 2018 to May 2019,analyze the influence of gender,hearing loss,and type of hearing curve on prognosis.Results Of the 56 patients(59 ears)with sudden deafness,40 were male and 19 were female;53were unilateral and 3 were bilateral;the mean age was 43.47 ± 16.51 years.Basic statistics and regression analysis were performed on the data.Among them,gender(In normal frequency therapy,male patients are less effective than female patients.In expanding high-frequency therapy,male patients are more effective than female patients),hearing loss(Extremely severe hearing loss has the highest total efficiency(70.58%)),and hearing curve(In the case of constant frequency therapy,the high frequency reduction type has the lowest total effective rate(20.00%);the extended high frequency treatment,the full frequency flat type extended high frequency treatment has the highest total efficiency(53.33%),which is significant compared with other types difference)are beneficial to the curative effect,both of which are statistically significant..Conclusion The treatment of patients with sudden deafness is based on a comprehensive analysis of the degree of full-frequency hearing loss and curve classification,and a comprehensive assessment may be more conducive to the treatment and prognosis of patients with sudden deafness. |
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