儿童梅尼埃病与老年梅尼埃病的临床比较研究

摘要

目的 儿童和老年梅尼埃病(Meniere’s disease,M D)是该病的两个特殊群体,发病率均较低.本文比较分析两者的差异,增加对两类人群MD诊断的认识水平.方法 本文MD患者均来自解放军总医院耳鼻咽喉-头颈外科眩晕中心.从2004年1月至2007年7月共计586例.其中,儿童10例；老年人13例.患者接受纯音测听、耳蜗电图、前庭双温试验及前庭诱发的肌源性电位检查.结果 (1)发生率:儿童期MD的发生率为1.71％(10/586).老年的发生率为2.22％(13/586).(2)首发症状:儿童首发典型MD症状(耳蜗症状和前庭症状均具备),占40％(4/10),耳蜗症状占30％(3/10);首发旋转性眩晕占20％(2/10),倾倒感10％(1/10).老年典型MD症状占69 2％(9/13),耳聋伴眩晕者15.4％(2/13),旋转性眩晕为7.7％(1/13).倾倒感7 7％(1/13).(3)听力图类型儿童MD听力图有两种类型:低频下降型和平坦型.低频听力下降为主占70％(7/10)平坦型曲线占30％ (3/10).老年MD患者的听力图呈现多样性,发病时可呈现为覆盆型、平坦型和高频下降为主型,其中高频下降者在病程长短的患者中均可见到.(4)前庭功能:儿童与老年MD前庭功能检查结果同样表现为多样性,前庭功能检查结果正常或异常与病程无关.结论 儿童MD纯音听力的特征为低频下降,前庭功能的特征呈多样性；老年MD的纯音听力高频损失常较低频更为明显,前庭功能检查结果同样也表现为多样性.%Objective Meniere's disease is a rare condition in both the elderly(≥60yrs)and children(≤ 15yrs). This article focuses on and compares their clinical characteristics. Methods The elderly and children with Meniere's disease treated between January 2004 and July 2007 were studied and their clinical manifestation, electrocochleography (ECoG), veelibular evoked myogmic potential (VEMP), caloric test and pure tone audiogram data were investigated. Results (l)The prevalence of Meniere's disease in the elderly was 2.22% (13/586) and the prevalence of Meniere's disease in children was 1.71%( 10/586)with the youngest being 3 years old. (2)The initial symptoms in the children included cochlear and vestibular symptoms (n=4), cochlear symptoms only (n=3), spinning vertigo only (n=2) and drop attacks only (n=l); in the elderly, 2 cases presented with both cochlear and vestibular symptoms, 9 cases with only cochlear symptoms, 1 cases with only spinning vertigo and 1 case with only drop attacks. (3)The audiogram: audiogram patterns in thechildren included low frequency dropping (7 cases) and flat pure tone audiogram (3 cases). Audiograms in the elderly were variable including low and high frequency hearing loss, flat hearing loss, and high-frequency hearing loss of irrelevant durations. (4)Vestibular function were variable with no particular patterns in both the children and elderly. Conclusions The audiogram in the elderly Meniere' s disease patients appears to show prominently high frequency hearing loss, while that in children patients can show low frequency dropping or flat hearing loss patterns. Vestibular function test data in children and the elderly with Meniere 's disease seem to be variable with no particular patterns.