目的 研究内耳出血致突发性聋伴眩晕患者的临床特点及可能发病机制.方法 研究分析2016年1月至2017年5月在中山大学附属第一医院住院的内耳出血致突发性聋伴眩晕患者30例临床资料,分析其眩晕临床特点、耳蜗及前庭功能变化、治疗随访效果.结果 30例患者眩晕症状均表现为天旋地转,伴恶心呕吐,其中11例持续24 h至3d,19例持续时间3～14 d;其中24例(80％)耳鸣数小时后耳聋与眩晕同时出现;全部30例患者患侧听力为极重度感音神经性聋,视频眼震电图均提示患侧半规管功能异常,耳石器功能检查均提示患侧颈源性前庭诱发肌源性电位(C-VEMP)、眼源性前庭诱发肌源性电位(O-VEMP)异常,其中合并良性阵发性位置性眩晕(BPPV)10例(10/30,33.3％).入院后经过相应治疗,出院时6例听力改善,有效率20％,16例患者仍头晕、走路不平稳,持续1～2个月渐消退.随访6个月,30例患者听力恢复差,其中9例(30.0％)患者半规管功能恢复正常,耳石器功能部分恢复;9例(30.0％)患者遗留快速头动或转身时出现一过性晕感即失平衡症状.结论 内耳出血致突发性聋伴眩晕患者临床特点为前庭性眩晕伴极重度感音神经性聋,前庭功能严重损害,部分患者合并BPPV,前庭和耳蜗症状一般同时出现,该类患者治疗效果差,预后不良.%Objective To analyze the clinical features and possible pathogenesis of sudden deafenss and vertigo induced by inner ear hemorrhage. Methods Clinical data of 30 patients with inner ear hemorrhage, from the first affiliated hospital of Sun Yat-sen university during Jan 2016 to May 2017, were retrospectively analyzed. Results Vergito and profound deafness were seen in all patients. The duration of vertigo ranged from 24 hours to three days in 11 cases, three to 14 days in the remaining 19 cases. Simultaneous occurrence of vergito and deafenss were seen in 24 patients. Semicircular canal hypofunction and abnormal cervical vestibular evoked myogenic potentials(C-VEMP)/ocular vestibular evoked myogenic potentials(O-VEMP) were detected in all cases. Ten patients had benign paroxysmal positional vertigo (BPPV) simultaneously. Hearing recovered in 20％ of the cohort posttreatment. Dizziness and balance disturbance disappeared 1 to 2 months after therapy in 16 cases. Long term (6 months) follow up revealed poor hearing outcome and vestibular rehabilitation. Conclusion Vestibular vertigo and profound sensorineural hearing loss, with unsatisfactory clinical prognosis, constituted the characters of inner ear hemorrhage-associated sudden deafness.
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