突发性聋伴良性阵发性位置性眩晕病例分析并文献复习

摘要

Objective:To summarize the clinical characteristics of the patients suffering from sudden senserineural hearing loss (SSNHL) with benign paroxysmal positional vertigo (BPPV),and to investigate the possible pathogenesis.Methods:The clinical materials of thirsty-five patients with SSNHL complicated with vertigo were retrospectively analyzed.The clinical information,including the traits of vertigo and prognosis of hearing loss of the patients in SSNHL with BPPV group (n=9),and SSNHL with non-BPPV group (n=26) were compared.Results:All patients had profound hearing loss and unsatisfied prognosis of hearing loss,and the response rate was 17.1％,the effective rate was 11.4％,and the curative rate was 5.7％.25.7％ of all cases were diagnosed of BPPV by medical history and postural tests,who had heavier hearing loss than the others.And BPPV comlicated with SSNHL was often found within 1 week after the hearing loss (average value:4.1 d),and all on the same side with the hearing loss ear.BPPV tended to happen in total deafness (6 cases,66.7％) and flat type (3 cases,33.3％),and were often involved in horizontal semicircular canal (6 cases,66.7％) and posterior semicircular canal (3 cases,33.3％).The patients with SSNHL complicated with BPPV needed more times of reduction maneuver (average value:2.3 times),with a satisfied therapeutic effect for reducing the vertigo of the patients.Conclusion:SSNHL complicated with BPPV has a high morbidity in the patients with heavy hearing loss,and often affect the horizontal semicircular canal,which needs the repeated reduction maneuver.%目的:总结突发性聋(SSNHL)伴良性阵发性位置性眩晕(BPPV)患者的临床特点,探讨其可能的发病机制.方法:回顾性分析35例SSNHL伴有眩晕患者的临床资料,比较SSNHL伴BPPV组(9例)与SSNHL伴非BPPV组(26例)患者眩晕发病特点及听力治疗情况等临床特点.结果:SSNHL伴眩晕患者的听力损失较重,预后较差,听力损失治疗有效率为17.1％,显效率为11.4％,治愈率为5.7％.病史及体位试验检查,确诊BPPV的患者占SSNHL伴眩晕患者的25.7％,这些患者的听力损失较SSNHL伴非BPPV组听力损失更重.SSNHL伴发的BPPV多于SSNHL发病1周内出现(平均4.1 d),常发生于全聋型患者(6例,占66.7％),其次为平坦下降型SSNHL患者(3例,占33.3％);所有患者的BPPV均发生于SSNHL受累的同侧耳,最常累及水平半规管(6例,占66.7％),其次为后半规管(3例,占33.3％),本组病例中未出现上半规管BPPV.SSNHL伴BPPV患者常需要多次复位治疗(平均2.3次),但复位后患者头晕症状缓解较快,后遗症状轻.结论:SSNHL伴BPPV发病率较高,常发生于重度听力损失患者中,且最常累及水平半规管,多次手法复位治疗有效.