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Objective:To explore the mediating effect of self-regulation fatigue between acceptance of hearing impairment and work withdrawal behavior in young and middle-aged patients with sudden deafness, so as to provide reference for the formulation of intervention measures for job withdrawal behavior.Methods:A cross-sectional survey was conducted to facilitate the selection of 326 young and middle-aged patients with sudden deafness who were treated in the Department of Otolaryngology, Head and Neck Surgery in the First Affiliated Hospital and the Second Affiliated Hospital of Air Force Military Medical University of the Chinese PLA from February 2021 to January 2022. The survey was carried out by general information questionnaire, the Revised Acceptance Disability Scale, the Self-Regulatory Fatigue Scale, and the Work Withdrawal Behavior Scale. Structural equation model method was used to analyze the mediating effect.Results:The acceptance of hearing impairment score in young and middle-aged patients with sudden deafness was (59.82 ± 10.99) points, the self-regulation fatigue score was (60.38 ± 8.84) points, and the work withdrawal behavior score was (39.06 ± 6.51) points. Self-regulation fatigue was negatively correlated with acceptance of hearing impairment ( r=-0.541, P<0.01). Work withdrawal behavior was negatively correlated with acceptance of hearing impairment ( r=-0.488, P<0.01), and was positively correlated with self-regulation fatigue ( r=0.587, P<0.01). Self-regulation fatigue played a partial mediating effect between the acceptance of hearing impairment and work withdrawal in young and middle-aged patients with sudden deafness, and the mediating effect ratio was 56.30%. Conclusions:The acceptance of hearing impairment can not only directly affect the work withdrawal behavior of young and middle-aged patients with sudden deafness, but also indirectly affect their work withdrawal behavior through self-regulation fatigue. Medical staff should pay attention to the internal relationship between the acceptance of hearing impairment, self-regulation fatigue and work withdrawal behaviors, so as to improve the acceptance of hearing impairment of patients, relieve their self-regulation fatigue, and avoid the occurrence of work withdrawal behaviors.
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Abstract Objective Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) is an otologic emergency, and an early prediction of prognosis may facilitate proper treatment. Therefore, we investigated the prognostic factors for predicting the recovery in patients with ISSHL treated with combined treatment method using machine learning models. Methods We retrospectively reviewed the medical records of 298 patients with ISSHL at a tertiary medical institution between January 2015 and September 2020. Fifty-two variables were analyzed to predict hearing recovery. Recovery was defined using Siegel's criteria, and the patients were categorized into recovery and non-recovery groups. Recovery was predicted by various machine learning models. In addition, the prognostic factors were analyzed using the difference in the loss function. Results There were significant differences in variables including age, hypertension, previous hearing loss, ear fullness, duration of hospital admission, initial hearing level of the affected and unaffected ears, and post-treatment hearing level between recovery and non-recovery groups. The deep neural network model showed the highest predictive performance (accuracy, 88.81%; area under the receiver operating characteristic curve, 0.9448). In addition, initial hearing level of affected and non-affected ear, post-treatment (2-weeks) hearing level of affected ear were significant factors for predicting the prognosis. Conclusion The deep neural network model showed the highest predictive performance for recovery in patients with ISSHL. Some factors with prognostic value were identified. Further studies using a larger patient population are warranted. Level of evidence: Level 4.
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Objective:To investigate the effects of deafness capsule combined with vinpocetine injection on hearing function, hemorheology and T lymphocyte subsets in patients with sudden deafness.Methods:Eighty patients with sudden deafness who received treatment in Wenzhou Central Hospital from April 2017 to October 2019 were included in this study. They were randomly assigned to undergo treatment either with vinpocetine injection (control group, n = 40) or with deafness capsule combined with vinpocetine injection (observation group, n = 40) for 1 month. Efficacy, hearing function, hemorheology, T lymphocyte subsets and adverse reactions were compared between the control and observation groups. Results:Total response rate in the observation group was significantly higher than that in the control group [90.00% (36/40) vs. 67.50% (27/40), χ2 = 6.050, P = 0.014). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). After 1 month of treatment, plasma viscosity, high-shear whole blood viscosity, low-shear whole blood viscosity in the observation group were (1.21 ± 0.29) mPa·s, (2.41 ± 0.31) mPa·s, (5.25 ± 1.29) mPa·s respectively, which were significantly lower than those in the control group [(1.65 ± 0.22) mPa·s, (4.94 ± 0.36) mPa·s, (8.64 ± 1.32) mPa·s, t = 7.64, 33.68, 11.61, all P < 0.001). The percentages of CD 8+, CD 4+, and CD 4+/CD 8+ T lymphocyte subsets in the observation group were (24.28 ± 2.16)%, (46.05 ± 6.52)% and (1.90 ± 0.28) respectively, and they were (27.41 ± 2.09)%, (40.54 ± 5.48)%, (1.48 ± 0.24) respectively in the control group ( t = 6.58, 4.09, 7.20, all P < 0.001). Pure tone threshold in the observation group was significantly lower than that in the control group [(38.07 ± 4.82) dB vs. (51.97 ± 5.96) dB, t = 11.46, P < 0.001). Conclusion:Deafness capsule combined with vinpocetine injection is highly effective on sudden deafness. The combined therapy can improve the hearing function, hemorheology, and the immunological function of T lymphocyte subsets in patients with sudden deafness.
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Objective:To explore the clinical application value of each sequence by analyzing the characteristics of labyrinthine signal on MRI in patients with unilateral sudden deafness.Methods:Totally 52 patients of unilateral sudden deafness with inner ear MRI were analyzed retrospectively at Beijing Tongren Hospital, Capital Medical University from January 2016 to July 2019, all of which could find abnormalities in the labyrinth, including 17 cases of plain scan and 35 cases of enhanced scan, with sequences including plain T 1WI, enhanced T 1WI, plain and enhanced delayed 3D fluid attenuation inversion recovery (3D-FLAIR). The affected labyrinthine signal characteristics of each sequence were analyzed and the involvement sites were judged. The ability of each sequence to show labyrinthine abnormal signal was evaluated and scored. The Friedman test and Wilcoxon signed rank sum test were used to compare the subjective scores of the ability to show labyrinthine high signal in different sequences in plain and enhanced patients, respectively. Fisher′s exact probability method was used to analyze the relationship between the affected sites and the recovery of hearing, tinnitus and vertigo symptoms. Results:Fifty-two patients (100%, 52/52) showed labyrinthine high signal on T 1WI, 8 (15.4%, 8/52) showed higher signal and 3 (5.8%, 3/52) showed low signal on T 2WI. Thirty-five (100%, 35/35) showed high signal on enhanced T 1WI, among which 27 had enhancement (77.1%, 27/35). Fifty-two (100%, 52/52) showed significant high signal of the affected labyrinth on 3D-FLAIR (17 plain scan, 35 enhanced scan). The scores were 2 (2, 2), 3 (2, 3), 3 (3, 4) and 4 (4, 4) of T 1WI, enhanced T 1WI, plain and enhanced 3D-FLAIR respectively. The overall difference in subjective scores of plain T 1WI, enhanced T 1WI and enhanced 3D-FLAIR in enhanced patients was statistically significant (χ2=64.528, P<0.001), and the comparison between the two was statistically different (all corrected P<0.05). The plain 3D-FLAIR score was higher than the plain T 1WI in patients with a statistically significant difference ( Z=-3.729, P<0.001). Twenty-seven cases (51.9%, 27/52) exhibited high signal at the ampulla of semicircular canals, with a statistically significant difference in the distribution of hearing recovery or not ( P=0.001). Conclusions:Both T 1WI and 3D-FLAIR sequences can effectively identify the labyrinthine high signal, but the latter was better than the former of its ability to display, especially delayed enhanced 3D-FLAIR. The high signal at the ampulla of semicircular canals was a characteristic predictor of non-recovery of hearing.
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Sudden sensorineural hearing loss (SSNHL) refers to the sudden and unexplained sensorineural hearing loss within 72 h and a decrease in hearing of ≥30 dB affecting at least 3 consecutive frequencies. It is one of the common emergencies in neurology and otolaryngology. Early etiological evaluation and systematic and targeted treatment are very important for delaying the progression of SSNHL and restoring hearing. Recent studies have shown that SSNHL overlaps with vascular risk factors of ischemic stroke, and may predict the risk of ischemic stroke. SSNHL may be one of the clinical manifestation and even the prodromal symptoms of ischemic stroke, especially the infarction of the blood supply area of the anterior inferior cerebellar artery or its branch internal auditory artery. Although these factors can not fully reveal the relationship between SSNHL and ischemic stroke, they are enough to warn clinicians that they should consider the possibility of ischemic stroke when receiving patients with SSNHL. Screening of vascular risk factors for patients with SSNHL as early as possible is helpful to avoid the risk of recurrence of ischemic stroke.
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Objective@#The aim of this study is to explore the best administration, timing and efficacy of dexamethasone and Mison in the treatment of different types of sudden deafness. @*Method@#242 cases of sudden deafness first diagnosed in our department were selected. According to the guidelines（2015）, the patients were divided into low frequency descending type （49 cases）, high frequency descending type （66 cases）, flat descending type （71 cases） and total deafness （56 cases）. Different types of patients were randomly divided into tympanic injection group and systemic administration group on the basis of routine treatment. Tympanic injection group was further divided into initial injection group and delayed injection group. Tympanic injection was performed under ear endoscope, once every other day, three times for low frequency descending deafness, and five times for other types of deafness. @*Result@#In comparison of total effective rate, there were significant differences among the three treatments in 49 cases of low frequency descending type, 71 cases of flat descending type and 56 cases of total deafness type （P<0.05）. In 66 cases of high frequency descending type, there was no significant difference among the three treatments （P>0.05）. In the comparison of cure rate, the difference of cure rate among the three treatment methods was also significant in low frequency descending type （P<0.05）. In the other three types of deafness, there was no significant difference among the three treatment methods （P>0.05）. There was no significant difference in the effective rate between men and women （P>0.05） in all patients treated by tympanic injection. There was significant difference in the effective rate of tympanic injection within 7 days of onset and 7 days after onset （P<0.05）. @*Conclusion@#Intratympanic injection of dexamethasone is safe, effective, and easy to use as an initial treatment for low frequency descent, flat, and full deafness, and the sooner the better.
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As barreiras de comunicação têm impactos diretos nos resultados de saúde das pessoas surdas, que muitas vezes ficam expostas a riscos de tratamentos inadequados sem consentimento. Neste contexto, a comunicação tem papel fundamental na avaliação e implementação dos cuidados específicos para essa clientela. Trata-se de uma revisão integrativa da literatura cujo objetivo foi identificar, avaliar e sintetizar evidências acerca de como é feito o atendimento a pessoa surda nos diversos serviços presentes na área da saúde. As bases de dados Pubmed/Medline, CINHAL e LILACS foram utilizadas para a busca dos estudos primários indexados nos últimos 10 anos. Os descritores controlados foram delimitados de acordo com o vocabulário padronizado para cada uma das bases de dados. Dos 3.273 estudos localizados e considerando os critérios de seleção adotados, 86 estudos foram lidos na íntegra e 11 estudos primários foram incluídos na revisão integrativa. Foi utilizado um instrumento validado para a extração dos dados. A análise dos dados foi descritiva. Os estudos primários incluídos foram divididos em três categorias temáticas: Uso das línguas de sinais ou escritas, Atendimento por intermédio de terceiros (intérpretes e familiares) ou leitura labial e; Uso de tecnologias de informação e comunicação e outros dispositivos de mídia. Por meio dos estudos primários avaliados pode-se observar que ainda há uma ausência de adequação dos serviços de saúde com relação ao atendimento da pessoa surda. Entre elas foram identificadas a ausência de treinamento dos profissionais de saúde em linguagem de sinais, dificuldades na compreensão da linguagem escrita, dificuldade de acesso a intérpretes de línguas de sinais, dependência de familiares e amigos para acessar os serviços de saúde e, dificuldades com a leitura labial. Os dados desta pesquisa possibilitam aos profissionais de saúde e de enfermagem conhecer melhor quais lacunas na comunicação com os surdos devem ser preenchidas nos serviços de saúde e dessa forma orientar a prática assistencial e políticas para a inclusão destes.
Communication barriers have a direct impact on the health outcomes of deaf people, who are often exposed to the risks of inappropriate treatment without consent. In this context, communication has a fundamental role in the evaluation and implementation of specific care for this clientele. It is an integrative review of the literature whose objective was to identify, evaluate and synthesize evidence about how care is provided for the deaf in the various services present in the health area. The Pubmed / Medline, CINHAL and LILACS databases were used to search for indexed primary studies in the last 10 years. The controlled descriptors were delimited according to the standardized vocabulary for each of the databases. Of the 3,273 studies located and considering the selection criteria adopted, 86 studies were selected for reading in full and 11 primary studies were included in the integrative review. A validated instrument was used for data extraction. Data analysis was descriptive. The included primary studies were divided into three thematic categories: Use of sign or written languages, Assistance through third parties (interpreters and family members) or lip reading and; Use of information and communication technologies and other media devices. Through the primary studies evaluated, it can be observed that there is still a lack of adequacy of health services in relation to the care of the deaf person. Among them were identified the lack of training of health professionals in sign language, difficulties in understanding written language, difficulty in accessing sign language interpreters, dependence on family and friends to access health services, and difficulties with lip reading. The data of this research enable health and nursing professionals to better understand which gaps in communication with the deaf should be filled in the health services and in this way guide the care practice and policies for their inclusion.
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Humans , Sign Language , Communication Barriers , Comprehensive Health Care , Persons With Hearing Impairments , LipreadingABSTRACT
The aim of this study is to explore the best administration, timing and efficacy of dexamethasone and Mison in the treatment of different types of sudden deafness. 242 cases of sudden deafness first diagnosed in our department were selected. According to the guidelines（2015）, the patients were divided into low frequency descending type （49 cases）, high frequency descending type （66 cases）, flat descending type （71 cases） and total deafness （56 cases）. Different types of patients were randomly divided into tympanic injection group and systemic administration group on the basis of routine treatment. Tympanic injection group was further divided into initial injection group and delayed injection group. Tympanic injection was performed under ear endoscope, once every other day, three times for low frequency descending deafness, and five times for other types of deafness. In comparison of total effective rate, there were significant differences among the three treatments in 49 cases of low frequency descending type, 71 cases of flat descending type and 56 cases of total deafness type （0.05）. In the comparison of cure rate, the difference of cure rate among the three treatment methods was also significant in low frequency descending type （0.05）. There was no significant difference in the effective rate between men and women （>0.05） in all patients treated by tympanic injection. There was significant difference in the effective rate of tympanic injection within 7 days of onset and 7 days after onset （<0.05）. Intratympanic injection of dexamethasone is safe, effective, and easy to use as an initial treatment for low frequency descent, flat, and full deafness, and the sooner the better.
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OBJECTIVE To analyze the damage range and objective evaluate the vestibular function impairment in patients with sudden deafness at the same time of cochlea damage. To explore the difference of vestibular function damage in patients with sudden deafness with different hearing loss curve types. METHODS Sixty patients with unilateral sudden deafness and vertigo who were hospitalized in our department from August 2016 to August 2018 were selected as experimental group. There were 11 cases of low frequency descending type, 15 cases of flat descending type, 18 cases of high frequency descending type and 16 cases of total deafness type. Sixty healthy volunteer as control group. Two groups of patients underwent caloric test, ocular vestibular evoked myogenic potential(oVEMP), cervical vestibular evoked myogenic potential(cVEMP) and video head impulse test(vHIT). RESULTS The abnormal positive rate of caloric test, oVEMP and cVEMP in the control group was 10.3％, 26.7％, 16.7％ respectively. The abnormal positive rate of caloric test, oVEMP and cVEMP in the experimental group was 68.3％, 60.3％, 43.7％ respectively. The difference between the two groups is statistically significant. The abnormal positive rate of vHIT in the control group was 13.3％. The abnormal positive rate of vHIT in the experimental group was 51.6％. The difference between the two groups is statistically significant. The positive rate of vestibular dysfunction in patients with total deafness and ascending type was higher than that of flat type and descending type, but there was no significant difference between f lat type and descending type. CONCLUSION Patients with sudden deafness may be accompanied by impaired cochlea and vestibular function in different ranges. The vestibular function of patients with sudden deafness can be evaluated effectively by combined caloric test, oVemp, cVEMP and vHIT. The incidence of vestibular dysfunction in patients with total deafness and ascending sudden deafness was higher than that of flat type and descending type. And there was no significant difference in the incidence of vestibular function injury between flat type and descending type patients.
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OBJECTIVE To discuss the correlation between effectual time and the curative effect in patients with all frequency descending sudden deafness. METHODS According to effectual time,the subjects were divided into first week effectual group and second week effectual group and the curative effect of each group was compared. RESULTS In patients with flat descent sudden deafness, the curative rate of the first week effectual group was higher than that of the second week effectual group, but there was no significant difference between the two groups(χ2=1.599, P =0.206). Meanwhile, the total significant effective rate of the first week effectual group was higher than that of the second week effectual group, without obvious difference between the two groups(χ2=0.124, P =0.725). Furthermore, in patients with total deafness type of sudden deafness, the curative rate of the first week effectual group was higher than that of the second week effectual group, showing no remarkable difference between the two groups(χ2=2.493, P =0.114). Besides, there was no remarkable difference in the comparison of the total significant effective rate (χ2=2.308, P =0.129), which was higher in the first week effectual group than that in the second week effectual group. CONCLUSION The course of treatment should be at least 2 weeks in patients with all frequency descending sudden deafness after onset.
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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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@#Sudden sensorineural hearing loss (SSNHL) is an otology emergency and carries significant morbidity if the diagnosis is missed. It can present to any specialty but in our local setting the patient usually presents to primary care as it is easily accessible. We present a case of SSNHL that was initially presented to a primary care centre and the patient was reassured without any investigation being carried out. SSNHL has many causes thus making diagnosis difficult. However, with knowledge of its possible, a diagnosis can be made and appropriate management can be advocated to the patient. Hence, we discuss the three main causes of SSNHL, while emphasizing the immune system-mediated mechanism as the main cause in this case.
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Objective@#To investigate the proper time of intratympanic steroid as combination therapy in treatment of patients with profound sudden sensorineural hearing loss(SSNHL) of total frequency type.@*Methods@#This prospective study included 50 patients with SSNHL in the First Affiliated Hospital of Chongqing Medical University from June 2017 to February 2018.All these patients had profound hearing loss averaged more than 81 dB at all frequencies (250-8 000 Hz). They were divided into two groups.The patients in group A were treated with simultaneous oral prednisone (1 mg/kg, qd) and intratympanic methylprednisolone (40 mg, qd) for 5 days.The patients in group B were treated with oral prednisone for 5 days as in group A, and then those who had no significant improvement were subsequently treated with intratympanic methylprednisolone (40 mg, qd)for further 5 days.All patients were treated with additional intravenous batroxobin and ginkgo biloba leaves extract.Following examination of pure tone audiogram, hearing gains and effective rates were statistically analyzed in both groups with SPSS software package(version 20.0).@*Results@#Hearings in both groups were improved significantly after treatment.In group A(20 cases), hearing gain was (29.2±22.7) dB and total effective rate was 65.0%, while in group B(22 cases), they were (27.3±22) dB and 68.2% respectively.There were no significant differences in hearing gain and recovery rate between two groups (hearing gain, P=0.793; total effective rate, P=0.827).@*Conclusions@#For patients with profound SSNHL of total frequency type, the efficacies of intratympanic steroid as simultaneous and subsequent therapy are equivalent. Therefore, subsequent intratympanic glucocorticoid is recommended for SSNHL patient of total frequency type to reduce complications and medical expenses.
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Objective@#To analyze the correlation between the changes of fibrinogen and the treatment effect of all-frequency sudden deafness, and to explore the individualized treatment strategy for the use of Batroxobin.@*Methods@#Patients with all-frequency sudden deafness who were admitted to Department of Otorhinolaryngology, People′s Hospital of Peking University, from January 2010 to September 2016 were selected. All patients were given standard treatment and regular use of Batroxobin. Value of fibrinogen on D1 (before treatment) / D3 / D7 (±1) and D14 (±2) were recorded, at the same time, the correlation between the changes of fibrinogen and prognosis of all-frequency sudden deafness by the audiograms of onset and after-treatment of all patients were analyzed. Independent t-test was used to analyze normal distributed measurement data and chi square linear trend test was used to analyze the curative effect of different fibrinogen groups.@*Results@#A total of 148 patients were included, the outcomes were worst when the patient′s fibrinogen was below 2 g/L or above 4 g/L before treatment, ineffective rate were both 50%. The fibrinogen was lowest when the treatment came to the third day. Normally, the patient′s prognosis was best when this value waved between 0.7 and 0.9 g/L, with a total effective rate between 73.9% and 83.3%. The fibrinogen value of the 7th day was a good indicator of the outcome, and Fib7 value was significant lower in patients of effective group than ineffective ones ((1.25±0.37)g/L vs (1.38±0.35) g/L, t=-0.27, P=0.04). Patients found a best recovery when Fib7 was below 1 g/L, and the higher the Fib7 value, the higher the inefficiency (χ2=7.55, P=0.01). Batroxobin showed safety during the treatment and found no complications.@*Conclusion@#The change of fibrinogen in the process of all-frequency sudden deafness is closely related to the curative effect.
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Objective To investigate the clinical characteristics and prognosis of Idiopathic sudden sensorineural hearing loss (ISSHL) in the elderly.Methods 215 older patients with ISSHL from the department of ENT in our hospital during 2010.12-2015.12 were collected.To analyze the effect of clinical characteristics,the type of hearing curve and the impact of family area on the prognosis of patients.Results Among the 215 elderly patients with ISSHL,there were 105 male patients (48.8％),110 female patients (51.2％),mean age 61-95(65.1 ± 14.6)years;including 197 cases of unilateral deafness (91.6％),bilateral hearing loss in 18 cases (8.4％);treatment onset time of 0.5-40 days,the median was 7 days in time.Deaf type force curve in 103 cases (47.9％),in high frequency descent type in 45 cases (20.9％),41 cases of flat type (19.1％),low frequency descent type in 26 cases (12.1％).After standard treatment,36 cases were cured,90 cases improved,89 cases ineffective,the total effective rate was 58.6％.After statistical analysis,the patient's hearing curve type,the side,first visiting time,and the prognosis from the urban or rural areas had significant effects on the prognosis of the patients,and the effect was statistically significant (P ＜ 0.05).Conclusions The prognosis of ISSHL in elderly patients is significantly related to the side of the disease,visiting time,the type of hearing curve,and the patients from the urban or rural areas.
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Objective@#To investigate the correlation between the proliferation inhibition effect of glucocorticoid (GC) on peripheral blood mononuclear cell (PBMC) and the pure tone average (PTA) improvement in SSNHL patients.@*Methods@#Sixty inpatients with SSNHL were included from July 2013 to October 2015 in Nanjing Drum Tower Hospital, Medical School of Nanjing University. Peripheral venous blood was collected before receiving treatment, then the PBMC was isolated for GC proliferation inhibition. PBMCs of each patient were cultivated into 4 groups: Group A: PBMCs+ Medium; Group B: PBMCs+ Medium+ lipopolysaccharide (LPS, 1 μmol/L); Group C: PBMCs+ Medium+ LPS+ Dexamethasone; Group D: Medium. PBMCs were maintained in a humidified 5% CO2 atmosphere at 37°C and were observed after 24 hours. 5-diphenyltetrazolium bromide (MTT) was used to measure PBMC proliferation inhibition rate. The PBMC proliferation inhibition rates were calculated according to the absorbance at 490 nm wavelength under a microtiter plate reader. Independent sample t tests of PBMC proliferation inhibition rate were performed between different groups. χ2 tests were performed between gender, affected ear side, accompanied by vertigo or not, audiometric curve, time period from onset to treatment, PBMC proliferation inhibition rate and the improvement of pure tone average (PTA). Linear correlation analyses were performed between PBMC proliferation inhibition rate, the time period from onset to treatment and the hearing improvement.@*Results@#The proliferation inhibition effect of GC on PBMC varied significantly among patients. The PBMC proliferation inhibition rate in GC insensitive group was lower than that in GC sensitive group (26.72%±21.82% vs 64.44%±25.48%, t=6.113, P<0.05). The PBMC proliferation inhibition rate in refractory group was lower than that in initial group (40.93%±28.57% vs 57.04%±31.19%, t=2.035, P=0.046). There was no statistical significance between gender, affected ear side, accompanied by vertigo or not, audiometric curve and the hearing improvement (χ2 value was 2.320, 0.031, 2.143, 0.106, respectively, all P>0.05). Both in initial group and refractory group, the linear correlation analyses showed a significant positive correlation between PBMC proliferation inhibition rate and the PTA improvement (r value was 0.615, 0.657, respectively, all P<0.05), as well as a significant negative correlation between time period from onset to treatment and the PTA improvement(r value was -0.542, 0.370, respectively, all P<0.05).@*Conclusions@#The proliferation inhibition rate of PBMC in vitro by GC is correlated with patients′ hearing improvement. The proliferation inhibition test might be used to predict the sensitivity to GC treatment and be helpful for individualized treatment of SSNHLin clinical practice.
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OBJECTIVE To evaluate the efficacyand safety of intratympanic injection of steroids in the treatment of sudden hearing loss with diabetes.METHODS PubMed, Medline, CNKI, CBM, VIP, and Wanfang databases were searched by electronic retrieval to collect documents meeting the inclusion criteria and extract data.Meta-analysis was performed using RevMan 5.3.RESULTS There were 9 articles included in the literature search,a total number of 587 ears, of which 294 ears accepted intratympanic injection of steroids as the experimental group. Another 293 ears was control group,of which 217 ears accepted systemic steroids and 76 ears accepted non-hormone therapy.Meta analysis results showed that the clinical effect of experimental group was more remarkable than that of the control group (Z=3.65, P<0.05;Z=3.70,P<0.05). The influence on blood sugar in experimental group was smaller than that of the control group (χ2=7.471,P<0.05). Other complications of intratympanic steroid injection were self-healing after tympanic membrane perforation, transient dizziness and so on.CONCLUSION There was a significant effect on patients with sudden hearing loss and diabetes through intratympanic steroid injection. It has little effect on blood glucose and slight complications, which is a priority in clinical practice.
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OBJECTIVE To analyze the effect of postaural injection in treating SNHL and the influence on ROS,sVCAM-1 levels.METHODS 242 low frequency descent sensorineural hearing loss patients from Jan.2010 to Jul.2016 in our hospital were selected as the research sbjects.They were randomly divided into two groups(n=121).All patients were treated with ginkgo biloba extract intravenous drip.The control group was treated with Methylprednisolone intravenous drip,while the observation group was treated with postaural injection of Methylprednisolone.The clinical effects between the two groups were compared after 14 days of treatment.The ABR result,serum ROS,sVCAM-1 levels were also copmpared before and after treatment.RESULTS The effective rates of 2 groups were 82.64％,61.16％ respectively,which indicated significant difference (P＜0.05).The Ⅰ and Ⅴ waves of observation group were decreased,and they was significantly lower than that of the control group(P＜0.05),the R-R interval between Ⅰ and Ⅴ waves of the 2 groups showed no significant difference (P＞0.05).After treatment,the serum ROS level of 2 groups were (0.66 ± 0.38) ng/ml,(2.31± 1.12) ng/ml respectively,the sVCAM-1 level of two groups were (230.5 ±26.4) ng/ml,(312.6 ±47.2) ng/ml respectively,the observation group was significantly lower than that of the control group (t=10.985,11.953,P＜0.05).CONCLUSION Methylprednisolone can improve the clinical effect in treating low frequency descent SNHLby improving the concentration of drugs in ear and increasing the activity of Na+/K+-ATP enzyme in blood vessel;It can also decrease ROS and sVCAM-1 level,alleviate oxidative stress,reduce vascular endothelial damage,which is worthy of recommendation.
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OBJECTIVE To compare the effects of post-aural injection of methylprednisolone and dexamethasone in flat-type sudden hearing loss.METHODS 142 patients with flat-type sudden hearing lossin our hospital were selected and divided into methylprednisolone group and dexamethasone group randomly.All patients in these two groups received local injection of glucocorticoidsoncein mastoid periosteum.Patients in methylprednisolone group were injected methylprednisolone solution;Patients in dexamethasone group were injected dexamethasone solution.The efficacy,hearing improvement of two groups were compared.RESULTS After the treatment,the recovery rate of methylprednisolone and dexamethasone group were 25.35％ and 16.90％,the total effective rate was 88.73％ and 63.38％,respectively;Each clinical index between two groups had statistically significant difference (P＜0.05);Moreover,the hearing improvement in methylprednisolone group was much better than dexamethasone group,withan averagedincrease of (26.5 ±4.3) dB in 125-250 Hz in methylprednisolone group while only (18.5 ± 6.2) dB in 125-250 Hz in dexamethasone group,which demonstrated statistical significantly difference(P＜0.05).CONCLUSION The clinical efficacy of local injection with methylprednisolone was better than dexamethasone,and demostrated mild adverse reactions,which could be widely applied in clinical therapy.
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OBJECTIVE To explore the difference of vestibular damage between sudden deafness and vestibular neuritis.METHODS Patients in otolaryngology head and neck surgery eenterin PLA general hospital from February 25 in 2016 to July 20 in 2016 were included in this research.Among these patients,55 cases were diagnosed as sudden deafness group,including 39 cases With vertigo.And other 46 cases were diagnosed as vestibular neuritis.Vestibular bithermal caloric test,head impulse test(head impulse test,HIT),cervical vestibular evoked myogenic potentials(cervical vestibular evoked myogenic potential,cVEMP),ocular vestibular evoked myogenic potentials(ocular vestibular evoked myogenic potential,oVEMP) were performed to evaluate their vestibular function and were compared.RESULTS The abnormal rate of vestibular bithermal caloric test in sudden deafness group 25.45％,and 97.82％ in vestibular neuritis group.There was significant difference between two groups(x2=54.01,P＜0.001).HIT:the abnormal ratein sudden deafness groupwas 9.09％ and 32.61％ in vestibular neuritis group,there was significant difference between two groups(x2=8.72,P=0.003).VEMP:the abnormal rate of cVEMP in sudden deafness group was 69.10％ and 43.47％ in vestibular neuritis group,there was significant difference between two groups(x2=6.72,P=0.010).But the abnormal rate of oVEMP in sudden deafness group was 54.55％ and 63.04％ in vestibular neuritis group,and there was not statistically significant difference between two groups(x2=0.745,P=0.388).CONCLUSION The vestibular damage of sudden deafness with vertigo was more likely involved with saccule and inferior vestibular nerve,more close to the nerve terminal,and the injury was in a low frequency range;but the vestibular damage in vestibular neuritis was wider,and the injury involved a full band,the damaged part may be higher.