sudden deafness
Introduction
Brief introduction Sudden sputum is also known as idiopathic convulsions or violent sputum, that is, in the absence of tinnitus, deafness, unexplained sudden sudden onset of tinnitus, deafness, rapid loss of hearing within a few hours or days to reach the peak. More involved in a single ear, 40 to 60 years old adults with high incidence, binaural patients accounted for 1%, more men, easy to develop in spring and autumn. According to Byl (1977), the incidence rate was 10.7/100,000. The statistics of hearing clinics in Beijing Tongren Hospital accounted for 4.8% of the first-time hearing deafness. According to recent internal and external literature reports, the disease seems to have a gradually increasing trend. The symptoms of the disease are mainly based on the past no tinnitus, history of deafness, sudden onset of tinnitus, deafness, short-term peak of deafness, half with vertigo, general diagnosis is not difficult, but sometimes should be differentiated from Meniere's disease, after Early hearing loss is rare, showing a volatility hearing curve, hearing loss does not exceed 60dB, while the former has more than 60dB hearing loss. There are four types of hearing curve: high frequency type, low frequency type, high and low frequency mixed type and all, flat curve accounted for 70%, those with Fu Cong phenomenon accounted for 60%, vestibular function decreased, 80% belonged to normal, in order to exclude acoustic neuroma, should be done X-ray or CT bridge cerebellar angle scan Systemic examination should also be performed to exclude hypertension, diabetes and syphilis, blood diseases, etc. Those with conditions can be tested for virus isolation within 3 weeks after the illness. basic knowledge The proportion of illness: 0.03% Susceptible people: no specific population Mode of infection: non-infectious Complications: dizziness
Cause
Sudden sputum
Before the onset, there are often emotional, allergic reactions such as anger, depression, sadness, and other factors such as fatigue, drinking, pregnancy and changes in ambient temperature and temperature. According to the recent reports in more than ten years, there are no fewer than 200 causes, according to Morrison (1976). Central lesions accounted for 50%, post-cochlear lesions accounted for 17%, trauma 10%, and idiopathic 23%. The idiopathic causes are now described as follows:
I. Patients with viral infections have a history of upper respiratory tract infection within one month before onset. It is reported that the incidence of sudden onset of upper respiratory tract infection is 8% to 30%. It has been confirmed by serological and viral isolation methods that can cause abrupt virus. Mumps virus, measles virus, influenza and parainfluenza virus, adenovirus type III, etc., can cause viral endolymphatic labyrinthitis, herpes zoster virus can cause viral neuronitis and ganglion inflammation, the virus enters the inner ear The route of infection is:
1 through the blood circulation into the inner ear;
2 from the subarachnoid space through the cochlear aqueduct into the inner ear;
3 The middle ear mucosa diffuses into the inner ear. After infection, the virus proliferates a lot, adheres to the red blood cells, makes the blood flow stagnate and is in a hypercoagulable state, and the virus can cause endometrial edema, so it is easy to cause blood vessel embolism, resulting in inner ear blood. Transport obstacles, cell necrosis.
2. Inner ear vascular disease In patients with diabetes, hypertension, arteriosclerosis and cardiovascular disease, the inner vascular matrix is more prone to spasm and thrombosis, which may explain why patients are induced by fatigue, anxiety and other factors. The observation of blood lipids, cholesterol and blood flow maps in paralyzed patients has not been found to have important correlations with the onset of the disease. Wright (1975) reported a case of sudden ablation after cardiopulmonary bypass surgery, and Zhong Naichuan (1980) reported the Northwest Plateau 2 A case of erythrocytosis that induces abruptness, an example of a sudden convulsion caused by embolization of the inner ear.
Third, the inner ear window membrane rupture , sputum, vomiting, sexual intercourse and diving, etc., can cause venous pressure and cerebrospinal fluid pressure suddenly increased, in addition to causing snail window, vestibular window membrane rupture, can also cause vestibular membrane, mulch and The endolymphatic sac rupture, and the potential congenital inner ear malformation is more likely to occur, which can cause lymphatic ion disorder and cell poisoning. There is too much lymphatic fluid in Meniere's disease, which can also cause rupture of the volute window and sudden axon.
Prevention
Sudden sputum prevention
At present, there are many domestic treatment methods, and the curative effect is about 75%. It is also reported that nearly one-third of patients can self-heal without treatment, hearing loss is >90dB, high-frequency hearing loss is serious, age is over 40 years old, no tibia Muscle reflex or accompanied by severe vertigo, hearing recovery is not ideal, the prognosis is not good for patients with a course of more than one month.
Complication
Sudden sputum complications Complications
Symptoms such as dizziness, ear blockage, and nystagmus may occur.
1. Cerebrospinal inflammation: The trauma of the auricle, the bite of the insect and the incision of the superficial infection may cause perichondritis, which causes the accumulation of pus between the cartilage and the perichondrium. The blood supply to the cartilage is provided by the perichondrium. If the perichondrium is separated from both sides of the cartilage, the auricle will be deformed due to ischemic necrosis. The same effect can occur with septic necrosis. Perichondritis tends to be painless, prolonged and destructive. Often caused by Gram-negative bacilli.
2. Cartilage necrosis: After infection with suppuration, pus accumulates between the perichondrium and the perichondrium, and the cartilage gradually necrosis due to blood supply disorders.
3. Auricular deformity: acquired factors such as auricular trauma, infection, etc. can also cause severe auricular deformities, and some can be complicated by external ear canal stenosis or atresia, but generally without middle ear malformation.
4. Auricle contusion can rupture blood vessels.
Symptom
Sudden onset symptoms common symptoms ear block nausea hearing loss deafness tinnitus vertigo hearing loss ear vestibular function impaired
According to the past no tinnitus, history of deafness, sudden onset of tinnitus, deafness, short-term peak of deafness, half with vertigo, general diagnosis is not difficult, but sometimes should be distinguished from Meniere's disease, the latter early hearing loss is very Less, in a volatility listening curve, the hearing loss does not exceed 60dB, while the former has more than 60dB hearing loss. There are four types of hearing curves: high frequency type, low frequency type, high and low frequency mixed type and full , flat type curve 70%, 60% have Fu Cong phenomenon, less vestibular function, 80% belong to normal, in order to exclude acoustic neuroma, should be done X-ray or CT bridge cerebellar angle scan, also should be systemic Check, exclude high blood pressure, diabetes and syphilis, blood diseases, etc., conditional patients can be tested for virus separation within 3 weeks after the disease.
Schuknecht (1962) observed the histological observation of 4 cases of sacral bone and the animal experiment of Saito (1986). The pathological changes of the sputum showed destructive endocarditis-like damage, firstly damage the outer hair cells to the cochlear bottom. Zhou Weizhong, edema around the blood vessels, neuroepithelial necrosis, the augmentation can disappear, the balloon, the elliptical sac may be involved, but the semicircular canal damage is lighter.
More often in the evening or in the morning, initially felt low-frequency or high-frequency tinnitus in a single ear, and suddenly heard a sudden hearing loss after a few hours, from partial deafness to complete deafness, can last for hours or days, half of the patients with dizziness, more Feeling that the ear side is rotated, the severe one has nausea, vomiting, and the degree of deafness is often positively correlated with the severity of vertigo. The vertigo can gradually disappear within one week, and about one third of the patients can gradually recover within 1 to 2 weeks, such as a Hearing still does not recover after the month, and many will be deaf for permanent sexy voice.
Examine
Sudden sputum inspection
1. Systemic examination: should be directed to the cardiovascular system, coagulation system, metabolism and immune response, neurological examination should exclude the internal auditory canal and cerebellar cerebral horn lesions, vertebral basal and cerebral vascular circulatory disorders, such as intra-audio And cervical vertebrae, CT scan of the head, fundus and cerebral blood flow examination.
2. Laboratory tests: including blood, erythrocyte sedimentation rate, clotting time, prothrombin time, platelet count, etc. Serological tests for virus and antibody titer measurement, blood sugar, blood lipids, blood nitrogen and serum syphilis test.
3. Otoscopy: The tympanic membrane is often normal or reddish.
4. Hearing examination: the pure tone audiometry bone conduction threshold rises, generally above 50dB, the hearing curve classification is mainly flat type, there are also high frequency decreasing type, high frequency steep drop type or mild low frequency falling type, on the threshold Audiometry, speech audiometry, acoustic impedance audiometry, cochlear electrogram examination and auditory brainstem response are used to identify cochlear and post-cochlear damage, to understand the nature, extent and dynamics of hearing loss.
5. Vestibular function examination: should include temperature change test, positional nystagmus test, fistula test, Romberg test, asturbance electrogram examination if necessary, Yagi intelligent report 51 cases of sudden sputum, 50 side of the initial diagnosis for positional nystagmus Examination, 38 cases of location nystagmus, 48 of the nystagmus electrograms, 30 cases of horizontal nystagmus.
Diagnosis
Sudden sputum diagnosis
(1) Eustachian tube stenosis: Many sudden sputum manifestations are low-frequency hearing loss. The initial symptoms of these patients are ear suffocation and low-pitched tinnitus, which resembles the eustachian tube stenosis, and the stimuli after venting; It is also the same as the eustachian tube stenosis or the middle ear catarrhal; if the bone conduction mask is incorrectly used during hearing examination, the patient's sudden hearing loss curve is often detected. Therefore, the sudden sputum can be misdiagnosed as eustachian tube stenosis and delay treatment. It should also be noted that both diseases can occur simultaneously.
(B) Meniere's disease: sudden death is often accompanied by dizziness, but no repeated episodes, only one episode leads to deafness and end; there is no dynamic change in the middle and low frequency hearing threshold; the positive rate of resuscitation phenomenon is low, although both may have Peripheral vestibular dysfunction, but sometimes sudden accommodative nystagmus, visible spontaneous nystagmus to the affected side during the 3 days of onset, and then to the paralyzed nystagmus of the fast-moving side, Meniere's disease Almost all have resilience.
(C) Acoustic neuroma: review literature, auditory neuroma with abrupt performance is more common than the general understanding, Berg reported 133 cases of acoustic neuroma, 17 cases mainly manifested as a sudden, and 4 people recovered before the operation of acoustic neuroma resection With the auditory function, he proposed that the sudden patient, even if recovered, must exclude the possibility of a small brain cerebral horn tumor.
