急性感音難聴 : 1診療所における6年間227症例の検討  [in Japanese] Acute Sensorineural Hearing Loss in 227 Outpatient Cases  [in Japanese]

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Abstract

診療所における急性感音難聴の実態を明らかにする目的で, 当院にて診療した症例について検討した. 平成6年10月より12年9月までの6年間に17, 146名の患者が来院したが, 急性感音難聴は227例 (1.3%) あった. 中等度以上の突発性難聴は45例 (20%), 急性低音障害型感音難聴は111例 (49%), それ以外の軽症の突発性難聴は35例 (15%), メニエール病が13例 (6%), 回転性めまいを伴った急性低音障害型感音難聴が9例 (4%) あった. その他の難聴14例 (6%) は, 音響外傷によるものが7例, 心因性, ムンプス, 聴神経腫瘍がそれぞれ1例あり, 外リンパ瘻, 糖尿病性腎症によるものではないかと思われた症例が1例ずつあった. 側頭部外傷後の難聴が2例あり, 内耳振盪によるものではないかと考えた.<BR>中等度以上の突発性難聴の場合, 発症から1週間以内に治療をはじめた群では60%が著明回復以上だったが, 8日以後にはじめた群では著明回復以上のものはなかった. 急性低音障害型感音難聴は男女比1: 2.3と女性に多く, 予後は良く, 不明例を除けば79%が治癒であった. 予後不明の者が19名 (17%) いたが, 経過がよかったので, 最終的確認前に通院しなくなったのではないかと想像する. 他の原因不明の軽症難聴は著明回復以上が58%で, 予後は比較的に良かった. メニエール病の聴力障害は予後がよくなかった. 音響外傷による難聴は水平型の高度低下を除けば予後はよい. 小児の心因性難聴は治癒したが, ムンプスによる1例は一側が聾となった. 中等度以上の突発性難聴の22%, 音響外傷以外の突発難聴では, 29%の患者は予後不明であったが, 重い症例や原因がはっきりしない場合は患者自ら大きな施設や専門病院を受診するからではないかと考える.

Subjects were 227 patients with acute sensorineural hearing loss of 17, 146 patients seen at our ear, nose, and throat (E.N.T.) outpatient clinic from October 1994 through September 2000.<BR>Of these, 45 suffered from profound and moderate idiopathic sudden hearing loss diagnosed when the arithmetical mean of hearing thresholds at 0.25, 0.5, 1, 2, and 4 KHz was 40 dB or worse. Of the 30 patients whose medical treatment was started within 7 days of onset, 18 (60%) showed excellent or complete recovery of hearing, whereas none of the 15 whose treatment was started 8 days or late after onset showed satisfactory improvement. In general, the sooner treatment was started, the better hearing recovered.<BR>Idiopathic acute low-tone sensorineural hearing loss was found in 111 (49%) patients with a female preponderance at a M: F ratio of 1: 2.3, but no gender difference was seen in other diseases. The most common symptom was a feeling of pressure or fullness in the affected ear. Only 16% of patients were aware of their hearing disturbance. Some 73 (66%) showed complete recovery.<BR>Meniere's disease was diagnosed in 13, in whom hearing improved in only 2 (15%). Probable Meniere's disease was diagnosed in 9 patients who had 1 definitive episode of vertigo with low-tone sensorineural hearing loss, and their prognosis was good.<BR>The prognosis in 7 patients with hearing loss due to acoustic trauma and 1 with psychogenic hearing loss was good, but normal hearing was not restored in 1 with mumps or 1 with acoustic neurinoma.<BR>A patient with diabetic nephropathy had low-tone hearing loss and nystagmus toward the affected ear. Attacks of vertigo were controlled by diuretic therapy, but hearing recovery occurred by a little less than 10 dB.<BR>Some 35 patients had mild idiopathic hearing loss and prognosis was relatively good. Hearing was disturbed after head injury in 2 and after nose blowing in 1, probably attributable to concussion of the labyrinth or the formation of a perilymphatic fistula. The diagnosis of this condition could not be made with certainty by surgical exploration of the ear.

Journal

  • Nippon Jibiinkoka Gakkai Kaiho

    Nippon Jibiinkoka Gakkai Kaiho 104(10), 1034-1043, 2001-10-20

    The Oto-Rhino-Laryngological Society of Japan, Inc.

References:  18

Cited by:  2

Codes

  • NII Article ID (NAID)
    10007899440
  • NII NACSIS-CAT ID (NCID)
    AN00191551
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    00306622
  • Data Source
    CJP  CJPref  J-STAGE 
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