急性低音障害型感音難聴における両側性の検討  [in Japanese] Bilaterality in Acute Low-tone Sensorineural Hearing Loss  [in Japanese]

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Abstract

急性低音障害型感音難聴 (以下ALHL) においては, 突発性難聴と比較して両側例が多いという印象が以前よりもたれていた. 今回この事実を確認し, 病態との関連を検討するため, 山梨大学附属病院耳鼻咽喉科, および関連病院の諏訪中央病院耳鼻咽喉科にて厚生労働省の急性高度難聴に関する調査研究班の診断基準に従い, ALHLと診断され治療を受けた274症例を対象に本症の両側性について検討した. これらの症例のうち臨床症状, 聴力レベルのいずれもが両側であった症例が32例, 少なくともいずれかが, 両側であった症例が76例存在した. ALHL症例の集計報告を渉猟すると文献上でも数%以上の両側例の存在が示唆された. また今回の集計で, 片側例の健側においても低音部の聴力レベルが高音部のそれに比較して低下する傾向が見られ, 本症における両側性の存在が確認された. しかし一方, 両側例の左右の耳は, その聴力像, グリセオールテスト結果, 予後判定においては必ずしも左右で一致しなかった. 本症の病態はいまだ確立したものではないが. 両側例における左右の病態, およびその程度は必ずしも一致しないことが推測された. 両側例と片側例で, その臨床症状, 検査結果に明らかな差は見られなかったが, その予後において両側例は治癒率が低い傾向が見られた. 本症の診断, 予後判定においては, 聴力レベルのみが両側である症例も含め両側例を考慮した取り扱いが必要であると考える.

Bilaterality in acute low-tone sensorineural hearing loss (ALHL) is more generally recognized than that in idiopathic sudden sensorineural hearing loss. Subjects were 274 patients diagnosed with ALHL based on criteria of a study group of the Ministry of Health, Labor and Welfare of Japan, i.e., total of 3 low-tone hearing of 70dB or more and, a total of 3 high-tone hearing of 60dB or less, and treated at the departments of otolaryngology at Yamanashi University and Suwa Central Hospital. ALHL involving bilateral ears symptoms and/or bilateral hearing impairment conforming to diagnostic criteria was selected and summarized. Clinical ear symptoms, clinical test results, and hearing levels (total 3 low tone-hearing, 1kHz, and total of 3 high-tone hearing) were statistically analyzed. We also reviewed Japanese clinical reports of ALHL that include bilateral cases.<BR>In 32 cases (11.7%) of 274 cases, both ear symptoms and hearing impairment were bilateral. In 22 (8.0%) of the 274, bilateral ear symptoms were present, but showed unilateral hearing loss conforming to diagnostic criteria. Another 22 (8.0%) out the 274 reported unilateral ear symptoms, but hearing tests indicated bilateral ALHL. A total of 76 cases (27.7%) of the 274 had bilaterality in either ear symptoms or hearing loss. Our review indicated that 9.0% (162 of 1803) ALHL patients were bilaterally affected, possibly indicating that ALHL includes a larger number of bilateral cases than currently assumed, if the opposite side were given a especially detailed clinical interview.<BR>Statistical analysis (Mann Whitney test, P<0.01) of hearing of unilateral cases indicated that 3 low-tone hearing was more affected than 3 high-tone hearing, even on the normal side. These results indicate that ALHL tends to be bilateral, possibly due to the mechanism of pathogenesis, and also that the mechanism may include both local and general conditions. This more closely resembles Meniere's disease than idiopathic sudden sensorineural hearing loss. Both sides of bilateral cases were not usually the same in hearing patterns, glycerol test results, or prognosis. A statistically significant difference (Mann Whitney test, P<0.01) in total of 3 low-tone hearing was seen between worse and better sides in bilateral cases. The degree of disease on both sides in bilateral cases thus was not always the same. Bilateral cases may result from both the influence of general conditions such as fatigue, stress, and lack of sleep and local conditions such as pathogenesis of endolymphatic hydrops that may cause differences in both ears. No clear difference was seen in clinical symptoms, hearing levels, and clinical examination, e.g., Schellong and glyceol tests, between unilateral and bilateral cases. Bilateral cases had a poorer prognosis (lower complete recovery ratio; x<SUP>2</SUP> test P<0.01) than unilateral cases. Our results indicated that cautious evaluation of opposite ear is necessary in diagnosis, treatment, and prognostication of ALHL.

Journal

  • Nippon Jibiinkoka Gakkai Kaiho

    Nippon Jibiinkoka Gakkai Kaiho 108(3), 214-221, 2005-03-20

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

References:  30

Cited by:  5

Codes

  • NII Article ID (NAID)
    10016429451
  • NII NACSIS-CAT ID (NCID)
    AN00191551
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    00306622
  • NDL Article ID
    7294951
  • NDL Source Classification
    ZS43(科学技術--医学--耳鼻咽喉科学)
  • NDL Call No.
    Z19-250
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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