王秋菊: 随着人口老龄化进程的加快,老年性听力损失与认知障碍的共病现象逐渐引起临床与科研领域的高度重视.大量研究提示,听力下降不仅影响老年人沟通能力与生活质量,还可能与认知功能减退呈显著相关,甚至在一定程度上加速痴呆的发生与发展.

ObjectiveTo develop a novel polyamino acid-based nanohydrogel drug delivery system for dexamethasone to enhance its delivery efficiency to the inner ear.MethodsA fluorescein-labeled polyglutamic acid-based polyamino acid dexamethasone nanohydrogel was synthesized, and its gelation time was measured. The hydrogel was surgically injected into the round window niche of guinea pigs to determine its degradation time in the middle ear cavity in vivo. The safety, pharmacokinetics, and distribution patterns of dexamethasone in the inner ear were evaluated.ResultsThe hydrogel exhibited a gelation time of 80 seconds in a 37℃ water bath. In vivo, the hydrogel was almost completely degraded within 7 days in the middle ear cavity of guinea pigs. Transient hearing loss was observed one day after administration, but hearing gradually returned to normal over time. No significant cytotoxicity, vestibular stimulation signs, or pathological abnormalities in spiral ganglion cells were observed. Histopathological examination revealed no significant inflammatory reactions. Pharmacokinetic analysis demonstrated sustained drug release and prolonged dexamethasone activity. Immunofluorescence staining confirmed the distribution of dexamethasone in both the cochlea and vestibular organs.ConclusionThe polyamino acid nanohydrogel exhibits excellent injectability and biodegradability, representing a safe and effective drug delivery system for the inner ear.

EDITORIAL article Front. Neurol., 03 January 2024Sec. Neuro-Otology Volume 14 - 2023 | https://doi.org/10.3389/fneur.2023.1344956

Objective To report results of subjective and objective hearing examination in elderly patients（over60 years old） with middle ear diseases. Methods Elderly patients with middle ear diseases（n=2, 976, average age=67.65 ±6.04 years, 60-70 years = 2,241, 71-80 years = 609, ＞ 80 years=126） received pure tone audiometry（4,117 ears）,acoustic immittance test（2,117 ears） and auditory brainstem response test（114 ears）. Results related to different gender and age groups were compared. Results Normal hearing with air-bone gap was identified in 111 cases, mild hearing loss in 861 cases, moderate loss in 759 cases, moderate to severe loss in 624 cases, severe loss in 309 cases, profound loss in117 cases, and complete loss in 52 cases. Hearing loss was unilateral in 143 cases. The main pattern of hearing loss were ascending and shallow descending with significantly different gender and age distributions（P＜ 0.001）. Tympanogram was type A in 449 ears（21%）, Ad in 100 ears（5%）, As in 69 ears（3%）, B in 587 cases（28%）, and C in 802 ears（38%）,with significant differences in acoustic reflex detection with different tympanogram types（P＜ 0.001）. The detection rate of auditory brainstem response waves Ⅰ, Ⅲ and Ⅴ was 60.53%, 62.28% and 84.21%, with their average latencies at 1.69±0.2 ms, 3.96 ±0.2 ms and 5.88±0.27 ms and Ⅰ-Ⅲ, Ⅲ-Ⅴ and Ⅰ-Ⅴ intervals being 2.26±0.14 ms, 1.92±0.2 ms and 4.17±0.2ms, respectively. Conclusion Ⅰn patients over 60 years of age with conduction deafness, air bone threshold gap was the largest at 250 and 4000 Hz, with air conduction thresholds showing most elevation in high frequency. With the increase of age, shallow and steep descending audiograms become more common, with prolonged ABR latencies but minimal change in inter-wave intervals.

BACKGROUND:Few related studies reported yet the association between vitamins and the onset of sudden sensorineural hearing loss (SSNHL).OBJECTIVE:To explore the relationship between the serum levels of fat-soluble vitamins A, D, and E and the risk of SSNHL.METHODS:This retrospective analysis included 310 SSNHL patients and 154 people without risk of hearing loss. The demographic information of all participants like age, gender, body mass index, occupation, cigarette smoking or drinking status, etc. were recorded. The serum levels of vitamins A, D, and E were determined using the electrochemical method.RESULTS:The results indicated that serum vitamin D levels in SSNHL patients were significantly lower. Vitamin D deficiency was only observed in SSNHL group. Similarly, serum vitamin A levels in female SSNHL patients were significantly lower than the control group. Meanwhile, serum vitamin E levels in male SSNHL patients were significantly lower than the control group.CONCLUSION AND SIGNIFICANCE:Our results revealed that the serum levels of fat-soluble vitamins A, D, and E in SSNHL patients were lower than those in the control group with normal hearing, indicating that the decrease of serum fat-soluble vitamins may be related to SSNHL pathogenesis.

目的 探讨伴发于突发性聋的耳鸣患者临床听力学特征,并分析耳鸣及声治疗短期疗效影响因素.方法 回顾性分析伴发于突发性聋的耳鸣患者人口学特征及心理声学特征,按照THI评分等级进行分组,使用卡方检验、单因素方差分析、Spearman相关分析、Logistic回归等分别分析各个因素对耳鸣严重程度的影响及其声治疗效果.结果 1.纳入的患者共108名,其中轻度耳鸣组49名(45.5％),中度耳鸣组34名(31.5％),重度耳鸣组25名(23.1％).2.经卡方检验,3组患者在SAS得分存在统计学差异(χ2=25.239,P<0.05),SAS分数随着耳鸣分级增加有升高的趋势.3.轻度耳鸣组和中度耳鸣组与重度耳鸣组的PQSI结果存在统计学差异(χ2=14.437,P<0.05).重度耳鸣组睡眠障碍人数多于其他两组,轻度耳鸣组和中度耳鸣组之间则无统计学差异.4.经Spearman相关分析,PQSI、SAS等级与THI得分及各因子之间有显著的正相关(r>0,P<0.005).5.经多元有序Logistic回归分析,结果显示影响THI等级与SAS等级、睡眠质量问题成正相关(P<0.005).6.经二元多因素logistic回归结果显示,伴发于突发性聋的耳鸣患者声治疗短时疗效影响因素是残余抑制试验结果(P=0.020).结论 耳鸣发生的严重程度与焦虑症状有显著的关联;重度耳鸣患者更容易合并睡眠障碍;伴发于突发性聋耳鸣患者的声治疗效果与残余抑制试验结果有关,残余抑制试验结果可以为临床声治疗耳鸣提供指导.

年龄相关性听力损失(age-related hearing loss ,ARHL)又称为老年性聋(presbycusis) ,被定义为一种双侧对称性的、进行性的与年龄有关的感音神经性听力损失(SN HL ) ,高频听力下降较为明显[1].对尸头颞骨标本的研究发现,ARHL涉及多种听觉结构,包括耳蜗内外毛细胞机械传导退化(感音性老年性聋)、血管纹功能减退(代谢性老年性聋)以及听神经退化(神经性老年性聋),而现实中常表现为多种结构病变.ARHL 被认为受到多种因素的影响,其潜在危险因素包括年龄、性别、种族、环境、生活方式、健康合并症以及遗传易感性[2 ].

老年性耳聋是听觉器官随着年龄增长而衰老,从而出现听力下降的现象.老年性耳聋严重影响着老年人的认知功能和生活质量.目前关于老年性耳聋治疗的研究集中在药物、人工耳蜗以及基因、干细胞治疗等几方面,其中药物治疗以抗氧化,调节线粒体功能和代谢、抑制细胞凋亡,调节Na+-K+-2Cl--联合转运体1(Na-K-2Cl co-transporter1,NKCC1)、保护毛细胞和抗炎为主.这些方法的治疗多为实验研究,临床效果仍没有确切的结论.基因、干细胞移植的生物疗法仍在基础研究阶段.对于此病的早期预防、及时治疗很重要.

Subjective tinnitus is the most common type of tinnitus, which is the manifestation of pathological activities in the brain. It happens in a substantial portion of the general population and brings significant burden to the society. Severe subjective tinnitus can lead to depression and insomnia and severely affects patients' quality of life. However, due to poor understanding of its etiology and pathogenesis, treatment of subjective tinnitus remains challenging. In recent decades, a growing number of studies have shown that subjective tinnitus is related to lesion-induced neural plasticity of auditory and non-auditory central systems. This article reviews cellular mechanisms of neural plasticity in subjective tinnitus to provide further understanding of its pathogenesis. (C) 2021 PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd.

目的 分析平坦下降及全聋型突聋患者的纯音测听和言语识别率特点.方法 对解放军总医院耳内科病房2014年5月至2018年7月收入院的平坦下降及全聋型突聋患者行纯音测听和言语识别率测试并记录结果,按听力损失程度和年龄分组,并进行组间比较.结果 1.平坦下降及全聋型突聋患者共1311例,从听力损失程度上看:轻度116例(8.85％)、中度305例(23.26％)、重度495例(37.76％)、极重度395例(30.13％),集中表现在中度及以上;2.从年龄分布上看:少年133例(10.14％)、青年296例(22.58％)、中年631例(48.13％)、老年251例(19.15％),发病人群主要集中在中年和青年;3.不同程度听力损失的性别比较无差异(P=0.148,P>0.05);4.不同程度听力损失的年龄比较有差异(P<0.001,P<0.05);5.不同程度听力损失的言语识别率比较有差异(P<0.001,P<0.05);6.各年龄段的言语识别率比较有差异(P<0.001,P<0.05);7.不同性别间言语识别率比较无差异(P=0.123,P>0.05).结论 平坦下降及全聋型突聋患者的言语识别率无性别差异,但受听力损失和年龄影响,随听力损失程度加重而下降,老年人较其他人群更为显著;不同程度听力损失的言语识别率得以量化为临床提供有价值的参考.平坦下降及全聋型突聋患者的听力损失无性别差异,听力损失程度集中表现在中度及以上,重度和极重度较多,中、青年为高发人群.

人群中耳鸣的患病率为10％ ～15％,其中存在临床问题的占20％.在日本,出现耳鸣并深感痛苦的患者大约有300万,一些难治性耳鸣的治疗效果不尽如人意. 本指南适用于慢性耳鸣患者,旨在规范耳鸣的循证诊断和治疗,提高耳鸣患者的生活质量.

在耳鼻咽喉头颈外科常见病的诊疗中,中西医各有优势与局限.临床诊疗中,中西医结合治疗的疗效肯定,但在优势病种选择及诊疗方案选择方面尚无统一意见.中华中医药学会组织中西医耳鼻咽喉头颈科专家一起进行探讨,从病因、机制、临床诊疗方法等方面出发,基于多项临床研究结果,综合专家意见,推荐将急性咽炎、慢性咽喉炎、咽异感症、癔症性失音、过敏性鼻炎、主观性耳鸣、耳源性眩晕遴选为优势病种,制定出中西医融合的诊疗方案及建议并形成专家指导意见,供临床参考.以期通过中西医结合治疗,使更多的患者受益.

Subjective tinnitus is the most common type of tinnitus, which is the manifestation of pathological activities in the brain. It happens in a substantial portion of the general population and brings significant burden to the society. Severe subjective tinnitus can lead to depression and insomnia and severely affects patients’ quality of life. However, due to poor understanding of its etiology and pathogenesis, treatment of subjective tinnitus remains challenging. In recent decades, a growing number of studies have shown that subjective tinnitus is related to lesion-induced neural plasticity of auditory and non-auditory central systems. This article reviews cellular mechanisms of neural plasticity in subjective tinnitus to provide further understanding of its pathogenesis.

目的 分析单侧突发性耳聋(idiopathic sudden sensorineural hearing loss,ISSNHL)患者治疗前后言语识别率(word recognition score,WRS)疗效及其影响因素.方法 收集2016-2019年间在解放军总医院耳内科住院治疗的220例ISSNHL患者的资料,包括一般情况、临床表现、纯音测听、言语测听等数据,对治疗前后纯音听阈(PTA)和最大言语识别率(WRSmax)进行比较分析,采用二元Logistic回归分析多因素对于WRS预后的作用.结果 相较于治疗前,ISSNHL患者治疗后患耳PTA和WRS有显著改善(P<0.001),且治疗后PTA和WRS存在显著负相关(r=-0.797,P<0.001).单因素分析发现性别、耳别、年龄、合并症、发病诱因以及伴随症状耳鸣、耳闷、眩晕均不是WRS疗效的影响因素(P值均>0.05),病程、听力曲线类型和听力损失程度为WRS疗效的影响因素(P值均<0.05).根据单因素分析结果,将病程、听力曲线类型和听力损失程度纳入Logistic回归模型,发现病程>2周,听力曲线为下降型和平坦型,听力损失为极重度是影响WRS疗效的危险因素(P<0.05).结论 ISSNHL患者治疗后WRS疗效为35.9％,其疗效的影响因素包括病程、治疗前听力曲线类型和听力损失程度.病程>2周患者疗效显著差于病程≤2周者;治疗前听力曲线为上升型患者,治疗后WRS疗效比下降型和平坦型患者更好;治疗前听力损失为极重度患者,治疗后WRS疗效较轻中度和重度患者更差.

Background: Sudden sensorineural hearing loss (SSHL) refers to the sudden occurrence of unexplained sensorineural hearing loss. The present study showed that different systemic diseases had different influence on the occurrence and hearing outcome of SSHL. Thyroid hormone is one of the important factors for the development of fetal ear and auditory function. However, the distribution of thyroid dysfunction in SSHL patients and the effect of thyroid dysfunction on the occurrence and hearing outcome of SSHL has not been studied. Methods: In this study, a retrospective analysis had been done in 676 patients with SSHL. We had described the distribution of thyroid function in patients with SSHL in detail, and by the statistical method, analyzed the relationship between the hearing outcome and thyroid dysfunction, respectively. Results: In all patients, 24.41% (165/676) had abnormal thyroid function testing results. The onset age of SSHL in FT3 abnormal group (including low and high group) was younger than that in normal FT3 group. Recovery group had more patients with lower-than-normal T3 level as compared to non-recovery patients. Significant associations between T3 levels and hearing outcome were observed in the subgroup with longer time elapse between symptom onset and treatment (≥14 d). Conclusion: The incidence of thyroid dysfunction in SSHL is significantly higher than in the general population. There was obvious relationship between T3 and FT3 item of thyroid dysfunction and the onset time and hearing outcome of SSHL, which indicated that T3 or FT3 indicator may be one of the affecting factors for the SSHL. Early screening and diagnosis of thyroid dysfunction, especial T3 level, may help to evaluate the prognosis in SSHL patients.

英国的国家卫生与临床优化研究所(National Institute for Health and Care Excellence ,NICE)于2020年3月11日发布了耳鸣的评估和管理指南,主要内容包括:指南的概述、建议、对于研究的建议、建议的合理性和影响等.为医护人员提供关于如何帮助耳鸣患者,以及何时应该转诊进行专家评估和管理的建议.

听神经病(Auditory Neuropathy,AN)是由于耳蜗传入通路病变引起的,其最典型的听力学表现为耳声发射或耳蜗微音电位能引出,而听性脑干反应引不出或严重异常.目前,临床对于AN的诊断已较为完善,但对于其听力学表现的解读仍存在不足,为加深临床对于其相关听力学表现的理解,本文将对各项应用于AN检查的听力学测试进行综述,为AN的早期发现与精准治疗提供依据.

耳蜗传入突触病变在临床上可表现为听神经病、隐性听力损失、耳蜗死区病.目前除听神经病,另外两类疾病主要依据主观测试,尚无明确可用于诊断的客观方法.耳蜗电图可早期发现耳蜗传入突触病变,本文就其对耳蜗传入突触病变诊断意义进行综述,为耳蜗病变的诊断和精准治疗提供依据.

目的 建立不同年龄组正常青中年人扩展高频(9-20kHz)测听各频率听阈的参考基线.方法 检测20-60岁正常人114例(228耳)扩展高频听阈,男42例,女72例,按年龄每10岁分为一组,共分4组,使用丹麦尔听美Conera纯音听力计Otosuite分别对9-20kHz各频率进行听阈检测.应用SPSS软件中的Kruskal-Wallis test对不同年龄组间扩展高频听阈进行统计分析,以P<0.05为差异具有统计学意义.结果 在9-20kHz,与其他三组相比,20-29岁组扩展高频听阈最低,9-16kHz各组间听阈相比差异有显著性(P<0.05).30-39岁组在9-14kHz听阈低于40-49岁组及50-60岁组,差异有显著性(P<0.05).50-60岁组扩展高频听阈最大.随着年龄的增长,听阈检出率逐渐下降,50-60岁组在18k、20kHz处的检出率为0％.结论 正常人扩展高频测听的听阈随年龄、频率的增高而升高.利用扩展高频测听结果评价早期高频听力损害时,需要考虑年龄以及所测频率,应根据每个年龄段相对应的听阈参考基线进行比较.