年龄对突发性耳聋的预后影响
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摘要
目的本研究旨在探索年龄对突发性耳聋预后是否具有独立影响作用,阐释是否存在明确的年龄转折点(即阈值效应)使得预后发生方向性的改变,为未来进行突发性耳聋预后研究时提供科学合理的年龄分组依据。方法本研究对2008年8月至2015年12月连续入住解放军总医院耳内科病房进行治疗的突聋患者进行回顾性分析,按年龄分组以方差分析、Kruskal-Wallis检验和卡方检验比较组间差异,年龄与预后(治疗后听阈值及治疗后听力增益)的相关性由线性回归模型评估并进行曲线拟合以及阈值效应分析。结果在调整了可能的混杂因素后,年龄与治疗后听阈、治疗后听力增益呈现非线性相关性,两个关键的年龄转折点分别为15岁和67岁。当年龄<15岁时,年龄每增加一岁,治疗后听阈降低1.2 dB(95%置信区间:-2.2~-0.2,P=0.020),听力增益提高1.2 dB(95%置信区间:0.2~2.2,P=0.019);年龄介于15-67岁的患者,年龄与突聋患者的听力结局无显著相关性,治疗后听阈和听力增益的回归系数均为0(P值分别为0.448与0.418);年龄>67岁时,年龄每增加1岁,治疗后听阈升高0.5dB(95%置信区间:0.0~1.0,P=0.033),听力增益减少0.5dB(95%置信区间:-1.0~0.0,P=0.033)。如不采用分段线性模型,用一条直线拟合数据,则得出治疗后听阈和听力增益的回归系数分别为0.1(95%置信区间:0.0~0.1,P=0.128)和-0.1(95%置信区间:-0.1~0.0,P=0.118),,并未恰当反映出年龄与突聋患者听力预后的关系。结论对小于15岁的突发性耳聋患者,年龄的增加是一个预后有利因素;对年长于67岁者,年龄与预后呈显著性负相关;对介于15至67岁的患者,年龄对预后的影响无统计学意义。
Objective The purpose of this study was to investigate whether age has an independent effect on the prognosis of sudden deafness, and to establish whether there is a clear age turning point(i.e., threshold effect) that leads to a change in the directionality of prognosis. Methods This study retrospectively analyzed sudden sensorineural hearing loss(SSHL) patients who were admitted to the otolaryngology ward in a tertiary medical center from August 2008 to December 2015. They were grouped by age and analyzed by analysis of variance, Kruskal-Wallis test, and chi-square test. The association between age and prognosis(final hearing level and hearing gain after treatment) were assessed by linear regression models and curve fitting in addition to threshold effect analysis. Results After adjustment for possible confounding factors, there was a nonlinear correlation between age and hearing outcomes defined by final hearing threshold and hearing gain. There was a threshold effect, and the two critical age turning points were 15 and 67 years, respectively. For patients younger than 15 years, the hearing threshold was improved by 1.2 dB(95% confidence interval[CI]:-2.2 to-0.2, P=0.020) and the hearing gain increased by 1.2 dB(95% confidence interval: 0.2-2.2, P=0.019) for every one year increase of age. For patients aging between 15 and 67 years old, age was not significantly related to hearing outcomes, and the regression coefficients with hearing threshold and hearing gain were 0.0(P values were 0.448 and0.418, respectively). For patients older than 67 years, the final hearing threshold increase was 0.5 dB(95% CI: 0.0 to1.0, P=0.033) and hearing gain decrease was 0.5 dB(95% CI:-1.0 to 0.0, P=0.033) for every 1 year of age increase.When using linear model to fit the data instead of the curve fitting model, the regression coefficients for hearing threshold and hearing gain were 0.1(95% CI: 0.0-0.1, P=0.128) and-0.1(95% CI:-0.1 to 0.0, P = 0.118)/year of age, respectively, which improperly reflected the relationship between age and hearing outcomes in SSHL patients. Conclusions For SSHL patients younger than 15 years, age is a favorable prognostic factor. While for those older than 67 years, there is a significant negative correlation between age and hearing outcomes. Age does not show a significant impact on final hearing threshold and hearing gain in SSHL patients aging between 15 and 67 years. Our findings provide a scientific reference range for future outcome research in the field of SSHL.
Objective The purpose of this study was to investigate whether age has an independent effect on the prognosis of sudden deafness, and to establish whether there is a clear age turning point(i.e., threshold effect) that leads to a change in the directionality of prognosis. Methods This study retrospectively analyzed sudden sensorineural hearing loss(SSHL) patients who were admitted to the otolaryngology ward in a tertiary medical center from August 2008 to December 2015. They were grouped by age and analyzed by analysis of variance, Kruskal-Wallis test, and chi-square test. The association between age and prognosis(final hearing level and hearing gain after treatment) were assessed by linear regression models and curve fitting in addition to threshold effect analysis. Results After adjustment for possible confounding factors, there was a nonlinear correlation between age and hearing outcomes defined by final hearing threshold and hearing gain. There was a threshold effect, and the two critical age turning points were 15 and 67 years, respectively. For patients younger than 15 years, the hearing threshold was improved by 1.2 dB(95% confidence interval[CI]:-2.2 to-0.2, P=0.020) and the hearing gain increased by 1.2 dB(95% confidence interval: 0.2-2.2, P=0.019) for every one year increase of age. For patients aging between 15 and 67 years old, age was not significantly related to hearing outcomes, and the regression coefficients with hearing threshold and hearing gain were 0.0(P values were 0.448 and0.418, respectively). For patients older than 67 years, the final hearing threshold increase was 0.5 dB(95% CI: 0.0 to1.0, P=0.033) and hearing gain decrease was 0.5 dB(95% CI:-1.0 to 0.0, P=0.033) for every 1 year of age increase.When using linear model to fit the data instead of the curve fitting model, the regression coefficients for hearing threshold and hearing gain were 0.1(95% CI: 0.0-0.1, P=0.128) and-0.1(95% CI:-0.1 to 0.0, P = 0.118)/year of age, respectively, which improperly reflected the relationship between age and hearing outcomes in SSHL patients. Conclusions For SSHL patients younger than 15 years, age is a favorable prognostic factor. While for those older than 67 years, there is a significant negative correlation between age and hearing outcomes. Age does not show a significant impact on final hearing threshold and hearing gain in SSHL patients aging between 15 and 67 years. Our findings provide a scientific reference range for future outcome research in the field of SSHL.
引文
1 Schreiber BE,Agrup C,Haskard DO,et al.Sudden Sensorineura Hearing Loss[J].Lancet,2010,375(9721):1203-1211.
2 Sakata T,Esaki Y,Yamano T,et al.A Comparison between the Feeling of Ear Fullness and Tinnitus in Acute Sensorineural Hearing Loss[J].International Audiology,2008,47(3):134-140.
3中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.突发性聋诊断和治疗指南(2015)[J].中华耳鼻咽喉头颈外科杂志,2015,50(6):443-447.The Editorial Board of Chin J Otorhinolaryngol Head Neck Surg Clinical Guidelines of Sudden Sensorineurl Hearing Loss in China.Chin J Otorhinolaryngol Head Neck Surg,2015,50(06)443-447.
4 Siegel L G.The Treatment of Idiopathic Sudden Sensorineura Hearing Loss.[J].Otolaryngologic Clinics of North America,1975,8(2):467.
5 Kernan WN,Viscoli CM,Brass LM,et al.Phenylpropanolamine and the Risk of Hemorrhagic Stroke[J].New England Journal o Medicine,2000,343(25):1826.
6 Kizilay A,Koca C F.Pediatric Sudden Sensorineural Hearing Loss[J].J Craniofac Surg,2016,27(4):e364-e366.
7 Li F J,Wang D Y,Wang H Y,et al.Clinical Study on 136 Children with Sudden Sensorineural Hearing Loss[J].Chin Med J(Engl),2016,129(8):946-952.
8 Bulgurcu S,Dikilitas B,Arslan I B,et al.Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Pediatric Patients with Idiopathic Sudden Hearing Loss[J].J Int Adv Otol,2017,13(2):217-220.
9 Na S Y,Kim M G,Hong S M,et al.Comparison of Sudden Deafness in Adults and Children.[J].Clinical&Experimental Otorhinolaryngology,2014,7(3):165-169.
10 Chung J H,Cho S H,Jeong J H,et al.Multivariate Analysis of Prognostic Factors for Idiopathic Sudden Sensorineural Hearing loss in Children[J].Laryngoscope,2015,125(9):2209-2215.
11 Chen YS,Emmerling O,Ilgner J,et al.Idiopathic Sudden Sensorineural Hearing Loss in Children.[J].International Journal of Pediatric Otorhinolaryngology,2005,69(6):817.
12 Morita S,Suzuki M,Iizuka K.Non-organic Hearing Loss in Childhood[J].International Journal of Pediatric Otorhinolaryngology,2010,74(5):441-446.
13 Na S Y,Kim M G,Hong S M,et al.Comparison of Sudden Deafness in Adults and Children.[J].Clinical&Experimental Otorhinolaryngology,2014,7(3):165-169.
14 Sakiko F,Satoshi I,Shin-Ya N,et al.Clinical Profile of Hearing Loss in Children with Congenital Cytomegalovirus(CMV)Infection:CMV DNA Diagnosis Using Preserved Umbilical Cord[J].Acta Oto-Laryngologica,2011,131(9):976-982.
15 Kim J Y,Han J J,Sunwoo W S,et al.Sudden Sensorineural Hearing Loss in Children and Adolescents:Clinical Characteristics and Age-related Prognosis[J].Auris Nasus Larynx,2018,45(3):447-455.
16 Mattox D E,Simmons F B.Natural History of Sudden Sensorineural Hearing Loss[J].Annals of Otology Rhinology&Laryngology,1977,86(4 Pt 1):463.
17钱怡,钟时勋,胡国华,等.少年儿童突发性聋的治疗及预后分析[J].中华耳科学杂志,2017,15(5):531-538.Qian Y,Zhong SX,Hu GH,et al.Treatment and Prognosis of Sudden Sensorineural Hearing Loss in Children[J].Chinese Journal of Otology,2017,15(5):531-538.
2 Sakata T,Esaki Y,Yamano T,et al.A Comparison between the Feeling of Ear Fullness and Tinnitus in Acute Sensorineural Hearing Loss[J].International Audiology,2008,47(3):134-140.
3中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.突发性聋诊断和治疗指南(2015)[J].中华耳鼻咽喉头颈外科杂志,2015,50(6):443-447.The Editorial Board of Chin J Otorhinolaryngol Head Neck Surg Clinical Guidelines of Sudden Sensorineurl Hearing Loss in China.Chin J Otorhinolaryngol Head Neck Surg,2015,50(06)443-447.
4 Siegel L G.The Treatment of Idiopathic Sudden Sensorineura Hearing Loss.[J].Otolaryngologic Clinics of North America,1975,8(2):467.
5 Kernan WN,Viscoli CM,Brass LM,et al.Phenylpropanolamine and the Risk of Hemorrhagic Stroke[J].New England Journal o Medicine,2000,343(25):1826.
6 Kizilay A,Koca C F.Pediatric Sudden Sensorineural Hearing Loss[J].J Craniofac Surg,2016,27(4):e364-e366.
7 Li F J,Wang D Y,Wang H Y,et al.Clinical Study on 136 Children with Sudden Sensorineural Hearing Loss[J].Chin Med J(Engl),2016,129(8):946-952.
8 Bulgurcu S,Dikilitas B,Arslan I B,et al.Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Pediatric Patients with Idiopathic Sudden Hearing Loss[J].J Int Adv Otol,2017,13(2):217-220.
9 Na S Y,Kim M G,Hong S M,et al.Comparison of Sudden Deafness in Adults and Children.[J].Clinical&Experimental Otorhinolaryngology,2014,7(3):165-169.
10 Chung J H,Cho S H,Jeong J H,et al.Multivariate Analysis of Prognostic Factors for Idiopathic Sudden Sensorineural Hearing loss in Children[J].Laryngoscope,2015,125(9):2209-2215.
11 Chen YS,Emmerling O,Ilgner J,et al.Idiopathic Sudden Sensorineural Hearing Loss in Children.[J].International Journal of Pediatric Otorhinolaryngology,2005,69(6):817.
12 Morita S,Suzuki M,Iizuka K.Non-organic Hearing Loss in Childhood[J].International Journal of Pediatric Otorhinolaryngology,2010,74(5):441-446.
13 Na S Y,Kim M G,Hong S M,et al.Comparison of Sudden Deafness in Adults and Children.[J].Clinical&Experimental Otorhinolaryngology,2014,7(3):165-169.
14 Sakiko F,Satoshi I,Shin-Ya N,et al.Clinical Profile of Hearing Loss in Children with Congenital Cytomegalovirus(CMV)Infection:CMV DNA Diagnosis Using Preserved Umbilical Cord[J].Acta Oto-Laryngologica,2011,131(9):976-982.
15 Kim J Y,Han J J,Sunwoo W S,et al.Sudden Sensorineural Hearing Loss in Children and Adolescents:Clinical Characteristics and Age-related Prognosis[J].Auris Nasus Larynx,2018,45(3):447-455.
16 Mattox D E,Simmons F B.Natural History of Sudden Sensorineural Hearing Loss[J].Annals of Otology Rhinology&Laryngology,1977,86(4 Pt 1):463.
17钱怡,钟时勋,胡国华,等.少年儿童突发性聋的治疗及预后分析[J].中华耳科学杂志,2017,15(5):531-538.Qian Y,Zhong SX,Hu GH,et al.Treatment and Prognosis of Sudden Sensorineural Hearing Loss in Children[J].Chinese Journal of Otology,2017,15(5):531-538.
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