Abstract | Ciljevi istraživanja: Ciljevi istraživanja bili su utvrditi jesu li dob i spol, te šećerna bolest, hipertenzija i dislipidemija prediktori oporavka iznenadnog gubitka sluha. Osim toga, ispitivali smo jesu li audiološki parametri, kao što su tipovi krivulje u tonalnoj audiometriji, šum i vrtoglavica, prediktori oporavka sluha te rezultira li što ranije započeta terapija ranijim i većim oporavkom sluha.
Materijali i metode: Materijali istraživanja su nalazi tonske audiometrije iz registra Zavoda za audiologiju. U nalazima su i podatci o dobi i spolu bolesnika, anamnestički podatci o eventualnim metaboličkim bolestima, vremenu proteklom od nastanka iznenadnog gubitka sluha, novonastalom šumu ili vrtoglavici. Tonskom audiometrijom smo ispitali pragove čujnosti, jačinu oštećenja, vrstu nagluhosti i tip krivulje tonske audiometrije.
Rezultati: Liječeno je 95 ispitanika, od kojih 54 (57%) muškaraca te 41 (43%) žena. Nismo dokazali statistički značajnu povezanost spola s oporavkom (χ2=0,641; P=0,726). S druge strane, postoji statistički značajna povezanost oporavka s dobnim skupinama (χ2=29,3; P<0,001). Od ukupnog broja ispitanika njih: 35 (37%) bili su hipertoničari, 23 (24%) dijabetičari, a 62 (65%) su imali dislipidemiju. Dokazali smo da nema statistički značajne povezanosti hipertenzije s oporavkom (χ2=2,46; P=0,292), ali da postoji statistički značajna povezanost oporavka s dijabetesom (χ2=36; P<0,001) te dislipidemijom (χ2=19,4; P<0,001). Kao simptome pridruženi gluhoći, analizirali smo šum i vrtoglavicu. 88 (93%) ispitanika imalo je šum, a 19 (20%) vrtoglavicu. Nismo dokazali razliku distribucije šuma između djelomičnog i potpunog oporavka (χ2=0,689; P=0,407), stoga smo analizirali ispitanike bez oporavka u odnosu na djelomično i potpuno oporavljene ispitanike zajedno gdje također nismo dokazali statistički značajnu povezanost (χ2=0,347; P=0,556). Također, nismo dokazali statistički značajnu povezanost vrtoglavice i oporavka (χ2=0,54; P=0,754). Audiometrijom smo dobili 4 oblika krivulje: u 11 (12%) ispitanika ravni oblik, 51 (54%) imali su silazni oblik, 27 (28%) uzlazni oblik, dok je 6 (6%) ispitanika imalo krivulju koja ukazuje na gluhoću. Postoji statistički značajna povezanost oblika krivulje s oporavkom (χ2=55; P<0,001). U skupini potpunog oporavka nije bilo nijednog ispitanika s dubokom ravnom krivuljom. U skupini ispitanika sa silaznom krivuljom (n=51) njih 53% (n=27) je doživjelo potpuni oporavak, a njih 43% (n=22) je imalo djelomični oporavak. Samo 2 ispitanika iz ove skupine nisu se oporavila. U skupini ispitanika sa uzlaznom krivuljom, njih 93% (n=25) doživjelo je potpuni oporavak, a samo 2 djelomični. Nadalje, utvrdili smo statistički značajnu razliku vremena dolaska u odnosu na oporavak (χ2=9,1; P=0,011). Razliku čini vrijeme dolaska kod potpunog oporavka gdje medijan dolaska iznosi 2 tjedna, u odnosu na vrijeme dolaska kod djelomičnog oporavka gdje medijan iznosi 3 tjedna (P=0,008). Između vremena dolaska ispitanika bez oporavka u odnosu na skupinu djelomičnog oporavka (P=0,192) i u odnosu na skupinu potpunog oporavka (P=0,363) nismo dokazali statistički značajnu razliku.
Zaključak: Iznenadni zamjedbeni gubitak sluha predstavlja hitno stanje u otorinolaringologiji, te veliki izazov u dijagnostičkom, terapijskom, prognostičkom i rehabilitacijskom smislu. Starija životna dob, šećerna bolest, dislipidemija, kasniji početak liječenja te određene vrste audiograma predstavljaju negativne prediktore oporavka. Degenerativni procesi povezani sa starenjem, kao i vaskularne promjene povezane s metaboličkim sindromom mogu dovesti do pogoršanja ili pak gubitka sluha. Osim toga, kasniji početak liječenja rezultira slabijim oporavkom, a duboka ravna krivulja te potpuna gluhoća u tonskoj audiometriji imaju izrazito lošu prognozu. |
Abstract (english) | Objectives: Objectives of the study were to determine whether age and sex, as well as diabetes, hypertension and dyslipidemia are predictors of recovery from sudden hearing loss. In addition, we examined are audiological parameters, such as curve types in tonal audiometry, tinnitus and vertigo, predictors of hearing recovery and whether early therapy results in earlier and greater hearing recovery.
Materials and methods: Research materials are the findings of tonal audiometry from the register of the Department of Audiology. The findings also include data on the age and sex of patients, anamnestic data on possible metabolic diseases, time elapsed since the onset of sudden hearing loss, newly formed tinnitus or vertigo. With tone audiometry, we examined the audacity thresholds, the severity of the damage, the type of deafness, and the type of tone audiometry curve.
Results: 95 subjects were treated, of whom 54 (57%) men and 41 (43%) women. We have not demonstrated a statistically significant gender association with recovery (χ2=0.641; P=0.726). On the other hand, there is a statistically significant association of recovery with age groups (χ2=29.3; P<0.001). Of the total number of subjects: 35 (37%) were hypertensive, 23 (24%) diabetic, and 62 (65%) had dyslipidemia. We proved that there is no statistically significant association between hypertension and recovery (χ2=2.46; P=0.292), but that there is a statistically significant association between recovery with diabtes (χ2=36; P<0.001) and dyslipidemia (χ2=19.4, P<0.001). As symptoms associated with deafness, we analyzed tinnitus and vertigo. 88 (93%) subjects had tinnitus and 19 (20%) had vertigo. We did not demonstrate a difference in tinnitus distribution between partial and complete recovery (χ2=0.689; P=0.407), therefore we analyzed subjects without recovery versus partially and fully recovered subjects together where we also did not demonstrate a statistically significant association (χ2=0.347; P=0.556). Also, we did not prove a statistically significant association between vertigo and recovery (χ2=0.54; P=0.754). We obtained 4 forms of curve by audiometry: in 11 (12%) subjects flat form, 51 (54%) had descending, 27 (28%) ascending form, while 6 (6%) subjects had a curve indicating deafness. There is a statistically significant association of curve shape with recovery (χ2=55; P<0,001). There were no subjects with deep flat curve in the full recovery group. In the group of subjects with descending curve (n=51) 53% of them (n=27) experienced a complete recovery and 43% (n=22) had a partial recovery. Only 2 respondents from this group did not recover. In the group of subjects with ascending curve, 93% of them (n=25) experienced a complete recovery and only 2 partial. Furthermore, we found statistically significant difference in arrival time in relation to recovery (χ2=9.1; P=0.011). The difference is the arrival time for complete recovery, where the median arrival is 2 weeks, compared to the arrival time for partial recovery, where the median arrival is 3 weeks (P=0.008). We did not prove a statistically significant difference between the arrival time of subjects without recovery in relation to the partial recovery group (P=0.192) and in relation to the complete recovery group (P=0.363).
Conclusion: Sudden sensorineural hearing loss is an emergency in otorhinolaryngology, and a major challenge in diagnostic, therapeutic, prognostic and rehabilitation terms. Older life expectancy, diabetes, dyslipidemia, later onset of treatment, and certain types of audiograms represent negative predictors of recovery. Degenerative aging – related processes, as well as vascular changes associated with metabolic syndrome, can lead to worsening or loss of hearing. In addition, a later onset of treatment results in a weaker recovery, and a deep flat curve and complete deafness int onal audiometry have an extremely poor diagnosis. |