KISEP Original Articles 臨床耳鼻 : 第 14 卷第 1 號 2003 J Clinical Otolaryngol 2003;14: ABSTRACT - 농형 ( 聾型 ) 돌발성난청의청력회복 부산대학교의과대학이비인후과학교실 전경명 고의경 이일우

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1 KISEP Original Articles 臨床耳鼻 : 第 14 卷第 1 號 2003 J Clinical Otolaryngol 2003;14: ABSTRACT - 농형 ( 聾型 ) 돌발성난청의청력회복 부산대학교의과대학이비인후과학교실 전경명 고의경 이일우 Hearing Recovery of Profound Sudden Deafness Kyong-Myong Chon, MD, Eui-Kyung Goh, MD and Il-Woo Lee, MD Department of Otolaryngology, College of Medicine, Pusan National University, Busan, Korea Background and Objectives:The number of patients with sudden deafness has gradually increased recently. Also it tends to be more severe in degree of hearing loss and poorer prognosis. Especially in profound sudden deafness, the recovery rate is poorer than non-profound sudden deafness. So we hypothesize profound sudden deafness has somewhat different healing process compared with non-profound sudden deafness and analysed clinical characteristics of this disease. Materials and Methods:We reviewed the chart of 555 cases of patients with sudden deafness from January of 1995 to December of Of 555 cases profound hearing loss was found in 78 cases (14.1%). Results:1) The recovery rate of profound sudden deafness was 55.1%, which was lower than that of non-proufound sudden deafness. Profound sudden deafness shows more frequent in female and the highest incidence at fifth decade. The recovery rate was also highest at the same age group. 2) Incidence of dizziness was higher in profound group and was related to the lower recovery rate than cases without dizziness. 3) About 30% of profound sudden deafness had mild to total deafness on the opposite side, which cases had poor prognosis than cases with normal hearing of the opposite side. 4) 55.1% of profound sudden deafness had increasing IgG titer in viral antibody study, which was higher rate than non-profound sudden deafness. 5) Many cases of profound sudden deafness had retrocochlear abnormality compared to non-profound sudden deafness. 6) In profound sudden deafness cases, so-called critical point from onset to beginning of treatment was 10 days, which had statistical significance. 7) The later begining of treatment was performed, the worse of final hearing threshold was resulted, and there was negative correlation between them (r=-0.429), and was statistically significant (p=0.004). 8) In about 49% of profound sudden deafness cases, fixing period of final hearing level was longer than 3 weeks, which suggested that the longer duration of treatment is necessary than usual sudden deafness. Conclusion:It was suggested that profound sudden deafness has more severe in pathologic abnormality than non-profound sudden deafness. Especially the rate of viral infection was higher in profound sudden deafness group. It may have good recovery result with somewhat longer duration of intensive care. (J Clinical Otolaryngol 2003;14:81-91) KEY WORDS:Profound sudden deafness Hearing recovery. 81

2 J Clinical Otolaryngol 2003;14:81-91 서 언 재료및방법 Table 1. The siegel s criteria of hearing improvement Type Hearing recovery Complete recovery Final hearing better than 25 db Partial recovery Slight improvement No improvement More than 15 db gain, final hearing 2545 db More than 15 db gain, final hearing poorer than 45 db Less than 15 db gain, final hearing poorer than 75 db 청력회복 결과 연령및성별분포와예후 Table 2. Recovery rate related to sex % Sex Comple. recov. Partial recov. Slight improv. No improv. Total Recovery rate Male Female Total %

3 발병에서치료개시까지의일수와예후 Table 3. Recovery rate related to age Age Comple. recov. Partial recov. Slight improv. No improv. Total % Recov. rate % Total Table 4. Recovery rate related to time of initial treatment Duration day Comple. recov. Partial recov. Slight improv. No improv. Total % Recov. rate % Total

4 J Clinical Otolaryngol 2003;14:81-91 동반증상 반대측의청력 회복이시작되는시기 Table 5. Recovery rate related to accompanied symptoms Symptoms Comple. recov. Partial recov. Slight improv. No improv. Total % Recov. rate % Tinnitus Vertigo Table 6. Recovery rate related to hearing in opposite ear Degreeof H.L. Comple. Recov. Partial recov. Slight improv. No improv. Total % Recov. rate % Normal Mild Moderate Severe Profound C5dip

5 Virus 항체가의상승 Final hearing level Time of initial treatment day Fig. 1. Relationship between time of initial treatment and final hearing level. 주파수별청력회복정도 Table 7. Recovery date in improved 43 cases Recovery date day Complete recovery Partial recovery Slight improv. Total % Total Table 8. Recovery rate related to virus IgG positive cases Cases Total Fig. 2. Recovery date in improved 43 cases. day C.R. P.R. S.I. Virus C.R. P.R. S.I. N.I. Positive cases Recov. rate % IgG /43 cases IgG /78 cases Herpes V-Z CMV Mumps V-ZVaricella-zoster, CMVCytomegalo, C.R.Complete recovery, P.R.Partial recovery, S.I.Slight improvement, N.I.No improvement 85

6 J Clinical Otolaryngol 2003;14:81-91 Mean final hearing level db K 2 K 4 K Ave Frequency Hz Fig. 3. Mean final hearing level related to frequency Cases db Fig. 4. Cases related to mean final hearing level. 보충현상유무와예후 청력이고정되는시기 Table 9. Recovery rate related to recruitment phenomenon Recruitment phenomenon Complete recovery Partial recovery Slight improv. No improv. Total % Recovery rate % Positive Negative Table 10. Fixing period of final hearing level in improved 43 cases Fixing period day Complete recovery Partial recovery Slight improv. Total (%) Total

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10 J Clinical Otolaryngol 2003;14:81-91 요약 중심단어 REFERENCES 1) Einer H, Tengborn L, Axelsson A, Edström S. Sudden sensorineural hearing loss and hemostatic mechanisms. Arch Otolaryngol Head Neck Surg 1994;120: ) Lindsay J, Davey P, Ward P. Inner ear pathology in deafness due to mumps. Ann Otol 1960;69: ) Yoo TJ, Tomoda K, Stuart JM, Cremer MA, Townes AS, Kang AH. Type II collagen-induced autoimmune sensorineural hearing loss and vestibular dysfunction in rats. Ann Otol 1983;92: ) Chon KM. Practice of sudden sensori-neural hearing loss. Jungmyung Dang. Busan; ) Yanagihara N, Asai M. Sudden hearing loss induced by acoustic neuroma: significance of small tumor. Laryngoscope1993;103: ) Chon KM, Roh HJ. The presumptive factors concerning to the prognosis of sudden deafness. Korean J of Otolaryngol 1988;31: ) Yoon TH, Paparella MM, Schachern PA, Alleva M. Histopathology of sudden hearing loss. Laryngoscope 1990; 100:

11 8) Mitsushima J, Suzuki M, Kitashima T, Kitano H, Yazawa Y, Kitajima K. Hearing restoration in patients with sudden total or near total deafness. Pract Oto (Kyoto) 2001;94: ) Oya R, Ogawa M, Saiga H, Sakai K, Asai H, Matsunaga T. A prognostic study of sudden deafness related to the type of deafness. Pract Otol (Kyoto) 1984;77: ) Sano H, Okamoto M, Nirayama M, Ono Y, Nitta M. Hearing recovery in sudden deafness with profound hearing loss. J Otolaryngol Jpn 1998;101: ) Yano D, Oda M, Ota Y, Kumatsu Y, Sasaki J, Ichijima L. Investigation of sudden total deafness. Audiology Japan 2001;44: ) Yanagita N, Suzuki Y, Murahashi K, Miyake H. Prognosis and pathogenesis of sudden deafness with scaling out. Pract Otol (Kyoto) 1982;75: ) Ogawa K, Yamaguchi T, Toda H, Yoshida S, Suzuki E. Investigation of high degree sudden deafness. Pract Otol (Kyoto) Supp 2000;105: ) Koike S, Shimizu Y, Ito B, Kamei M. Investigation of sudden deafness with scaling out. J Otolaryngol Jpn 1993; 96: ) Schuknecht HF, Kimura RS, Nantal PM. The pathology of sudden deafness. Acta Otolaryngol 1973;76: ) Hood LJ, Berlin CB. Contemporary application of neurobiology in human hearing assessment. Neurobiology of hearing: the cochlea ed by Altschuler RA, Bobbin RP, Hoffman DW. Raven Press, New York; ) Albers FWJ, Demuynck KMNP, Casselman JW. Three-dimentional magnetic resonance imaging of the inner ear in idiopathic sudden sensorineural hearing loss. ORL 1994; 56: ) Kurokawa T, Yamaura K. Four cases of idiopathic sudden sensori-neural hearing loss. Pract Otol (Kyoto) 1998;91: ) Schuknecht HF, Donovan ED. The pathology of sudden sensorineural hearing loss. Arch Otolaryngol 1986;243: ) Cole RR, Jahrsdoerfer RA. Sudden hearing loss: an update. Am J Otol 1988;98:

KISEP 돌발성난청의병인에서면역계의역할에관한연구 Abstract 여상원 박용수 김규식 장기홍 Role of Immune System in the Pathogenesis of Sudden Deafness Sang Won Yeo, M.D., Yong S

KISEP 돌발성난청의병인에서면역계의역할에관한연구 Abstract 여상원 박용수 김규식 장기홍 Role of Immune System in the Pathogenesis of Sudden Deafness Sang Won Yeo, M.D., Yong S KISEP 40 8 1997 돌발성난청의병인에서면역계의역할에관한연구 Abstract 여상원 박용수 김규식 장기홍 Role of Immune System in the Pathogenesis of Sudden Deafness Sang Won Yeo, M.D., Yong Soo Park, M.D., Que Chic Kim, M.D., Ki Hong Chang, M.D.

KISEP Original Articles 臨床耳鼻 : 第 14 卷 第 1 號 2003 J Clinical Otolaryngol 2003;14: ABSTRACT - 농형 ( 聾型 ) 돌발성난청의청력회복 부산대학교의과대학이비인후과학교실 전경명 고의경 이일우

KISEP Original Articles 臨床耳鼻 : 第 14 卷第 1 號 2003 J Clinical Otolaryngol 2003;14: ABSTRACT - 농형 ( 聾型 ) 돌발성난청의청력회복 부산대학교의과대학이비인후과학교실 전경명 고의경 이일우