양성돌발성체위성현훈을 동반한 돌발성감각신경성난청의 임상적 특성

박성민,권빈,이성원,홍석민,김성균 대한평형의학회 2020 Research in Vestibular Science Vol.19 No.2

Objectives: Idiopathic unilateral sudden sensorineural hearing loss (SSNHL) with simultaneous benign paroxysmal vertigo (BPPV) is known to be associated with poor hearing recovery. We aimed to investigate clinical findings in patients with SSNHL with BPPV and analyze prognostic factors including presence of BPPV related to hearing outcome.Methods: We retrospectively reviewed the electronic medical data of 14 patients with concurrent SSNHL and BPPV (combined group). We selected 52 patients without BPPV as a control group who have matched initial threshold of pure tone audiometry and age of each patient in the combined group. We evaluated clinical characteristics of all participants and compared hearing outcomes between the 2 groups. A multivariate logistic regression analysis was performed to investi-gate the factors related to hearing recovery.Results: Initial mean pure tone audiometry (PTA) threshold of combined group was 90.36±26.2 dB. Posterior canal was most commonly involved (n=7, 50%), and 8 (57%) patients showed abnormal video head impulse test results. There was no significant difference between hearing recovery rates of combined and control group (p=0.237) and mean pure tone audiometry threshold changes were not significantly different between the 2 groups (p=0.942). Old age (≥60 years), high initial PTA threshold (>90 dB), and obesity (body mass index ≥ 25 kg/m2) were poor prognostic predictors. Conclusions: There was no difference between hearing outcomes of combined group and profound SSNHL only group. BPPV was not a significant prognostic factor of SSNHL patients.

소리의 종류와 크기에 따른 일과성 청력 역치 상승과 회복의 차이

이채관 ( Chae Kwan Lee ) 한국산업보건학회 (구 한국산업위생학회) 2020 한국산업보건학회지 Vol.30 No.4

Objective: This study aimed to investigate the differences in temporary threshold shift (TTS) and recovery patterns according to different types of sound and volume. Methods: TTS and recovery patterns were assessed for eight students after 30-minute exposure to both 70.0 dB and 90.0 dB of factory noise (noise) as well as music. TTS was measured before exposure and two minutes post exposure, and recovery patterns were evaluated every 10 minutes for one hour. The subjects performed activities of daily life and sleeping times as usual but taking drugs or drinking alcohol were prohibited. The experiment was repeated three times with an interval of at least 16 hours. ANOVA and T-test were carried out using SPSS 19.0 for Windows. Results: The hearing threshold of all subjects before exposure was less than 30 dB at all frequencies. Mean TTSs of 70 dB noise and 90 dB noise exposure were 0.14 and 4.48 dB (p<0.001). Meanwhile, the difference in music was insignificant (-0.63 dB and 0.55 dB, p=0.063). A significance in the difference was also found between the mean TTS of music and noise exposure, more obviously at 90.0 dB (p<0.001) than at 70 dB (p=0.232). The TTS differences were found frequency-wise in terms of sound type. Mean TTS by frequency was higher at 4,000 and 6,000 Hz than at other frequencies, and higher in noise than music at the same sound pressure. The TTS difference in each frequency between both sound types was significant at 90 dB (p<0.001). Subjects mostly recovered from TTS in one hour after exposure, but not with 90 dB-noise exposure. Conclusion: TTS and recovery patterns were different depending on the sound type. When exposed to factory noise, TTS was greater and recovery time was longer compared to music at the same sound pressure. These results suggested that the difference in cognitive processes and psychological factors according to the type of sound causes a change in TTS and recovery.

돌발성 난청에서 발병 후 2주 이상 지연된 스테로이드 복합 치료의 이점

김민우,진명호,최준용,곽민영 대한이비인후과학회 부산,울산,경남 지부회 2021 임상이비인후과 Vol.32 No.3

Objectives: We evaluated hearing recovery rates in sudden sensorineural hearing loss (SSNHL) according to a de- lay from onset to treatment. Materials and Methods: 281 subjects with SSNHL, who received steroid combination treatment as an initial treatment, were included in this study. We divided the patients into groups of the delay from onset to treatment: ≤48 hours, ≤7 days, ≤14 days, ≤21 days, ≤30 days, and 31–60 days groups. Results: Complete recovery (CR) rates were 21.2% in ≤48 hours group, 25.3% in ≤7 days group, and 7.9% in ≤14 days group. The CR was not found in groups with treatment delayed group after 14 days. The CR rate in ≤14 days group had 0.019- fold (95% CI: 0.051–0.769) decreased odds than the ≤48 hours group. Meaningful hearing recovery (MR) rates were 36.9%–47.1% in groups that received treatment within 14 days, and those of 17.7%–21.1% were observed in groups with a delay between 14 and 30 days. Of patients with treatment delays more than 31 days, hearing recovery of any type was not found. The MR rate in ≤30 days group had 0.234-folds decreased odds than ≤48 hours group (95% CI 0.061–0.906). Conclusions: Hearing recovery rates according to the delay of initial steroid treatment in SSNHL patients were identified. Clinicians can provide patients with information for hearing outcomes of delayed initiation of steroid treatment. Shared information facilitates better making decision with regard to their treatment plan.

돌발성 난청의 임상적 관찰

강성호,문교갑,박철원,이형석,안경성 한양대학교 의과대학 1993 한양의대 학술지 Vol.13 No.2

Sudden sensorineural hearing loss is not rare but its pathophysiology has not been fully determined and treatment regimin is still controversial at present. 1)Sex and affected side distribution of sudden hearing loss was 16 patients (44.4%) in male and 20 patients (55.6%) in female, 32 patients (88.9%) in unilateral cases and 4 patients (11.1%) in bilateral cases. 2)Complete recovery was seen in 10 ears (25%), partial recovery in 6 ears (15%), slihgt recovery in 9 ears (22.5%), and no response in 15 ears (37.5%). 3)In evaluation prognosis: a)Patients treated within 10 days after onset showed better recovery rate (64.5%) than those treated 10 days of later (55.6%). b)Flat and ascending type hearing loss had a higher recovery rate (73.7%) than descending and profound loss (52.4%). c)Patients with mild and moderate hearing loss showed better recovery rate (72.2%) than those with severe and profound loss (54.5%) d)patients with vertigo showed poorer recovery rate (47.6%) than those without vertigo (78.9%).

마우스에서 고려 홍삼의 구강내 섭취를 통한 소음성 난청의 예방효과

안중호(Joong Ho Ahn),김태수(Tae Soo Kim),정하나(Hana Chung),이나영(Nayoung Lee),정종우(Jong Woo Chung) 고려인삼학회 2009 Journal of Ginseng Research Vol.33 No.2

고려 홍삼이 소음성 난청에서 청력 보호 및 회복에 관여하는 지를 밝히기 위하여 마우스에서 홍삼을 투여 후 소음에 노출시켜 청력 역치의 변화 및 와우의 활성 산소 유리기에 대한 노출 정도를 보았다. 영구적 청력 역치 이동의 경우에 홍삼은 청력 보호 및 회복에 관여하지 못했다. 하지만 일과성 청력 역치 이동의 경우에는 홍삼이 어느 정도의 농도 이상으로 투여 된다면 청력 회복에 효과적으로 작용하는 것으로 밝혀졌다. 향후 홍삼의 난청 억제 효과에 대해 적정 농도 및 투여 방법 등에 대한 후속연구가 뒤따라야 하겠고 인간에서 발생하는 소음성 난청에의 적합성 판정을 위해 보다 장기적인 소음 노출 기간과 장기적인 홍삼 복용에 대한 연구가 필요하겠다. 또한 홍삼내의 여러 활성물질에 관한 연구를 통하여 보다 효과적인 화합물을 찾기 위한 노력도 동반되어야 할 것이다. It is well known that the saponin of Korean red ginseng (KRG) has an anti-oxidant effect and could suppress the accumulation of lipid peroxidation. The aim of the present study was to observe the inhibitory effect of KRG on mice with noise-induced hearing loss, and to determine its optimal dose. BALB/c mice with a normal hearing level and normal Preyer's reflexes were used in the study. The mice in the permanent-threshold-shift (PTS) group were exposed to noise (120-㏈ SPL, white noise band) in a noise booth for 3 h a day, for three consecutive days. The mice in the experimental group were given heat-processed red-ginseng extract (50 ㎎/㎏, 100 ㎎/㎏, and 200 ㎎/㎏), and those in the control group were given normal saline alone during their noise exposure. The mice in the temporary-threshold-shift (TTS) group were exposed to noise (120 ㏈SPL, white noise band) in a noise booth for 3 h. The mice in the experimental group were given heat-processed red-ginseng extract (50 ㎎/㎏, 100 ㎎/㎏, and 200 ㎎/㎏), and those in the control group were given normal saline alone before their noise exposure. The hearing levels of the mice were measured through auditory brainstem response (ABR) immediately and 1, 3, 5, 7, and 14 days after their noise exposure. Cochleae were removed from the mice 14 days after their noise exposure. Immunochemical and immunofluorescent staining were performed to observe the expression of 8-oxoG in cochlea. In the PTS group, the hearing function of the mice in all the groups was not recovered after their noise exposure. In the TTS group, however, the hearing function of the mice in all the groups was recovered within 14 days. Reduced hearing impairment and early recovery were observed in the mice that were given 200 ㎎/㎏ KRG, and early recovery was observed in the mice that were given 100 mg/kg KRG. The immunopositive staining of 8-oxoG was detected in the stria vascularis in the control group but was diminished in the mice that were given 200 ㎎/㎏ KRG. The ingestion of more than 100 ㎎/㎏ KRG demonstrated a protection and recovery effect on the noiseinduced-TTS group. Since KRG has been reported to be a safe compound even up to hundreds of mg/kg, a higher concentration of it may effectively protect and recover TTS.

Combination Therapy with Systemic Steroids, an Antiviral Agent, Anticoagulants, and Stellate Ganglion Block for Treatment of Sudden Sensorineural Hearing Loss

Kye Hoon Park,이치규,이종대,박무균,Byung Don Lee 대한청각학회 2012 Journal of Audiology & Otology Vol.16 No.2

Background and Objectives: Sudden sensorineural hearing loss (SSNHL) is commonly defined as a loss of at least 30 dB in three contiguous frequencies occurring within 3 days. Systemic steroid administration has become the most widely accepted treatment option for SSNHL. Since viral infection and vascular compromise are considered specific causes of SSNHL, antiviral agents, anticoagulants, and stellate ganglion block have been used for its treatment, although the evidence of their effectiveness is weak. The present study evaluated the hearing recovery rate in the combination therapy group (systemic steroids, antiviral agent, anticoagulants, and stellate ganglion block) in comparison with patients treated with systemic steroids alone. Subjects and Methods: A total of 85 patients diagnosed with SSNHL were treated with combination therapy (group A, 46 patients) or systemic steroids only (group B, 39 patients). Hearing improvement was defined as a hearing gain of more than slight improvement using Siegel's criteria. All patients were treated with a 10-day course of systemic steroids (10-mg dexamethasone for 5 days, followed by tapering for 5 days). Acyclovir, heparin, and stellate ganglion block were included in the group A treatment regimen. Results: The overall rate of hearing improvement was 60.9% (28/46 patients) in group A, which was significantly higher than that (38.5%, 15/39 patients) in group B. The distribution of prognostic factors was not significantly different between the two groups with the exception of the degree of initial hearing loss, which was more severe in group A. Upon analysis according to prognostic factors, group A showed a better hearing improvement recovery rate than group B in patients with hearing loss >70 dB, age >41 years, dizziness, and early treatment (<1 week). Conclusions: Thus SSNHL patients treated with combination therapy have a higher likelihood of hearing improvement than those treated with systemic steroids alone.

돌발성 난청의 임상적 분석

박영균,임태승,이도용,김용기,최봉남 朝鮮大學校 附設 醫學硏究所 1997 The Medical Journal of Chosun University Vol.22 No.1

Sudden hearing loss(SHL) is defined as an abrupt onset of sensorineural hearing loss which develops over a period of hours or a few days without definitive cause. However, the etiology, treatment and prognosis of the sudden hearing loss are controversial at present time. Authors observed 33 cases(30 patients) with SHL who had been admitted and treated in our ENT department from January. 1992 to December, 1996.. They were evaluated by clinical and statistical analysis. The results were as follows : 1. Of the 33 cases, 8 cases(24.3%) had complete recovery, 6 cases(18.2%) had partial recovery, 3 cases(9.0%) had slight recovery and 16 cases(48.5%) had no response. 2. Those patients who were treated within 2 weeks from onset had better improvement(p<0.01). 3. Those patients who had ascending or flat audiogram pattern had better improvcment(p<0.05). 4. The patients with tinnitus had better improvement than those with vertigo(p<0.001).

돌발성 난청의 임상적 고찰

우훈영,차건원,김석경,전병훈 인제대학교 1987 仁濟醫學 Vol.8 No.3

돌발성 난청의 병인 및 치료에는 여러 이견이 있다. 저자들은 과거 2년간 인제의대부속 서울백병원에서 입원 및 동일한 치료를 받은 15례의 돌발성 난청을 분석하여 현훈증을 동반하지 않거나 초기 청력이 완전농이 아닌 예가 청력 회복이 잘 됨을 알 수 있었다. The authors have reviewed 15 cases of sudden hearing loss those were admitted and treated under same treatment plan in Dept. of otolaryngology, Paik hospital from May 1984 to April 1986. The results were as follows 1.It occured most frequently in spring (March to May) (53%, 8/15) 2.Therapeutic results were 1 case of complete recovery, 2cases of partial recovery, 5cases of slight improvement, and 7 cases of no improvement. 3.Those patient who were not deaf initially and who had no associated vertigo revealed better recovery rate. 4.There were no different recovery rate in early treatment cases (within 8 days) 5.There were no different recovery rate between elevated and lowered ESR group

사업장 소음 폭로에 의한 일과성 역치 상승과 회복

조수헌,하미나,한상환,주영수,성주헌,강종원,윤덕로,송동빈,이명학,김선태 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.2

To determine the recovery time from noise-induced temporary threshold shift(TTS), a prospective field study was conducted at three worksites where workers are known to be exposed high level of noise. Subjects were selected according to answers on a questionnaire which inquired about otological history and previous noise exposure, including avocational, military and occupational exposures. After excluding employee with past otologic problems, recent exposure to high level noise, and under medications, total 92 employees participated in the study. Among 92 participants, complete consecutive audiometric examinations were carried out at 0∼2 hours, 5∼7 hours, 14∼16 hours after worktime noise exposure on 26 participants wearing hearing protectors and 22 participants wearing no protective devices. The difference between the hearing level 0∼2 hours after noise exposure and 5∼7 hours is statistically significant by paired t-test(p<0.01). The median recovery times calculated from the data of 22 participants wearing no protective hearing devices are 15.6 hours at 4000Hz, and 7.7 hours, 10.3 hours, 8.4 hours at 1000Hz, 2000Hz and 8000Hz respectively. These data suggest that when measuring the pure tone audiometry for noise exposed workers, at least 16 hours noise-free interval is required.

Ingestion of Korean Red Ginseng after Noise Exposure Can Potentiate Rapid Recovery of Hearing in Mice

Kang, Woo-Seok,Chung, Jong-Woo The Korean Society of Ginseng 2010 Journal of Ginseng Research Vol.34 No.4

One mechanism of inner ear damage by noise-induced hearing loss (NIHL) is the production of reactive oxygen species (ROS). Because Korean red ginseng (KRG) has an anti-ROS effect in various tissues, KRG may have a role in preventing NIHL. A window period exists in which ROS formations continue after noise exposure, and further damage can be prevented by antioxidants. In this study, we aimed to investigate the effects of KRG after exposure to noise. KRG (200 mg/kg) was fed to mice for 3 days after noise exposure. The change in hearing level was analyzed by measuring the auditory brainstem response. To induce a temporary threshold shift (TTS) of hearing, mice were exposed to 110 dB white noise for 3 hours. Fast recovery of hearing was observed in mice fed KRG 1 hour and 1 day after noise exposure for 3 days. The expression of 8-oxoguanine was not observed in the inner ears of mice fed KRG 1 hour after noise exposure, but was evident in the stria vascularis of mice in the control group (noise exposure only). From this study, we conclude that KRG acted as an effective inhibitor of NIHL in TTS cases.