2012AAO-HNS 突发性聋临床实践指南
在美国突发性感觉神经耳聋(SSNHL)的发病率约为5~20/10万人,每年新发病例在4000例左右。该指南对SHL成年患者的诊断、治疗和随访做出了相应推荐,希望医生能更精确的做出诊断、快速介入治疗、减少不必要的治疗方案改动、避免不必要的实验室检查和影像检查,从而改善患者听力和康复结果。
快速和准确做出诊断的重要性:
①将感觉神经性耳聋与传导性耳聋相鉴别;
②双侧SSNHL、复发SSNHL或局部神经病学改变等症状表明患者存在潜在病因,应采取对症治疗;
③对特发性突发感觉神经耳聋(ISSNHL)的诊断以听力测验结果为准,即3次连续测量听力丧失超过30分贝,根据病史和体格检查排除其他病因。
应避免的不必要检查和治疗包括:
①常规脑CT对诊断没有必要,且让患者接受了离子辐射。
②不推荐采用常规、无靶向、实验室检查;
③不需服用的药物包括:抗病毒药、溶栓药、血管舒张药、血管活性药或抗氧化药。
对ISSNHL的初始治疗应包括皮质类固醇激素
①激素给药方式可为系统性的或通过鼓室内设备递送。
②可给予高压氧疗法。
随访和咨询的重要性
①医生应当告知ISSNHL患者该病的自然病程、治疗的利弊和目前疗效中的不足之处;
②医生应在确诊ISSNHL后6个月内对患者进行随访;
③医生应建议听力恢复不完全的患者接受听力辅助设备。
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The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) is the world's largest organization representing specialists who treat the ear, nose, throat, and related structures of the head and neck. The Academy represents more than 12,000 otolaryngologist—head and neck surgeons who diagnose and treat disorders of those areas. The medical disorders treated by our physicians are among the most common that afflict all Americans, young and old. They include chronic ear infection, sinusitis, snoring and sleep apnea, hearing loss, allergies and hay fever, swallowing disorders, nosebleeds, hoarseness, dizziness, and head and neck cancer. The AAO-HNS Foundation works to advance the art, science, and ethical practice of otolaryngology-head and neck surgery through education, research, and lifelong learning