特发性突发性感觉神经性听力损失(ISSNHL)的特征是突然出现听力损失,有时伴有眩晕。血管病变(例如,耳蜗缺血,或耳蜗梗塞)是ISSNHL的最可能原因之一。这篇综述旨在介绍目前对内耳解剖的理解,ISSNHL的临床特征,及其治疗策略。迷路动脉是唯一向内耳供血的末端动脉,它有三个分支前庭前动脉,主要的耳蜗动脉,和前庭耳蜗动脉(VCA)。VCA的闭塞可由多种因素引起。VCA穿过狭窄的骨管。ISSNHL通常在排除突发性感音神经性听力损失(SSNHL)的耳蜗后病变后诊断。如前庭神经鞘瘤。因此,对于SSNHL患者,建议进行头部MRI或听觉脑干反应评估.CHADS2评分高的严重SSNHL患者,中风风险指数,与CHADS2评分较低的严重SSNHL患者相比,前庭神经鞘瘤的发生率显着降低,提示卒中高危人群的严重ISSNHL是由血管损伤引起的。abrinhrinthine出血引起SSNHL或眩晕,在ISSNHL。要诊断丙炔内出血,需要对MRI进行仔细的解释,并且一小部分被诊断为ISSNHL的患者实际上可能患有丙炔内出血。许多研究报道了ISSNHL与动脉粥样硬化或心血管危险因素之间的关联(例如,糖尿病,高血压,血脂异常和心血管疾病),与对照组相比,ISSNHL患者的卒中风险可能升高。健康耳朵一侧的听力水平增加,高弗雷明汉风险评分,高中性粒细胞与淋巴细胞比率,高血小板与淋巴细胞比率,严重的白质病变可能是ISSNHL患者预后不良的因素。血栓形成相关基因与ISSNHL易感性之间的关联已在许多研究中报道(例如,凝血因子2,凝血因子5,纤溶酶原激活物抑制剂1,血小板相关基因,同型半胱氨酸代谢相关酶基因,内皮素-1,一氧化氮3,磷酸二酯酶4D,补体因子H,和蛋白激酶C-eta)。以减轻内耳血管损伤为目的的ISSNHL治疗包括全身给药类固醇,鼓室内注射类固醇,高压氧治疗,前列腺素E1,降纤治疗,和氢气吸入疗法,但目前尚无ISSNHL的循证治疗方法.由于血管损害而明确诊断和治疗ISSNHL的突破对于改善生活质量至关重要。
Idiopathic sudden sensorineural hearing loss (ISSNHL) is characterized by abruptly appearing hearing loss, sometimes accompanied by vertigo.
Vascular pathologies (e.g., cochlear ischemia, or cochlear infarction) are one of the most likely causes of ISSNHL. This
review aims to present current understanding of inner ear anatomy, clinical features of ISSNHL, and its treatment strategies. The labyrinthine artery is the only end artery supplying blood to the inner ear, and it has three branches: the anterior vestibular artery, the main cochlear artery, and the vestibulo-cochlear artery (VCA). Occlusion of the VCA can be caused by a variety of factors. The VCA courses through a narrow bone canal. ISSNHL is usually diagnosed after excluding retrocochlear pathologies of sudden sensorineural hearing loss (SSNHL), such as vestibular schwannoma. Therefore, a head MRI or assessing auditory brainstem responses are recommended for patients with SSNHL. Severe SSNHL patients with high CHADS2 scores, an index of stroke risk, have a significantly lower rate of vestibular schwannoma than severe SSNHL patients with low CHADS2 scores, suggesting that severe ISSNHL in individuals at high risk of stroke is caused by
vascular impairments. Intralabyrinthine hemorrhage causes SSNHL or vertigo, as in ISSNHL. The diagnosis of intralabyrinthine hemorrhage requires careful interpretation of MRI, and a small percentage of patients diagnosed with ISSNHL may in fact have intralabyrinthine hemorrhage. Many studies have reported an association between ISSNHL and atherosclerosis or cardiovascular risk factors (e.g., diabetes mellitus, hypertension, dyslipidemia and cardiovascular disease), and subsequent risk of stroke in patients with ISSNHL may be elevated compared to controls. Increased hearing level on the healthy ear side, high Framingham risk score, high neutrophil-to-lymphocyte ratio, high platelet-to-lymphocyte ratio, and severe white matter lesions may be poor prognostic factors for patients with ISSNHL. The association between thrombosis-related genes and susceptibility to ISSNHL has been reported in many studies (e.g., coagulation factor 2, coagulation factor 5, plasminogen activator inhibitor-1, platelet-associated genes, a homocysteine metabolism-related enzyme gene, endothelin-1, nitric oxide 3, phosphodiesterase 4D, complement factor H, and protein kinase C-eta). Treatment of ISSNHL with the aim of mitigating the
vascular impairment in the inner ear includes systemically administered steroids, intratympanic steroid injections, hyperbaric oxygen therapy, prostaglandin E1, defibrinogenation therapy, and hydrogen inhalation therapy, but there is currently no evidence-based treatment for ISSNHL. Breakthroughs in the unequivocal diagnosis and treatment of ISSNHL due to
vascular impairment are crucial to improve quality of life.