Abstract Objective To investigate the factors associated with the onset of sudden deafness and to provide a theoretical basis for reducing the incidence of sudden deafness. Methods A survey of factors associated with the onset of sudden deafness in patients hospitalized in our department was conducted in the form of questionnaire + medical record survey, and the results were counted. Results The average age of 378 patients at the time of onset was 42.0±10.2 years, and the proportion of male and female onset was 59%; than 41%;; the proportion of young people under 35 years of age onset was 31%; the history of excessive fatigue before onset was 51.6%; the psychological stress factor was 27.8%; the mental irritation factor was 18.3%; the history of upper respiratory tract infection was 9.5%;;; 4.8%;; and Family history accounted for 2.4%;; comparison of mental and physical labor was 62%; than 38%;; no obvious seasonal factors for year-round onset; with systemic diseases accounted for 34.1%;. Conclusion Most patients with sudden deafness have factors associated with its onset, and overexertion, mental stress, mental stimulation, and systemic diseases are obvious predisposing factors for its onset, and there is an increasing trend of onset in young people, and the onset is higher in men and mental workers.
Keywords: sudden deafness; etiology
Sudden deafness is a sudden, unexplained sensorineural hearing loss with a hearing loss of more than 30 dB at three connected frequencies, with an onset time ranging from a few hours to several days. Clinical observation shows that the incidence of sudden deafness in modern society shows a significant increase, and many social factors such as mental stimulation and stress can induce sudden deafness and even have an impact on its prognosis. We conducted a questionnaire survey to analyze the role of these factors in the development of sudden deafness in 378 patients diagnosed and hospitalized with sudden deafness in our hospital from January 2002 to May 2008.
1. Materials and methods
1.1
Clinical data
The 378 patients with sudden deafness were from the inpatients of our department from January 2002 to May 2008. According to the diagnostic basis and efficacy criteria of sudden deafness [3], sudden deafness was diagnosed if the following conditions were met: (i) sudden onset of non-fluctuating sensorineural hearing loss, moderate or severe or more; (ii) the etiology of the occurrence of hearing loss was unknown; (iii) it could be accompanied by tinnitus at the same time; (iv) it could be accompanied by vertigo, nausea and vomiting by colleagues but not repeatedly; (v) there were no other symptoms of cranial nerve damage except for the VIII cranial nerve The patient has no history of trauma. The patient had no history of trauma, and the audiological examination included pure tone audiometry, acoustic conductance, otoacoustic emission and brainstem evoked potential, and CT or magnetic resonance examination except for lateral skull base lesions.
1.2 Methods
Patients responded to the questionnaire designed by us (Table 1) on the second day after admission and performed the morbidity factor statistics in combination with the admission examination. The results were statistically analyzed by CHISS, a statistical software of Gaozhi Chinese.
Table 1: Onset factors of sudden deafness
Causative factor number
Onset factors
Related explanation
1.Overexertion
Some patients have a history of self-perceived physical exertion
2.Mental stimulation
There was mental stimulation before the onset of the disease
3.Psychological pressure
Patients have self-perceived invisible psychological pressure from society or family
4.History of upper sensation
Episodic manifestations from 2 weeks before to 7 days after the onset of the disease
5. History of previous onset
The current onset is a relapse
6.Family history
3 generations of direct and collateral relatives with sudden deafness
7.Occupational characteristics
Occupational characteristics of the patient: mental or physical labor
8. Smoking or alcohol consumption factors
Patients who have smoked for a long time or/and drink more alcohol before the onset of the disease
9.Season of onset
According to the classification of spring, summer, autumn and winter seasons of the year onset
10.Systemic diseases
With hypertension, diabetes, hyperlipidemia and at least one of these factors
2. Results
In 378 patients, the youngest was 14 years old and the oldest was 78 years old, with an average age of 42.0±10.2 years at the time of onset; in terms of the ratio of male to female onset, 223 cases were male and 155 cases were female, with a male to female incidence rate of 59%;:41%; with significant differences between the two; the ratio of left, right, and bilateral ear onset was 46%;:47%;:7%; with no significant differences between left and right ear onset Among the 378 patients with sudden deafness, 78 had vertigo, 45 had severe total deafness in one ear, and 30 had severe total deafness in both ears; in terms of occupational factors, 225 were engaged in mental labor and 153 in physical labor, with a ratio of 59.5%;:40.5%; among the 378 cases, 65 had smoking and/or alcohol consumption. Among the 378 cases, 65 cases had smoking and/or alcohol consumption, accounting for 17.2% of the group;; the group found no significant difference in the incidence rate throughout the year.
Among them, 195 cases (51.6%) had a history of excessive fatigue before the onset of the disease; 105 cases (27.8%) had mental stress factors; 69 cases (18.3%) had mental irritation factors; 129 cases (34.1%) had at least one systemic disease such as hypertension, diabetes mellitus, hyperlipidemia, etc.; 36 cases (9.5%) had a history of upper respiratory tract infection; 18 cases (4.8%) had a previous episode; and 18 cases (4.8%) had family history of infection. 4.8%;; 9 cases with family history, accounting for 2.4%;.
3. Discussion
Clinical observation shows that the incidence of sudden deafness has a significant increasing trend. However, the etiology of sudden deafness is still unclear, and many hypotheses exist for its pathogenesis, such as the viral infection theory, the inner ear blood supply disorder theory, the autoimmune theory and the membrane vagus rupture theory [4], and various precipitating factors also play an important role in the pathogenesis of sudden deafness. These predisposing factors may contribute to the pathological changes elaborated by the various theories mentioned above.
The viral infection theory is currently accepted by many scholars, such as mumps virus, cytomegalovirus, herpes virus, etc. This may be due to acute cochlear infection caused by viruses, and we observed a history of upper respiratory tract infection in 9.5%; of 378 patients, which indicates that the role of viral infection in the pathogenesis of sudden deafness is not very obvious. The theory of impaired blood supply to the inner ear suggests that the blood vessels supplying the inner ear are peripheral vessels and have few anastomotic branches, which increases the vulnerability of the blood supply system to the inner ear. As a result, blood flow decreases and cochlear blood perfusion decreases, causing ischemia and hypoxia in the inner ear, resulting in necrosis and degenerative changes of inner ear hair cells. Our group found that 34.1% of the 378 patients with sudden deafness also had at least one disease of hypertension, diabetes mellitus, and cardiovascular disease; which may also be due to their inner ear microcirculation disorders. These diseases are important predisposing factors for sudden deafness.
Our survey found that some social factors have a prominent feature in the onset of sudden deafness. This indicates that the incidence of sudden deafness is no longer predominant in middle-aged and elderly people, but the incidence of sudden deafness is increasing in young people; the proportion of men in the incidence of sudden deafness is higher than that of women, which is different from the previous conclusion that the incidence of sudden deafness is the same in men and women. The incidence of sudden deafness is higher in men than in women, which is different from the previous conclusion that the incidence is the same in men and women. The reason for this may be that fatigue, stress, and mental stimulation can increase the level of norepinephrine in the body, and norepinephrine, as a transmitter, can cause the secretion of vasoactive substances, thus causing changes in vasodilatory function and blood rheology. [5], and these predisposing factors such as fatigue, stress, and mental stimulation mentioned above happen to be very common social phenomena in modern society; in addition, the increasing social competitiveness faced by young people under 35 years of age and men in society also induces and aggravates the above factors, and this may also be a social factor in the marked increase in the onset of sudden deafness. The higher incidence in brain workers compared to manual workers may be related to the excessive mental stress and low physical activity in brain workers [6]. Therefore, in order to reduce the occurrence of sudden deafness, it is very important to take countermeasures such as relieving fatigue, relaxing emotions, and appropriate exercise against the various social factors mentioned above, the adjustment of which is very important not only for the prevention of sudden deafness, but also for its prognosis.