中华耳科学杂志

目的 突发性聋是耳科常见急症，目前其病因尚未完全阐明、预后难以评估，因此其治疗上缺乏针对性。单侧突聋患者发病时健耳的听力数据可以间接体现患者发病前听觉系统的基本状况，如是否存在老化、声损伤状态。本研究提取发病初期健耳听力曲线特征，利用聚类分析的方法研究其与单侧突聋患者预后的关系。方法 回顾性选取2022年8月至2023年4月间就诊并治疗于首都医科大学附属北京同仁医院的单侧突聋患者229例，分段提取单侧突聋患者发病时健耳听力曲线特征，采用聚类分析算法分为两簇，聚类成功后，返回分析两簇患者临床特征差异及治疗结局差异。结果 229名患者成功地完成二聚类(轮廓系数=0.45)，两簇患者治疗有效率具有明显差异(P=0.02)，治疗有效率的差异主要来源于≥51岁年龄层。结论 健耳4⁸ kHz听力差值是不依赖双耳听阈绝对值的提示突聋预后的独立因素。对于年龄≥51岁和(或)平坦型听力下降的患者而言，若伴有健耳8 kHz听力陡降特征，其预后显著不良，应采用更为积极的治疗方案。该类人群或许能够探索出独立的病因病理。

Objective Sudden hearing loss is a common emergency in otology. Its etiology has not been fully elucidated and its prognosis is difficult to assess, hindering targeted treatment. Hearing in the healthy ear at the onset of unilateral sudden hearing loss may indirectly reflect the baseline condition of the patient's auditory system, including aging and sound damage. In this study, hearing data of the healthy ears in the early stage of the disease were extracted,and their relationship to the prognosis of unilateral sudden hearing loss was examined by cluster analysis. Methods Data from 229 patients with unilateral sudden hearing loss treated in Beijing Tongren Hospital, Capital Medical University,from August 2022 to April 2023 were collected as a retrospective cohort. Hearing of the healthy ear at the onset of unilateral sudden hearing loss was extracted in segments, and the cluster analysis algorithm was used to divide them into two clusters. After successful clustering, clinical presentation and treatment outcomes were compared between the two clusters. Results clustering of the 229 patients yielded a silhouette coefficient of 0.45. There was a significant difference in treatment efficacy between the two clusters(P=0.02). The disparity in treatment efficacy primarily arose from patients aged 51 years and older. Conclusion Hearing in the healthy ear at 4 to 8 kHz serves as an independent prognostic indicator in sudden hearing loss, independent of the absolute binaural hearing thresholds. For patients aged 51 years and older and/or those presenting with a flat audiometric configuration, a concomitant sharp decline in hearing at 8 kHz in the healthy ear is associated with significantly poorer prognosis, for whom aggressive treatment strategies should be considered. This population may warrant further exploration of independent etiological and pathological factors.