中华耳科学杂志

目的 分析突发性耳聋中的特殊类型—听力缓降型患者的临床特征及疗效。方法 回顾性分析2008年至2025年解放军总医院收治的52例缓降型突发性聋患者临床资料，对其人口学特征、发病诱因、伴随症状、伴发疾病及听力学特征结果进行统计描述，并评估听力损失动态缓慢下降至最低程度不同持续时间（<3 d组、3～7 d组）患者的疗效差异。结果 34.6%(18/52)的缓降型突发性聋患者至少存在一种诱因，其中过度熬夜史（21.2%,11/52）最常见。伴随症状以耳鸣（94.2%,49/52）、耳闷（57.7%,30/52）为主，23.1%(12/52)的患者听力缓慢下降至最低程度后伴发眩晕；伴发疾病以高血压（21.2%,11/52）和糖尿病（11.5%,6/52）最为多见；听力损失类型以全频受累为主（94.2%,49/52），以全聋型（73.1%,38/52）最为多见；听力损失程度以全聋占比最高（44.2%,23/52）。缓降型突发性聋患者治疗后总有效率为82.7%(43/52),<3 d组有效率为84.4%,3～7 d组为80%。从听力恢复的频率上看，<3 d组低频区听力痊愈率（25%,8/32）及有效率（87.5%,28/32），均高于高频区听力痊愈率（15.6%,5/32）及有效率（71.9%,23/32）;3～7 d组低频区听力痊愈率（25%,5/20）及有效率（75%,15/20），均高于高频区听力痊愈率（10%,2/20）及有效率（70%,14/20）。结论 缓降型突发性聋患者以全频进行性听力下降为特征，听力损失严重，常伴耳鸣、耳闷及眩晕。该类型患者总体疗效较好，尤其是听力进展时间<3 d的患者，且低频区听力恢复显著优于高频区。

Objective To report clinical characteristics and therapeutic outcomes of patients with gradually declining sudden sensorineural hearing loss(SSNHL). Methods Clinical data of 52 patients with gradually declining SSNHL admitted to the PLA General Hospital from 2008 to 2025 were retrospectively analyzed, including demographic data, pathogenic precipitators, accompanying symptoms, comorbidities and audiological features. Therapeutic outcomes was compared among patients with different time courses of continued hearing decline until the worst level(i.e. <3 days and 3～7 days). Results At least one precipitator was identified in 34.6%(18/52) of patients, with staying up late being the most common(21.2%, 11/52). The main accompanying symptoms were tinnitus(94.2%, 49/52) and aural fullness(57.7%, 30/52), and vertigo developed in 23.1%(12/52) of patients after hearing loss progressed to the worst level. The most common comorbidities were hypertension(21.2%, 11/52) and diabetes mellitus(11.5%, 6/52). Audiologically, most patients showed involvement of all frequencies(94.2%, 49/52), with total deafness being the most prevalent(73.1%, 38/52) and showing the worst degree of hearing loss(44.2%, 23/52). The rate of overall treatment effectiveness was 82.7%(43/52): 84.4% for the <3 days group and 80% for the 3～7 days group. In terms of frequency-specific hearing recovery, the had higher the rates of complete recovery and overall effectiveness for low-frequencies(25%, 8/32 and 87.5%, 28/32 for the <3 days group, and 15.6%, 5/32 and 71.9%, 23/32 for the 3～7 days group) were better than for high-frequencies(25%, 5/20 and 75%, 15/20 for the <3 days group, and 10%, 2/20 and 70%, 14/20 for the 3～7 days group). Conclusions Patients with progressively declining SSNHL are characterized by continued hearing decline often involving all frequencies, severe hearing impairment, and frequent accompaniment of tinnitus, aural fullness, and vertigo. This type of SSNHL has a favorable therapeutic response, with better outcomes in patients whose hearing loss stops progressing in <3 days. Additionally, low-frequency hearing recovery is often superior to high-frequency hearing recovery.