耳聋的病因与分类PPT课件.ppt

耳聋的分类与病因,Hearinglossclassification&etiology,耳的症状学Earsemeiology,耳痛otalgia耳漏Otorrhea耳痒earitch耳鸣tinnitus耳聋hearingloss眩晕vertigo面瘫faceparalysis耳后肿胀tumefaction,2,耳聋的分类,按耳聋病发的时间分类antenatalpre-birthhearinglossinheritance1.先天性耳聋：出生以前的耳聋2.后天性耳聋：出生以后的耳聋postnatalafterbirthhearingloss,遗传,遗传,非遗传,非遗传,3,耳聋的分类,按病发的部位分类Hearinglossclassaccordingtoinflammationpart.1.蜗前聋：传导性耳聋，外耳、中耳病变。Pre-cochleahearingloss:conductivehearingloss,externalearandmiddleearhaveinflammation.2.蜗性聋：感应性耳聋，耳蜗本身病变。Cochleahearingloss:sensorineuralhearingloss,thecochleahastheinflammation.3.蜗后聋：神经性耳聋，大脑听中枢病变。CentralHearingloss:sensorineuralhearingloss,nervecenteristhemorbidpart.,感音神经性耳聋,传导性耳聋,4,耳聋的分类,Conductivehearingloss传音性（传导性、蜗前聋）,SensorineuralHearingloss感音神经性（蜗性、蜗后聋）,Mixedhearingloss混合性,CentrumHearingloss中枢性（蜗后聋）,5,Hearinglosstypes,ConductivehearinglossSensorineuralhearinglossMixedhearingloss,6,正常听力图Thenormalaudiogram,频率Frequencyonthex-axis声强Intensityonthey-axisFrequencyrange:125-8000HzIntensityrange:-10-120dB(airconduction),耳聋程度,PTA(dBHL),国际标准我国标准degreegradetypegrade,25A26-40mildB41-55moderateC2级重听56-70moderatesevereD1级重听71-90severeE2级聋90profoundF1级聋,重听,聋,我国听力“残疾标准”（1986）与国际标准（1980）对照表,传导性耳聋Conductivehearingloss,9,ExampleofConductivehearingloss,10,传导性耳聋Conductivehearingloss,1.骨导正常Boneconditionisnormal.2.气导下降Aircondition3.气骨导差10dBA-Bgapismorethan10dB.,11,传导性耳聋的听损程度,12,传导性耳聋的听损程度,1.鼓膜穿孔。2.鼓膜穿孔伴听骨链中断。3.鼓膜和听骨完全缺如。4.鼓膜完整伴听骨链中断。5.鼓膜完整+听骨链中断+卵圆窗封闭。6.外耳道堵塞。,13,传导性耳聋的常见病变,耳部畸形Earmalformations耵聍栓塞Impactedearwax外耳湿疹Acuteotitismedia外耳道炎Inflammationoftheearcanal外耳道塌陷Dentoftheearcanal耳道扩大Expandoftheearcanal异物eyewinker,鼓膜穿孔Perforatedeardrum流脓Purulence穿孔后愈合ScaroverafterPerforated肿瘤或胆脂瘤Exostosesandosteomas鼓膜疤痕Eardrumscar鼓膜硬化Eardrumsclerosis,14,常见的中耳疾病,化脓性中耳炎Suppurativeotitismedia分泌性中耳炎Secretoryotitismedia耳硬化症Otosclerosis听骨链固定Fixationoftheossicularchain听骨链中断Interruptionoftheossicularchain鼓室硬化tympanasclerosis,15,Congenitalmalformations,(EngstrmandEngstrm,1979,pp.4),16,Impactedearwax,Courtois,pp.10,17,Perforatedeardrums,18,Perforationofeardrum,19,Exostosis,20,Osteoma,21,Acuteotitismedia,22,Chronicotitismedia,23,Otosclerosis,24,Treatmentofconductivehearingloss,MedicineOperationGuidanceHearinginstruments,25,感因神经性耳聋Sensorineuralloss,26,响度改变AlteredloudnessPoorersensitivitytosoftandintermediatesoundsSometimesincreasedsensibilitytoloudsounds失真Distortion(missingfrequencies)言语分辨率下降Poordiscrimination(especiallyinnoisecondition)耳鸣Tinnitus,伴随症状Associatedproblems,27,Relationshipofloudnessandintensitylevel,Stach,1998pp.97,28,Frequencyresolvingability,Stach,1998pp.96,29,Sensorineuralhearingloss,1.气骨导都下降。Airconductivedecline2.气导早期以高频下降为主，晚期低频也下降。Highfrequencydeclineatfirsttime,thenbothdecline.3.气骨导差10dBA-Bgapismorethan10dB,42,耳聋相关疾病,耳聋分类,时间-congenital&acquired性质-organic&functional/psychogenic部位-conductive,sensorineural&mixedcochlear,retrocochlear¢ral病因,44,耳聋病因,中耳疾病及耳硬化症先天性聋中毒性聋感染性聋老年性聋爆震性聋及噪声性声损伤内耳免疫及自身免疫性内耳病全身及其它器官系统的慢性疾病引起的耳聋特发性突聋外淋巴瘘蜗后性聋诈聋和精神性聋,45,中耳疾病,急性/慢性化脓性中耳炎耳硬化症原因不明原发于骨迷路局灶性病变镫骨性-环韧带镫骨活动受限/固定CHL耳蜗性-耳蜗/内听道SNHL双侧20-40y缓慢进行性加重听力图：早期气导上升型平坦型Carhart切迹（2kHz15dB)声导抗：AsCT：骨迷路、两窗区/内耳道骨壁上界限分明的局灶性硬化改变,46,先天性聋,遗传性遗传方式病变部位发病时间非遗传性产前期母体的感染、中毒分娩期窒息、外伤,47,中毒性聋,氨基甙类抗生素链霉素、卡那霉素、庆大霉素、新霉素某些抗肿瘤药顺铂、卡铂、氮芥袢利尿剂速尿、利尿酸水杨酸制剂阿司匹林（停药后一般可迅速消失）奎宁局部麻醉药的卡因、利多卡因（轻度，各个频率，可恢复）重金属铅、镉、汞、砷（不可逆蜗后性聋、伴前庭损害）吸入性有害气体氨基苯、CO、CS2、SO2（内耳、中枢）其它万古霉素、多粘菌素B中成药牛黄清心丸（雄黄为砷剂）,48,感染性聋,腮腺炎-儿童单侧SNHL高频不可逆麻疹-双耳不对称性SNHL高频不可逆带状疱疹-单侧前庭SNHL可逆细菌性脑膜炎-10-20%早期双耳重度波动梅毒-3-38%早期/晚期双侧突发前庭重度,49,老年性聋,原因：听觉系统衰老症状：不明原因双侧缓慢进行性加重SNHL-高频为主言语识别能力明显下降,50,声创伤,爆震性/急性-中耳内耳噪声性声创伤-世界性七大公害之首强度时间频谱（高频低频，窄带宽带）影响听阈频率损伤部位（外毛-内毛细胞，蜗底-蜗顶）4000Hz切迹,51,自身免疫性内耳病（AIED）,自身免疫性损害累及耳蜗&/前庭临床特点中年女性双侧不对称或单侧快速进行性/波动性蜗性或蜗后性HL伴其它自身免疫性疾病病程较长（数周）诊断缺乏敏感可靠的试验诊断方法治疗高剂量类固醇药物和免疫抑制剂少数经恰当治疗可获较好疗效的内耳病之一,52,外淋巴瘘,原因：外淋巴和中耳腔之间的骨质破损膜性组织/韧带破裂致使外淋巴和中耳腔交通诊断：有使中耳或颅内压突然升高的病史单耳突发性SNHL伴前庭症状治疗后眩晕不减轻&SNHL逐渐加重,53,特发性突聋,突然发生原因不明数分钟、数小时单耳高频SNHL50伴眩晕7-10d内治疗效果较好1/31/31/3,54,全身性疾病,甲状腺功能减退症肾脏疾病糖尿病高血压和高血脂症血液性疾病,55,助听器选配对象/适应症,有残余听力药物或手术治疗无效，病情稳定传导性聋耳硬化症特发性突聋前庭导水管扩大综合症,56,骨导助听器选配适应症,外耳道闭锁、狭窄、长期流脓等不适宜用耳塞者1k和2kHzABGHL40dB,57,验配助听器的步骤,询问病史Toaskexperienceinthepast:听力不好有多长时间了？做过哪些检查和治疗？是否戴过助听器,效果怎样?howlongyouhavehearingloss?Didyouseeadoctor?didyouwearahearingaids?howaboutyourfeeling?检查耳部Tolookoverear:耳廓外型是否正常？外耳道是否通畅？是否有分泌物？如果有是干性还是湿性,鼓膜是否完整？有无鼓膜内陷、中耳积液、穿孔、炎性息肉等。auricleshape?externalearcanal?eardrum?middleear？Cerumen?,58,验配助听器的步骤,3.检查听力并对照检查结果作出分析。Toanalysishearingtestsresult.4.选