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目的研究鼻咽癌患者放化疗后远期的听力变化规律及其影响因素,为制定鼻咽癌治疗方案提供依据。方法 22名鼻咽癌患者在放疗前及放疗中、放疗结束时及放疗后3、6、24个月接受耳内镜检查、纯音测听以及声导抗检查,对数据进行统计分析得出鼻咽癌放化疗后听力改变的规律。结果放疗后24个月内,共有18耳发生分泌性中耳炎。随着放化疗后时间的推移,纯音测听中各频率气骨导差值总体呈逐渐上升趋势;而鼓室声导抗中鼓室图梯度(GRAD)值呈逐渐下降趋势,放疗后24个月该下降趋势逐渐平缓;鼓室图宽度(TW)值开始呈逐渐上升趋势,放疗后24个月上升趋势渐趋平缓。放疗后24个月时,44耳中有5耳发生低频感音神经性耳聋,有17耳发生高频感音神经性耳聋。应用logistic回归分析筛选出放疗后24个月感音神经性听力下降的影响因素包括:年龄、放疗后发生分泌性中耳炎以及应用顺铂。结论鼻咽癌患者放化疗后发生以高频下降为主的感音神经性听力下降。年龄、放疗后发生分泌性中耳炎以及应用顺铂均为感音性听力损害的影响因素。放疗后分泌性中耳炎的发展在放疗后24个月开始有所好转。
Objective To study the long-term hearing changes of nasopharyngeal carcinoma patients after radiotherapy and chemotherapy and its influencing factors, to provide a basis for the development of nasopharyngeal carcinoma treatment options. Methods Twenty-two patients with nasopharyngeal carcinoma underwent endoscopy, pure tone audiometry and acoustic impedance before radiotherapy, at the end of radiotherapy, and at 3, 6, and 24 months after radiotherapy. Statistical analysis of the data showed that the nasopharynx Hearing changes after cancer radiotherapy and chemotherapy. Results Within 24 months after radiotherapy, a total of 18 ears had secretory otitis media. With the passage of time after radiotherapy and chemotherapy, pure tone audiometry in all frequencies of air-bone conduction difference showed an overall upward trend; while the tympanic cavity acoustic conductivity in the tympanogram gradient (GRAD) showed a gradual downward trend 24 months after radiotherapy The trend of decrease was gradually flatten. The width of tympanogram (TW) began to increase gradually, and the trend of increase was gentle 24 months after radiotherapy. At 24 months after radiotherapy, 5 ears of 44 ears had low frequency sensorineural deafness and 17 ears had high frequency sensorineural deafness. Logistic regression analysis was used to screen out the influencing factors of sensorineural hearing loss at 24 months after radiotherapy, including age, secretory otitis media after radiotherapy and cisplatin. Conclusion The patients with nasopharyngeal carcinoma after radiotherapy and chemotherapy occurred in high-frequency decline of sensorineural hearing loss. Age, post-radiotherapy otitis media with effusion and the use of cisplatin are sensitive hearing loss factors. The development of secretory otitis media after radiotherapy began to improve 24 months after radiotherapy.