Research On The Relationship Between Uric Acid And Sudden Deafness And The Factors Affecting The Prognosis Of Sudden Deafness

Objective: Sudden deafness refers to the sudden onset of sensorineural hearing loss, usually within minutes, hours, or within three days(usually in about 12h), bottoming out at the patient hearing, at least in the connected frequency hearing loss greater than 20 d B.It can be caused by a variety of causes, such as: infection; tumors and tumor-like lesions; window membrane rupture and traumatic brain injury; drug poisoning; autoimmune response; inner ear blood disorders; congenital abnormalities; idiopathic disease, part of Meniere’s disease, multiple sclerosis and sarcoidosis patients and so on. While the above causes can lead to sudden deafness, but in our clinical work, we found that it is difficult to find the exact causes. Now, there are two theories widely recognized by people: viral infection and circulatory disorders of the inner ear. There is no unified treatment for the disease because of the unclear etiology. So its treatment is also varied. Therefore, the treatment of sudden deafness becomes extremely complex in the clinical works, which makes the study on the sudden deafness prognostic factors more meaningful.Uric acid is the end product of purine catabolism in the human body. It is mainly produced by the liver, adipose tissue and muscle tissue and excreted in the urine. In recent years, as people’s living standards up and changes in diet hyperuricemia incidence is rising. In recent years, a large number of studies have shown that high uric acid is associated with hypertension, obesity, insulin resistance, fatty liver and chronic kidney disease. The relationship between uric acid and human health receive more and more attention. It has been found that uric acid levels are related to hereditary hearing loss, but the relationship between uric acid levels and sudden deafness is rare mentioned. In clinical work, we find that gout patients are often accompanied by tinnitus and hearing loss, so it is necessary for us to explore whether uric acid level is related to sudden deafness, and it is of great significance for the treatment and prognosis of sudden deafness.The purpose of the experiment is to explore the relationship between uric acid and sudden deafness and to find the effect about sudden deafness in different factors on the prognosis.Methods: This study included sudden deafness who visited our department from January 2012 to December 2015.All the patients were in line with sudden deafness diagnostic criteria for Chinese Medical Association of Otolaryngology- Head and Neck Surgery Branch established, and they all examined by routine ENT examination, pure tone audiometry, acoustic impedance audiometry and internal auditory canal and brain CT or MRI to exclude internal auditory canal and intracranial lesions. By excluding the incomplete cases which not had uric acid level and which was associated with hypertension, diabetes, gout, cerebral infarction, liver and kidney and other systemic diseases, we got 125 cases as the experimental group. Then we collectted 90 cases of hospitalized patients with deviation of nasal septum as the control group, and these cases also excluded the incomplete cases which not had uric acid level and which was associated with hypertension, diabetes, gout, cerebral infarction, liver and kidney and other systemic diseases. And these two groups had no statistical significance in terms of age and sex. Then We compared two groups of their blood uric acid levels. Then we divided 125 patients with sudden deafness into four groups according to the time period from the onset of hearing loss and beginning of treatment(within 5 days, 6-10 days, 11-15 days, more than 15 day) to compare the level of uric acid; Removing incomplete cases we got 129 cases to explore the effect of prognosis of sudden deafness, including Age, sex, time period from the onset of hearing loss and beginning of treatment, concomitant symptoms(tinnitus, aural fullness, vertigo) and comorbidities(hypertension, diabetes, hyperuricemia) as affecting factor to analysis. The above information were used SPSS 13.0 statistical software package for data statistics analysis, measurement data were expressed as mean ± standard deviation, the uric acid levels between sudden deafness group with deviation of nasal septum group use T test to compare; the levels of uric acid with time of onset to treatment in sudden deafness patients use analysis of variance to compare; Age, sex, treatment time, concomitant symptoms(tinnitus, aural fullness, vertigo) and comorbidities(hypertension, diabetes, hyperuricemia) use the the chi-square test to compare; Multivariate analysis use Logistic regression analysis. All above, P<0.05 was considered as statistically significant.Results:1 The uric acid levels between sudden deafness group with deviation of nasal septum group were statistically significant(P<0.05),and the uric acid levels in sudden deafness group were higher than deviation of nasal septum group;The levels of uric acid with different treatment time in sudden deafness patients were statistically significant(P<0.05),and in addition to 10-15 days group and 15 days group, the uric acid level of any rest two groups was statistically significant. And uric acid levels of the group(within 5 days for treatment) were higer than that group(6-10 days for treatment). The uric acid levels of the group(6-10 days for treatment) were higer than that group(more than 10 days for treatment).2 The prognosis was correlated with time period from the onset of hearing loss and beginning of treatment,tinnitus,diabetes and hyperuricemia, and no correlation with age, sex, aural fullness, vertigo and hypertension. Time period from the onset of hearing loss and beginning of treatment:We divided the patients into 4 groups(within 3 days, 4-7 days, 8-14 days, more than 14 days) according to different onset to treatment times. The four groups had statistically significant(P<0.05) in results. The group-within 3 days for treatment, had 60 cases, and the total effective rate was 70%. The group-4-7 days for treatment had 37 cases, and the total effective rate was 59.46%. The group- 8-14 days for treatment, had 13 cases, and the total effective rate was 53.85%. The group-more than 3 days for treatment, had 19 cases, and the total effective rate was 26.42%. From the total efficiency of the trend, the earlier time for treatment, the better prognosis. Tinnitus: It was statistically significant between the group with tinnitus and the group without tinnitus. There are 106 patients who have tinnitus, and the total effective rate was 63.20%.The patients without tinnitus have 23 cases, and the total effective rate was 39.13%.Diabetes: In 129 cases of sudden deafness patients, there were 24 cases(18.60%) with diabetes mellitus. The total effective rate about the sudden deafness patients with diabetes was 37.50%, and without diabetes sudden deafness patients had a total effective rate about 63.81%. It was statistically significant between the two groups(P<0.05), and the patients with diabetes had a poor prognosis. Uric acid: The two groups differences-hyperuricemia group and normal uric acid group in patients with sudden deafness, were statistically significant. Hyperuricemia group in patients with sudden deafness had 19 cases, and the total effective rate was 36.84%. The normal uric acid group in patients with sudden deafness had 110 cases, and the total effective rate was 62.73%.3. The logistic regression analysis showed that the time period from the onset of hearing loss and beginning of treatment, tinnitus and high uric acid on sudden deafness prognosis were statistically significant. The earlier time for treatment, the better prognosis; Sudden deafness patients with tinnitus had better prognosis; Sudden deafness patients with hyperuricemia had poor prognosis.Conclusions: Compared with the same period of deviation of nasal septum in hospital patients, the uric acid levels in patients with sudden deafness were high, and uric acid levels decreased gradually with with the passage of time. So the uric acid may be one of the risk factors for sudden deafness. The time for treatment in patients with sudden deafness sooner, the better prognosis we got. Tinnitus is the favorable factor for sudden deafness patients’ s prognosis. The patients with tinnitus had a better prognosis than the patierts without tinnitus, But the exact mechanism needed further study. Hyperuricemia was the unfavorable factor for sudden deafness patients’ s prognosis. The patients with hyperuricemia had a worse prognosis than the patierts with normal uric acid levels.