血液透析患者に見られた急性感音難聴の3症例

抄録

Case 1 is a 47-year-old female who developed tinnitus and severe hearing loss in her right ear. Case 2 is a 64-year-old male with severe hearing loss and tinnitus of the right ear and mild dizziness. Case 3 is a 35-year-old male with moderate right hearing loss and tinnitus. In all of these three cases, hearing loss occurred suddenly in one ear when the patients were not undergoing actual hemodialysis procedures. All cases were treated with steroids and other drugs. In Case 1, hearing loss showed a significant improvement, but soon after the recovery, about the same degree of hearing loss recurred to the same ear. She was treated again with the same drugs, and her hearing eventually returned to the same level as the other ear. After the second recovery, her hearing did not change. In Case 2, hearing loss showed a slight to moderate improvement mainly at low and middle frequencies, but did not change thereafter. In Case 3, his hearing once returned to normal, but soon after, a moderate hearing loss at low frequencies occurred in the opposite ear and then returned to normal again. In the literature, there were 39 reported cases of sensorineural hearing loss of sudden onset which occurred in hemodialysis and peritoneal dialysis patients in our country, including our three cases. There appear to be many other unreported cases of the same kind, and the incidence of such acute sensorineural hearing loss in dialysis patients would be much higher than that of idiopathic sudden sensorineural hearing loss. A close observation at the clinical courses of these cases, including ours, indicated that this type of acute sensorineural hearing loss in dialysis patients would present diverse clinical pictures which are somewhat different from those of usual idiopathic type, and thus, should be considered as a different group of cases. Also, the possible underlying mechanism in this type of hearing loss was reviewed and discussed.