等待肾移植和肝移植的成年患者的听力学特征

文献信息

中文摘要

目的： 听力损失是慢性肾脏病（CKD）和慢性肝病（CLD）患者中一种未被充分认识的合并症，尤其是在等待实体器官移植的患者中。早期识别听觉功能障碍对于优化沟通、治疗依从性和移植后护理至关重要。描述等待肾移植或肝移植的成年候选人中听力损失的患病率、严重程度和听力图模式。
方法： 在三级学术中心对36名因晚期CKD或CLD而接受肾移植或肝移植评估的成年患者进行了一项横断面研究。所有参与者均接受了耳显微镜检查、鼓室压测量、纯音测听、畸变产物耳声发射（DPOAEs）以及使用耳鸣残疾量表进行的耳鸣评估。听力损失定义为任一耳在0.5-4 kHz范围内的纯音平均值>20 dB HL。
结果： 30.6%的患者被识别出听力损失（CLD：31.6%；CKD：29.4%），主要为轻至中度，呈对称性高频感音神经性模式。56.9%的耳观察到畸变产物耳声发射异常，提示亚临床耳蜗功能障碍。38.2%的参与者报告有耳鸣，两组之间无显著差异。所有耳鸣病例均被归类为轻微或轻度残疾。在CKD患者中，使用乙酰水杨酸与听力损失显著相关（P=.003）。
结论： 听力损失和耳鸣在等待移植的晚期CKD或CLD患者中很常见。包括DPOAEs在内的全面听力学评估可通过识别有听觉损害风险的患者并为耳毒性药物决策提供信息，从而改善移植前评估。

英文摘要

OBJECTIVE: Hearing loss is an underrecognized comorbidity in patients with chronic kidney disease (CKD) and chronic liver disease (CLD), particularly among those awaiting solid organ transplantation. Early identification of auditory dysfunction is essential to optimize communication, treatment adherence, and post-transplant care. To describe the prevalence, severity, and audiometric patterns of hearing loss in adult candidates for kidney or liver transplantation.
METHODS: A cross-sectional study was conducted in 36 adult patients with advanced CKD or CLD evaluated for kidney or liver transplantation at a tertiary academic center. All participants underwent otomicroscopy, tympanometry, pure-tone audiometry, distortion product otoacoustic emissions (DPOAEs), and tinnitus assessment using the Tinnitus Handicap Inventory. Hearing loss was defined as a pure-tone average >20 dB HL across 0.5-4 kHz in either ear.
RESULTS: Hearing loss was identified in 30.6% of patients (CLD: 31.6%; CKD: 29.4%), predominantly mild to moderate, with symmetrical high-frequency sensorineural patterns. Distortion product otoacoustic emissions abnormalities were observed in 56.9% of ears, suggesting subclinical cochlear dysfunction. Tinnitus was reported in 38.2% of participants, with no significant differences between groups. All cases of tinnitus were classified as slight or mild handicap. Use of acetylsalicylic acid was significantly associated with hearing loss among CKD patients (P=.003).
CONCLUSIONS: Hearing loss and tinnitus are common in patients with advanced CKD or CLD awaiting transplantation. Comprehensive audiological assessment, including DPOAEs, may improve pre-transplant evaluation by identifying patients at risk for auditory impairment and informing ototoxic medication decisions.