突发性感音神经性听力损失与卒中：病理生理联系、临床证据及诊断意义的叙述性综述

文献信息

中文摘要

背景： 突发性感音神经性听力损失（SSNHL）长期以来被推测可能是后循环卒中的潜在早期预警信号，但其因果关联及临床意义仍极具争议。
总结： 本叙述性综述综合了当前同行评议证据，涉及SSNHL与卒中之间的病理生理联系、流行病学关联、诊断策略及整合管理。现有研究结果表明，解剖学和病理生理学上的重叠支持该关联的生物学合理性，且该关联主要由椎基底动脉循环系统介导。共同的血管性和促血栓形成因素，包括血脂异常、高同型半胱氨酸血症及MTHFR基因多态性，可能进一步促成所观察到的关联。临床上，SSNHL可能在一小部分患者中作为后循环梗死的首发表现，尤其是伴有神经系统症状或多个血管危险因素者；然而，现有流行病学数据并不一致，且证据不足以将SSNHL定义为普通人群中卒中的独立预测因素。
关键信息： 本综述得出结论，风险分层以及耳鼻咽喉科医生与神经科医生之间的跨学科协作在临床实践中至关重要：对于高危SSNHL患者，应及时进行神经血管评估，以便早期发现脑血管疾病；未来需要大规模前瞻性队列研究及听力学-神经学联合评估模型，以阐明因果关系并优化临床路径。

英文摘要

Background Sudden sensorineural hearing loss (SSNHL) has long been hypothesized as a potential early warning sign of posterior circulation stroke, yet the causal association and clinical implications remain highly controversial. Summary This narrative review synthesizes current peer-reviewed evidence on the pathophysiological links, epidemiological associations, diagnostic strategies, and integrated management of SSNHL and stroke. Current findings demonstrate that anatomical and pathophysiological overlaps support the biological plausibility of this association, which is predominantly mediated by the vertebrobasilar circulatory system. Shared vascular and prothrombotic factors, including dyslipidemia, hyperhomocysteinemia, and MTHFR gene polymorphisms, may further contribute to the observed association. Clinically, SSNHL may present as an initial manifestation of posterior circulation infarction in a small subset of patients, particularly those with accompanying neurological symptoms or multiple vascular risk factors; however, existing epidemiological data are inconsistent, and there is insufficient evidence to define SSNHL as an independent predictor of stroke in the general population. Key Messages This review concludes that risk stratification and interdisciplinary collaboration between otolaryngologists and neurologists are critical in clinical practice: for high-risk SSNHL patients, timely neurovascular evaluation is warranted to enable early detection of cerebrovascular disease, and future large-scale prospective cohort studies and combined audiological-neurological assessment models are needed to clarify the causal relationship and optimize clinical pathways.