儿童突发性聋诊断和治疗专家共识(2026)

Expert consensus on the diagnosis and treatment of sudden sensorineural hearing loss in children (2026)

摘要

目的 制定儿童突发性聋(pediatric sudden sensorineural hearing loss, PSSNHL)诊断和治疗专家共识,为临床规范化诊疗提供依据。方法 由国内儿童耳鼻咽喉头颈外科及相关交叉学科专家共同发起,检索中英文数据库,遴选9个临床问题,经两轮改良德尔菲法形成9条推荐意见。结果 共识将PSSNHL定义为72 h内发生的感音神经性听力损失,至少在相邻两个频率听力下降≥20 dBHL,年龄≤18岁。诊断需综合病史采集、体格检查及听力学、影像学、遗传学等多学科评估;检查策略按年龄制定。不推荐常规分型治疗,但可参考成人分型思路指导病因判断;鉴别诊断重点排除功能性听力下降、先天性中耳畸形、内耳解剖学异常等。治疗首选糖皮质激素(甲泼尼龙或泼尼松龙1 mg/kg,最大60 mg/d,连用5 d),初始治疗无效者可考虑鼓室内或耳后注射地塞米松作为补救治疗;可联合改善微循环药物、营养神经药物等,高压氧可作为可选辅助治疗。治疗1个月无效者需转向助听器或人工耳蜗干预。疗效评估采用2015年中国指南分级标准,预后与就诊时间、听力损失程度、双侧发病、伴发眩晕等因素密切相关。结论 本共识为PSSNHL的规范化诊疗提供了临床依据,有助于实现早发现、早干预,最大程度改善或挽救患儿听力。

Abstract

Objective The aim is to develop an expert consensus on the diagnosis and treatment of paediatric sudden sensorineural hearing loss (PSSNHL), and to provide evidence for standardised clinical practice. Methods This consensus was initiated by experts in paediatric otolaryngology, head and neck surgery, and related interdisciplinary fields in China. Nine clinical questions were selected through a systematic review of literature from Chinese and English databases, and nine recommendations were formulated through two rounds of the modified Delphi method. Results PSSNHL is defined as sensorineural hearing loss that occurs within 72 hours and involves a hearing threshold decrease of at least 20 dBHL in two or more adjacent frequencies in patients aged 18 years or under. A diagnosis requires a comprehensive, multidisciplinary assessment, including taking a patient's history, conducting a physical examination, and carrying out audiological, imaging, and genetic evaluations. Examination strategies are age-specific. Although routine classification-based treatment is not recommended, adult classification approaches may inform the diagnosis. The differential diagnosis should particularly exclude functional hearing loss, congenital middle ear malformations and inner ear anatomical abnormalities. The first-line treatment is corticosteroids (methylprednisolone or prednisolone at a dose of 1 mg/kg, up to a maximum of 60 mg/day for five days). Intratympanic or post-auricular dexamethasone injection may be considered as salvage therapy after initial treatment has failed. Adjuvant therapies include microcirculation-improving agents and neurotrophic drugs, and hyperbaric oxygen therapy may be used as an additional treatment. For patients with no hearing recovery after one month, hearing aids or cochlear implantation should be considered. Efficacy is evaluated according to the 2015 Chinese Guideline Grading Criteria. Prognosis is closely related to the time taken to commence treatment, the severity of hearing loss, bilateral involvement and the presence of accompanying vertigo. Conclusion This consensus provides clinical evidence for the standardised diagnosis and treatment of PSSNHL. This enables the condition to be detected and treated early, maximising the chance of preserving and recovering hearing in children.

关键词

儿童突发性聋 / 诊断 / 治疗 / 专家共识 / 糖皮质激素

Key words

Pediatric sudden sensorineural hearing loss / Diagnosis / Treatment / Expert consensus / Glucocorticoids

参考文献

[1] 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会 . 良性阵发性位置性眩晕诊断和治疗指南(2017)[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(3): 173-177. DOI: 10.3760/cma.j.issn.1673-0860.2017.03.003

[2] Franz L, Gallo C, Marioni G, de Filippis C, et al. Idiopathic Sudden Sensorineural Hearing Loss in Children: A Systematic Review and Meta-analysis[J]. Otolaryngol Head Neck Surg, 2021, 165(2): 244-254. DOI: 10.1177/0194599820976571

[3] 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会. 突发性聋诊断和治疗指南(2015)[J]. 中华耳鼻咽喉头颈外科杂志, 2015, 50(6): 443-447. DOI: 10.3760/cma.j.issn.1673-0860.2015.06.002

[4] Wood JW, Shaffer AD, Kitsko D, et al. Sudden sensorineural hearing loss in children: management and outcomes: a meta-analysis[J]. Laryngoscope, 2021, 131(2): 425-434. DOI: 10.1002/lary.28829

[5] 冯永. 大龄语前聋患者的人工耳蜗植入: 一个不容忽略的群体[J]. 中国耳鼻咽喉颅底外科杂志, 2015, 21(3): 175-177. DOI: 10.11798/j.issn.1007-1520.201503001

[6] 徐静, 付勇. 109例儿童突发性耳聋预后的影响因素分析[J]. 临床耳鼻咽喉头颈外科杂志, 2024, 38: 598-603. DOI: 10.13201/j.issn.2096-7993.2024.07.008

[7] Theunissen SCPM, Rieffe C, Netten AP, et al. Psychopathology and its risk and protective factors in hearing-impaired children and adolescents: a systematic review[J]. JAMA Pediatr, 2014, 168(2): 170. DOI: 10.1001/jamapediatrics.2013.3974

[8] Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical practice guideline: sudden hearing loss (update)[J]. Otolaryngol-head Neck Surg, 2019, 161(S1): 1-45. DOI: 10.1177/0194599819859885

[9] Kitoh R, Nishio SY, Sato H, et al. Clinical practice guidelines for the diagnosis and management of acute sensorineural hearing loss[J]. Auris Nasus Larynx, 2024, 51(4): 811-821. DOI: 10.1016/j.anl.2024.06.004

[10] Furutate S, Iwasaki S, Nishio SY, et al. Clinical profile of hearing loss in children with congenital cytomegalovirus (CMV) infection: CMV DNA diagnosis using preserved umbilical cord[J]. Acta Otolaryngol, 2011, 131(9): 976-982. DOI: 10.3109/00016489.2011.583268

[11] Chen YS, Emmerling O, Ilgner J, et al. Idiopathic sudden sensorineural hearing loss in children[J]. Int J Pediatr Otorhinolaryngol, 2005, 69(6): 817-821. DOI: 10.1016/j.ijporl.2005.01.015

[12] Na SY, Kim MG, Hong SM, et al. Comparison of sudden deafness in adults and children[J]. Clin Exp Otorhinolaryngol, 2014, 7(3): 165. DOI: 10.3342/ceo.2014.7.3.165

[13] United Nations. General Assembly. Convention on the Rights of the Child, 20 November 1989[J]. Annu Rev Popul Law, 1989, 16(95): 485-501

[14] 李凤娇, 薛希均, 王莉, 等. 儿童突发性聋患者的预后分析[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(22): 1931-1935. DOI: 10.13201/j.issn.1001-1781.2015.22.001

[15] Chen KT, Jiang HY, Zong L, et al. Side-related differences in sudden sensorineural hearing loss in children[J]. Int J Pediatr Otorhinolaryngol, 2018, 114: 5-8. DOI: 10.1016/j.ijporl.2018.08.022

[16] 王凯, 江红群, 叶菁, 等. 44例突发性聋住院患者心理状况临床分析[J]. 中华耳科学杂志, 2018, 16(1): 61-64. DOI: 10.3969/j.issn.1672-2922.2018.01.016

[17] Bi J, Pen YF, Yu B, et al. Clinical features and efficacy analysis of idiopathic sudden sensorineural hearing loss in children: a single-center, retrospective study (2015-2025)[J]. Eur Arch Oto Rhino Laryngol, 2026: 1. DOI: 10.1007/s00405-026-10312-x

[18] 毕静, 周智英, 蒋艾, 等. 儿童青少年突发性聋的临床分析及近期疗效观察[J]. 中华耳科学杂志, 2018, 16(1): 42-47. DOI: 10.3969/j.issn.1672-2922.2018.01.013

[19] 谢邵兵, 易星, 强清芬, 等. 儿童突发性聋患者的临床特征及预后分析[J]. 听力学及言语疾病杂志, 2017, 25(6): 587-590. DOI: 10.3969/j.issn.1006-7299.2017.06.008

[20] Chen TY, Papaioannou V, Liberman G, et al. Importance of early objective auditory testing in the presentation of sudden sensorineural hearing loss in children[J]. Am J Otolaryngol, 2024, 45(1): 104087. DOI: 10.1016/j.amjoto.2023.104087

[21] Ioannis P, Georgios K, Alexandra K, et al. Pseudohypacusis: the most frequent etiology of sudden hearing loss in children[J]. Eur Arch Oto Rhino Laryngol, 2009, 266(12): 1857-1861. DOI: 10.1007/s00405-009-0983-y

[22] Li FJ, Wang DY, Wang HY, et al. Clinical study on 136 children with sudden sensorineural hearing loss[J]. Chin Med J, 2016, 129(8): 946-952. DOI: 10.4103/0366-6999.179791

[23] Lee JS, Hong SK, Kim DH, et al. The neutrophil-to-lymphocyte ratio in children with sudden sensorineural hearing loss: a retrospective study[J]. Acta Oto Laryngol, 2017, 137(1): 35-38. DOI: 10.1080/00016489.2016.1217561

[24] 徐静, 付勇. 儿童突发性耳聋与血脂和凝血功能的相关性分析[J]. 中国眼耳鼻喉科杂志, 2025, 25(5): 402-407. DOI: 10.14166/j.issn.1671-2420.2025.05.009

[25] Ječmenica J, Bajec-Opančina A. Sudden hearing loss in children[J]. Clin Pediatr (Phila), 2014, 53(9): 874-878. DOI: 10.1177/0009922814533402

[26] Patel P, Parkes W, Pritchett C, et al. Auditory characteristics in children with enlarged vestibular aqueduct[J]. Otol Neurotol, 2025, 46(5): 544-551. DOI: 10.1097/mao.0000000000004485

[27] Han YW, Li SB, Song YK, et al. Risk factors for infant hearing loss: a meta-analysis[J]. Eur J Pediatr, 2024, 183(5): 2401-2409. DOI: 10.1007/s00431-024-05498-3

[28] Gorthey S, Patel R, Vambutas A. Immune-mediated sensorineural hearing loss in the pediatric population[J]. Otolaryngol-head Neck Surg, 2022, 166(4): 768-771. DOI: 10.1177/01945998211028796

[29] Weisleder DH, Weisleder P. Functional hearing disorder in children[J]. Semin Pediatr Neurol, 2022, 41: 100956. DOI: 10.1016/j.spen.2022.100956

[30] Qiu WW, Stucker FJ, Yin SS, et al. Current evaluation of pseudohypacusis: strategies and classification[J]. Ann Otol Rhinol Laryngol, 1998, 107(8): 638-647. DOI: 10.1177/000348949810700802

[31] 陈英. 金纳多治疗儿童感音神经性聋临床疗效观察[J]. 天津医药, 2001, 29(6): 378-379. DOI: 10.3969/j.issn.0253-9896.2001.06.032

[32] 陆翼年, 雍军, 夏寅, 等. 突发性聋听力损失程度及疗效的多因素分析[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(11): 827-834. DOI: 10.13201/j.issn.2096-7993.2022.11.004

[33] Lu YQ, Zhou LQ, Imrit TS, et al. Sudden sensorineural hearing loss in children: clinical characteristics, etiology, treatment outcomes, and prognostic factors[J]. Otol Neurotol, 2019, 40(4): 446-453. DOI: 10.1097/mao.0000000000002190

[34] 张芳, 杨博, 杜莉. 26例学龄儿童突发性聋临床分析[J]. 中国耳鼻咽喉头颈外科, 2021, 28(10): 636-639. DOI: 10.16066/j.1672-7002.2021.10.011

[35] 张维娜, 王玲玲, 李林格. 儿童突发性耳聋的临床特征及疗效影响因素分析[J]. 重庆医学, 2022, 51(19): 3305-3308, 3313. DOI: 10.3969/j.issn.1671-8348.2022.19.013

[36] 黎颖强. 儿童感音神经性听力损失临床特征与炎症指标相关性研究, 华中科技大学, 2024

[37] 曹咏梅, 冯娟娟, 余爵波. 不同听力曲线类型儿童突发性感音神经性聋预后差异及影响因素分析[J]. 中国听力语言康复科学杂志, 2025, 23(2): 161-164. DOI: 10.3969/j.issn.1672-4933.2025.02.012

[38] Özer EE, Aysel A. The role of hyperbaric oxygen therapy in sudden sensorineural hearing loss in children[J]. Turk J Pediatr Dis, 2022, 16(6): 512-518. DOI: 10.12956/tchd.1037035

[39] Övet G, Alataş N, Güzelkara F. Sudden pediatric hearing loss: comparing the results of combined treatment (intratympanic dexamethasone and systemic steroids) with systemic steroid treatment alone[J]. Otol Neurotol, 2016, 37(6): 742-747. DOI: 10.1097/mao.0000000000001077

[40] Pitaro J, Bechor-Fellner A, Gavriel H, et al. Sudden sensorineural hearing loss in children: Etiology, management, and outcome[J]. Int J Pediatr Otorhinolaryngol, 2016, 82: 34-37. DOI: 10.1016/j.ijporl.2015.12.022

[41] 侯志强, 王秋菊. 不同年龄段突聋患者的临床特点及预后研究进展[J]. 听力学及言语疾病杂志, 2013, 21(4): 418-421. DOI: 10.3969/j.issn.1006-7299.2013.04.029

[42] Barron KA, Haimowitz SZ, Shah VP, et al. A review of bilateral sudden sensorineural hearing loss in pediatric patients[J]. Int J Pediatr Otorhinolaryngol, 2023, 165: 111459. DOI: 10.1016/j.ijporl.2023.111459

[43] Reading JCS, Hall A, Nash R. Paediatric sudden sensorineural hearing loss: pooled analysis and systematic review[J]. J Int Adv Otol, 2021, 17(1): 64-71. DOI: 10.5152/iao.2020.8902

[44] 张燕霞, 张强伟, 任鸿杰, 等. 1196例突发性聋预后影响因素分析[J]. 中华耳科学杂志, 2015, 13(1): 126-131. DOI: 10.3969/j.issn.1672-2922.2015.01.024

[45] Chung JH, Cho SH, Jeong JH, et al. Multivariate analysis of prognostic factors for idiopathic sudden sensorineural hearing loss in children[J]. Laryngoscope, 2015, 125(9): 2209-2215. DOI: 10.1002/lary.25196

[46] Kim JY, Han JJ, Sunwoo WS, et al. Sudden sensorineural hearing loss in children and adolescents: Clinical characteristics and age-related prognosis[J]. Auris Nasus Larynx, 2018, 45(3): 447-455. DOI: 10.1016/j.anl.2017.08.010

[47] Bogaz EA, de Albuquerque Maranhão AS, Inoue DP, et al. Variables with prognostic value in the onset of idiopathic sudden sensorineural hearing loss[J]. Braz J Otorhinolaryngol, 2015, 81(5): 520-526. DOI: 10.1016/j.bjorl.2015.07.012

[48] 许明, 罗兴谷, 唐洪波, 等. 儿童突发性聋的临床特征及预后相关因素分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 41-44. DOI: 10.6040/j.issn.1673-3770.0.2018.019

[49] Aldè M, Di Berardino F, Marchisio P, et al. Sudden sensorineural hearing loss in children with dual positivity of serum anti-EBV IgM and anti-CMV IgM antibodies: a preliminary study[J]. Minerva Pediatr, 2024, 76(6): 722-727. DOI: 10.23736/s2724-5276.21.06314-x

[50] Lin FZ, Wu W, Tan FF, et al. Apolipoprotein AI is a protective factor for idiopathic sudden sensorineural hearing loss: a two-sample Mendelian randomisation study[J]. Int J Audiol, 2026: 1-10. DOI: 10.1080/14992027.2026.2647268