全身联合鼓室内注射地塞米松治疗突发性聋的疗效分析

倪茂美; 刘蕾; 赵睿; 聂敏; 杨秀海

doi:10.13201/j.issn.1001-1781.2018.09.004

全身联合鼓室内注射地塞米松治疗突发性聋的疗效分析

- 贵州省人民医院耳鼻咽喉头颈外科(贵阳,550002)

详细信息

通讯作者: 倪茂美, E-mail:414631076@qq.com

中图分类号: R764.43

收稿日期: 2018-02-05

Analysis of efficacy of systemic and intratympanic dexamethasone combination therapy in the treatment of sudden sensorineural hearing loss

- Department of Otorhinolaryngology Head and Neck Surgery, Guizhou Provincial People's Hospital, Guiyang, 550002, China

More Information

Corresponding author: NI Maomei, E-mail: 414631076@qq.com

Received Date: 05 February 2018

摘要

摘要: 目的: 观察全身联合鼓室内注射地塞米松对突发性聋的治疗效果。方法: 纳入突发性聋患者98例,随机分为3个组:全身激素治疗组(39例)、鼓室注射治疗组(28例)、联合用药治疗组(31例)。所有患者均接受银杏达莫注射液、甲钻胺和质子泵抑制剂药物治疗。所有患者治疗前后均进行听力测试。结果: 98例患者中,共计65例(66.3%)治疗有效,3组间的治疗有效率差异无统计学意义(P=0.61),眩晕加耳鸣的患者治疗有效率低(P=0.00),有家族史者治疗有效率低于无家族史者(P=0.02);治疗有效率与患者的耳聋程度(P=0.68)及听力曲线图(P=0.28)无明显相关性。结论: 静脉注射地塞米松、鼓室内注射地塞米松及二者联合治疗突发性聋,3种方法间无明显的疗效差异。
- 突发性聋 /
- 全身给药 /
- 鼓室给药 /
- 激素治疗
Abstract: Objective: To evaluate the effect of systemic and intratympanic dexamethasone combination therapy on sudden deafness.Method: A total of 98 patients randomly divided into three groups:an intravenous corticosteroid (systemic corticosteroid monotherapy group); an intratympanic corticosteroid (IT monotherapy group); and a combination therapy group (IT plus systemic combination group). All patients were treated additionally with ginkgo-damole and mecobalamine and proton pomp inhibitor. An audiometry was performed before and after the therapies in all patients.Result: Of the total of 98 patients, 39 received systemic corticosteroids, 28 received intratympanic (IT) corticosteroids, and 31 received a combination of the two. A total of 65 patients (66.3%) responded positively to corticosteroid therapy. No significant differences were observed between the three groups (systemic group, IT and combination therapy group) in their overall response to treatment (P=0.61). Patients who suffered from concomitant tinnitus and dizziness responded less positively to the treatment (P=0.00). Positive family history of SSNHL seems to be negative prognostic factors in the response to treatment (P=0.02).The effective rate of treatment was not significantly related to the initial severity of hearing loss (P=0.68) and pattern (P=0.28). Conclusion: There was no significant difference in treatment between systemic, intratympanic, and combined corticosteroid therapy for sudden hearing loss.
- sudden sensorineural hearing loss /
- systemic administration /
- intratympanic /
- corticosteroid therapy

HTML全文

参考文献(16)

[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, 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.
[2]	MICHEL O.The revised version of the German guidelines sudden idiopathic sensorineural heating loss[J].Laryngorhinootologie, 2011, 90:290-293.
[3]	BYL F M Jr.Sudden hearing loss:eight years' experience and suggested prognostic table[J].Laryngoscope, 1984, 94:647-661.
[4]	HUGHES G B, FREEDMAN M A, HABERKAMP T J, et al.Sudden sensorineural hearing loss[J].Otolaryngol Clin Noah Am, 1996, 29:393-405.
[5]	TERANISHI M, KATAYAMA N, UCHIDA Y, et al.Thirty-year trends in sudden deafness from four nationwide epidemiological surveys in Japan[J].Am Otolaryngol, 2007, 127:1259-1265.
[6]	KARA E, GETIK F, TARKAN O, et al.Modified intratympanic treatment for idiopathic sudden sensorineural hearing loss[J].Eur Arch Otorhionlaryngol, 2010, 267:701-707.
[7]	赵晖, 张天宇, 付窈窈, 等.鼓室内注射地塞米松治疗极重度以上突发性聋的临床研究[J].中华耳鼻咽喉头颈外科杂志, 2009, 44 (4):297-301.
[8]	夏瑞明, 李华亭, 余力生.全聋型和重度平坦型突发性聋的治疗及预后[J].中华耳鼻咽喉头颈外科杂志, 2007, 42 (10):726-730.
[9]	NAKAGAWA T, KUMAKAWA K, USAMI S, et al.A randomized controlled clinical trial of topical insulin-like growth factor-1therapy for sudden deafness refractory to systemic corticosteroid treatment[J].BMC Med, 2014, 12:219-221.
[10]	LI P, ZENG X L, YE J, et al.Intratympanic methylprednisolone improves hearing function in refractory sudden sensorineurall hearing loss:a cortrol study[J].Audiol Neurootol, 2011, 16:198-202.
[11]	STAEHLER R J, CHANDRASEKHAR S S, ARCHER S M, et al.American Academy of OtolaryngologyHead and Neck Surgery.Clinical practice guideline:sudden heating loss[J].Otolaryngol Head Neck Surg, 2012, 146:S1-S35.
[12]	杨萍丽, 张志平.地塞米松不同时间间隔鼓室内灌注在治疗突发性聋中的临床研究[J].临床耳鼻咽喉头颈外科杂志, 2017, 31 (11):822-824.
[13]	BATTAGLIA A, BURCHETTE R, CUEVA R.Combination therapy (intratympanic dexamethasone+high-dose prednisone taper) for the treatment of idiopathic sudden sensorineural hearing loss[J].Otol Neurotol, 2008, 29:453-460.
[14]	HAN C S, PARK J R, BOO S H, et al.Clinical efficacy of initial intratympanic steroid treatment on sudden sensorineural hearing loss with diabetes[J].Otolaryngol Head Neck Surg, 2009, 141:572-578.
[15]	中国突发性聋多中心临床研究协作组.中国突发性聋分型治疗的多中心临床研究[J].中华耳鼻咽喉头颈外科杂志, 2013, 48 (5):355-361.
[16]	周霓, 李玲波.突发性聋预后相关因素的研究进展[J].临床耳鼻咽喉头颈外科杂志, 2017, 31 (4):323-326.