Effect of tympanic dexamethasone injection in the treatment of different types of sudden deafness
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摘要: 目的 探讨地塞米松用于治疗不同类型突发性聋的最佳给药方式、时机及疗效。方法 选取初次确诊为突发性聋的患者242例，根据2015年突发性聋指南，将患者分为低频下降型49例、高频下降型66例、平坦下降型71例、全聋型56例。不同类型的患者在常规治疗的基础上随机分为鼓室注射组和全身给药组，鼓室注射组再分为初始注射组和延后注射组。鼓室注射在耳内镜下进行，隔日注射1次，低频下降型聋注射3次，其余类型注射5次。结果 总有效率比较，49例低频下降型、71例平坦下降型和56例全聋型中，3种治疗方法之间差异有统计学意义(P＜0.05)，在66例高频下降型中，3种治疗方法之间差异无统计学意义(P＞0.05)。所有经鼓室注射治疗的患者中，男女之间有效率差异无统计学意义(P＞0.05)，发病7 d内和7 d后接受鼓室注射的有效率差异有统计学意义(P＜0.05)。结论 鼓室内注射地塞米松治疗突发性聋安全、有效、操作方便，可作为低频下降型、平坦型和全聋型突发性聋的初始治疗方案，且越早开始效果越好。Abstract: Objective The aim of this study is to explore the best administration, timing and efficacy of dexamethasone and Mison in the treatment of different types of sudden deafness.Method 242 cases of sudden deafness first diagnosed in our department were selected. According to the guidelines(2015), the patients were divided into low frequency descending type (49 cases), high frequency descending type (66 cases), flat descending type (71 cases) and total deafness (56 cases). Different types of patients were randomly divided into tympanic injection group and systemic administration group on the basis of routine treatment. Tympanic injection group was further divided into initial injection group and delayed injection group. Tympanic injection was performed under ear endoscope, once every other day, three times for low frequency descending deafness, and five times for other types of deafness.Result In comparison of total effective rate, there were significant differences among the three treatments in 49 cases of low frequency descending type, 71 cases of flat descending type and 56 cases of total deafness type (P < 0.05). In 66 cases of high frequency descending type, there was no significant difference among the three treatments (P>0.05). In the comparison of cure rate, the difference of cure rate among the three treatment methods was also significant in low frequency descending type (P < 0.05). In the other three types of deafness, there was no significant difference among the three treatment methods (P>0.05). There was no significant difference in the effective rate between men and women (P>0.05) in all patients treated by tympanic injection. There was significant difference in the effective rate of tympanic injection within 7 days of onset and 7 days after onset (P < 0.05).Conclusion Intratympanic injection of dexamethasone is safe, effective, and easy to use as an initial treatment for low frequency descent, flat, and full deafness, and the sooner the better.
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Key words:
- hearing loss, sudden /
- dexamethasone /
- intratympanic therapy /
- systemic administration
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表 1 不同类型突发性聋治疗分组情况及疗效
组别 例数 无效 有效 显效 痊愈/例(%) 总有效/例(%) χ2 P 低频下降型 6.889 0.018 全身给药组 21 7 3 8 3(14.29) 14(66.67) 早期注射组 16 0 1 4 11(68.75) 16(100.00) 延迟注射组 12 2 1 6 3(25.00) 10(83.33) 高频下降型 0.124 0.947 全身给药组 34 15 10 7 2(5.88) 19(55.88) 早期注射组 13 5 4 3 1(7.69) 8(61.54) 延迟注射组 19 8 7 3 1(5.26) 11(57.89) 平坦下降型 11.447 0.003 全身给药组 31 15 5 7 4(12.90) 16(51.61) 早期注射组 21 1 5 8 7(33.33) 20(95.24) 延迟注射组 19 8 6 3 2(10.53) 11(57.89) 全聋型 14.383 0.001 全身给药组 21 14 5 2 0(0.00) 7(33.33) 早期注射组 23 3 10 7 3(13.04) 20(86.96) 延迟注射组 12 7 4 1 0(0.00) 5(41.67) 
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