The efficacy of intratympanic or combined steroids as the salvage treatment for moderate-to-severe to profound sudden sensorineural hearing loss
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摘要: 目的 观察并比较鼓室注射甲泼尼龙(IMT)及全身鼓室联合应用糖皮质激素对突发性聋(SSNHL)挽救性治疗的临床疗效及其特点。方法 收集经常规治疗后疗效欠佳的中重度以上的SSNHL患者90例。其中45例患者接受单纯IMT治疗(IMT组)，45例接受全身应用地塞米松+IMT治疗(全身激素+IMT组)。IMT组隔日进行1次，共4次。采用纯音测听法观察2组治疗前后平均纯音听阈(PTA)的改善情况，同时对伴随相关症状的患者行耳鸣残疾量表(THI)、耳鸣视觉模拟量表(VAS)以及汉密尔顿焦虑量表(HAMA)评估。结果 2组患者治疗后PTA均显著改善，IMT组听力恢复的有效率为31.1%，全身激素+IMT组为51.1%，组间比较差异无统计学意义。2种治疗方法对于发病时间 < 30 d的患者听力疗效均明显优于发病时间>30 d的患者，且组间差异无统计学意义。2种治疗方法对于THI、VAS和HAMA评分亦有显著改善，且组间比较差异无统计学意义。结论 对于常规治疗无效的中重度以上SSNHL患者，更推荐使用IMT治疗，用药时间越早疗效越佳。Abstract: Objective The objective is to investigate and compare the efficacy of intratympanic methylprednisolone or combination therapy as the salvage treatment for idiopathic sudden sensorineural hearing loss (ISSNHL).Method Ninety patients with moderate-to-severe to profound SSNHL which were unresponsive to the conventional treatment were recruited. Among these 90 patients, 45 patients underwent intratympanic methylprednisolone therapy (IMT) alone and 45 patients underwent systemic dexamethasone+IMT(systemic steroids+IMT). IMT was performed every other day, with a total of four times. The pure-tone audiogram (PTA) before and after IMT or systemic steroids+IMT was conducted. And for those with tinnitus or anxiety, tinnitus handicap inventory(THI), visual analog scale (VAS) as well as Hamilton anxiety rating scale (HAMA) were performed before and after the treatment.Result The success rate was 31.1% with IMT and 51.1% with systemic steroids+IMT, and the difference was not significant between the two groups. The efficacy of patients with less than 30 days of onset was better than those with more than 30 days, and the difference was not significant, either. Both groups showed significant improvement in the scores of THI, VAS, and HAMA, but no significant difference was found between the two groups.Conclusion Intratympanic methylprednisolone is recommended as the salvage treatment for patients with moderate-to-severe to profound SSNHL which showed little efficacy after the conventional treatment. Prompt medication improves the therapeutic efficacy.
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Key words:
- Sudden sensorineural hearing loss /
- Intratympanic /
- Combined therapy /
- Methylprednisolone
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表 1 2组基本情况比较
M(P25，P75)，例(%) 项目 IMT组(45例) 全身激素+IMT组(45例) P 年龄/岁 47.0(32.5，60.0) 48.0(36.0，62.5) 0.482 性别 0.670 男 18 20 女 27 25 侧别 0.478 左 25 26 右 20 19 发病时间/d 30.0(18.5，40.5) 25.0(15.5，30.0) 0.078 首次治疗前PTA/dB HL 82.5(73.1，92.0) 77.5(67.6，87.4) 0.184 首次治疗后PTA/dB HL 80.0(71.1，88.8) 72.5(66.3，81.5) 0.106 入院时听力下降程度 中重度 11(24.4) 21(46.7) 0.028 重度 24(53.3) 17(37.8) 0.138 极重度 10(22.2) 7(15.6) 0.419 耳鸣 43(95.6) 45(100.0) 0.475 焦虑 17(37.8) 17(37.8) 1.000 
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表 2 2组治疗前后PTA比较
M(P25，P75), dB HL 组别 治疗前 治疗后 改善值 P IMT组 78.8(70.6，86.3) 70.0(55.6，78.1) 7.5(5.0，19.4) 0.000 全身激素+IMT组 71.3(64.4，80.0) 60.0(45.6，75.0) 16.3(3.8，25.0) 0.000 P 0.054 0.048 0.261
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表 3 2组不同发病时间PTA改善值比较
M(P25，P75)，dB HL 组别 < 30 d 30~90 d P IMT组 18.8(6.9，22.8) 5.6(4.7，10.0) 0.001 全身激素+IMT组 20.0(10.0，27.2) 6.3(1.9，20.0) 0.040 P 0.660 0.645
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表 4 2组听力疗效分级比较
例(%) 组别 痊愈 显效 有效 无效 IMT组 0(0.0) 5(11.1) 9(20.0) 31(68.9) 全身激素+IMT组 0(0.0) 7(15.6) 16(35.6) 22(48.9) P 0.535 0.099 0.054
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表 5 2组患者耳鸣改善程度比较
M(P25，P75) 组别 THI总分 功能性评分 严重性评分 情感评分 VAS评分 IMT组 4.0(2.0，18.0) 2.0(2.0，8.0) 0.0(0.0，2.0) 0.0(0.0，6.0) 3.0(1.0，9.0) 全身激素+IMT组 4.0(1.0，18.0) 2.0(0.0，8.0) 0.0(0.0，4.0) 2.0(0.0，8.0) 4.0(0.0，10.0) P 0.816 0.500 0.851 0.593 0.563
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表 6 2组患者焦虑改善程度比较
M(P25，P75) 组别 例数 治疗前HAMA分值 治疗后HAMA分值 HAMA改善值 IMT组 17 8.0(5.5，13.0) 4.0(2.0，6.0) 5.0(1.0，7.5) 全身激素+IMT组 17 9.0(5.5，11.5) 4.0(2.5，6.0) 2.0(1.5，7.5) P 0.849 0.663 0.890
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