非手术序列化治疗单侧梅尼埃病48例

Non-surgical serialization treatment of unilateral Meniere disease in 48 cases

目的探讨按听力分期进行非手术序列化治疗梅尼埃病的疗效。方法将单侧梅尼病患者48例按听力分期进行序列化治疗,Ⅰ期患者给予常规饮食控制、扩血管、营养神经及维生素药物治疗;Ⅱ期患者在常规治疗的基础上加用鼓室或耳后乳突骨膜下注射甲泼尼龙琥珀酸钠40 mg,1次/3 d,共3次,效果不佳时加用鼓膜置管及鼓室充气治疗;Ⅲ期患者常规治疗基础上加鼓膜置管后鼓室灌注甲泼尼龙琥珀酸钠40 mg,1次/3 d,共3次,及应用鼓气球鼓室充气治疗;Ⅳ期患者在常规治疗基础上,加用庆大霉素4万U＋0.5%碳酸氢钠0.5 m L鼓室注射1次/周,根据患者眩晕、听力变化、耳鸣情况决定注射次数,一般为2~3次,对于前庭功能低下患者进行前庭功能康复训练。观测48例患者眩晕、听力、活动能力及耳鸣变化18~24个月。结果眩晕完全控制12例,基本控制33例,部分控制3例,临床有效率为93%。听力改善为A级（改善〉30 d B或各频率〈20 d B）12例;B级（改善15~30 d B）6例;C级（改善0~14 d B）29例;D级（改善〈0 d B）1例,听力下降10 d B。活动能力完全控制（A级）16例,基本控制（B级）32例,临床有效率为100%。各期耳鸣患者治疗后的耳鸣致残量表得分均低于治疗前,差异有统计学意义,P〈0.05。结论按听力分级非手术序列化治疗梅尼埃病眩晕基本控制率高,活动能力明显改善,Ⅰ期和Ⅱ期患者听力改善明显,而各期耳鸣均有显著改善。该方法操作简单方便,不良反应少,手术风险避免,患者医疗费用降低。

Objective To explore the efficacy of treating Meniere disease by non-operative serialization through various listening stages. Methods Serialized treatment was conducted in 48 patients with unilateral Meniere disease according to the listening stages. In period Ⅰ,patients received regular diet control,blood vessel expansion,nerve nutrition and vitamin medication. In period Ⅱ,on the basis of conventional treatment,patients were injected with odium succinate40 mg,once in 3 days for 3 times. If it was not effective,tympanostomy tube and tympanic cavity inflation were administered. In period Ⅲ,on the basis of regular treatment,patients underwent tympanic cavity perfusion after tympanostomy tube and injection of prednisolone sodium of 40 mg,once in 3 days for 3 times,and received inflation treatment in middle ear drum balloon. In period Ⅳ,on the basis of conventional treatment,patients received gentamicin40 000 U ＋ 0. 5%,sodium bicarbonate 0. 5 m L and tympanic cavity injection once a week. The frequency of injection was commonly 2-3 times a week,determined by circumgyration,hearing changes and situations of tinnitus. For patients who had lowvestibular apparatus function,rehabilitation training of vestibular function was provided. Patients＇ vertigo,hearing,activity ability and tinnitus changes were followed up for 18-24 months. Results Vertigo was fully controlled in 12 cases,basically controlled in 33 cases,partially controlled in 3 cases,and the clinical effective rate was 93%.The hearing ability was improved to A level in 12 cases（ 30 db or the frequency 20 db）,to B level in 6 cases（ 15-30 db）,to C level in 29 cases（ 0-14 db）,and to D level in 1 case（ improvement 0 db）. The mobility was fully controlled in 16 cases（ A level）,basically controlled in 32 cases（ B level）,and the effective rate was 100%. The score of Tinnitus Handicap Inventory after treatment was significantly decreased（ P〈0. 05）. Conclusion Treatment of Meniere disease vertigo by non-operative serialization through different listening stages can achieve high control rate,and patients＇ mobility is apparently improved. For patients in stage Ⅰ and Ⅱ,the tinnitus and hearing are significantly improved. For patients in all stages,tinnitus can be obviously improved. The method is simple and causes fewside effects. It can avoid operation risks,and reduce the medical costs.