耳后与鼓室注射甲强龙治疗慢性原发性耳鸣的疗效对比

Comparative study of retroauricular and tympanic injection of methylprednisolone in the treatment of chronic primary tinnitus

目的对比观察耳后与鼓室注射甲强龙治疗慢性原发性耳鸣的临床疗效及安全性。方法选取北京京煤集团总医院耳鼻咽喉科2018年1月至2020年12月收治的慢性原发性耳鸣90例患者作为研究对象进行回顾性研究,按照甲强龙不同给药途径分为耳后组(42例,耳后注射甲强龙40 mg/次,1次/2 d,连续治疗4周)与鼓室组(48例,鼓室注射甲强龙40 mg/次,1次/2 d,连续治疗4周)。于治疗前和治疗4周后采用耳鸣致残量表(tinnitus handicap inventory,THI)评估耳鸣严重程度及残疾程度,检测两组治疗前后耳鸣响度,评估临床疗效,统计相关不良反应。结果治疗前两组THI评分、耳鸣响度比较,差异无统计学意义(P>0.05),治疗4周后两组THI评分和耳鸣响度均较治疗前明显下降,差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。治疗前两组耳鸣残疾程度比较,差异无统计学意义(P>0.05),治疗4周后两组轻微残疾和轻度残疾均增多,中、重度和极重度残疾均减少,其中两组治疗后1级占比均明显升高,3级占比均明显下降,差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。两组治疗总有效率比较,差异无统计学意义(P>0.05),鼓室组眩晕、局部疼痛发生率均明显高于耳后组,差异有统计学意义(P<0.05)。结论耳后与鼓室注射甲强龙治疗慢性原发性耳鸣均可改善耳鸣严重程度及残疾程度,降低耳鸣响度,疗效相当,但耳后注射相关不良反应较少,整体安全性优于鼓室注射。

Objective To observe the clinical efficacy and safety of retroauricular and tympanic injection of methylprednisolone in the treatment of chronic primary tinnitus.Methods A retrospective study of 90 patients with coal surface tinnitus admitted to the Department of Otolaryngology at Beijing Jingmei Group General Hospital from January 2018 to December 2020 was conducted.The patients were divided into the retroauricular group(n=42;retroauricular injection of methylprednisolone 40 mg/injection,one injection every other day continuously for 4 weeks)and the tympanic group(n=48;tympanic injection of methylprednisolone40 mg/injection,one injection every other day continuously for 4 weeks).Before treatment and 4 weeks after treatment,the tinnitus handicap inventory(THI)was used to evaluate the severity of tinnitus and the degree of disability.Tinnitus loudness before and after treatment was detected in the two groups,the clinical efficacy was evaluated,and related adverse reactions were statistically analyzed.Results There was no significant difference in the THI score and tinnitus loudness between the two groups before treatment(P>0.05).After 4 weeks of treatment,the THI score and tinnitus loudness of the two groups were significantly decreased compared with before treatment(P<0.05),but there was no significant difference between the two groups(P>0.05).Before treatment,there was no significant difference in the degree of tinnitus disability between the two groups(P>0.05).After 4 weeks of treatment,the slight and mild disabilities were increased in both groups,while the moderate,severe,and extremely severe disabilities were decreased.After treatment,the proportion of grade 1 adverse events was significantly increased in both groups(P<0.05),and the proportion of grade 3 adverse events was significantly decreased in both groups(P<0.05);however,there was no significant difference between groups(P>0.05).There was no significant difference in the total effective rate between the two groups(P>0.05).The incidence of vertigo and local pain in the tympanic group was significantly higher than the retroauricular group(P<0.05).Conclusion Both the retroauricular and tympanic injections of methylprednisolone improved the severity and disability of tinnitus and reduced tinnitus loudness;however,there were fewer adverse reactions related to the retroauricular injection and the overall safety was better than tympanic injection.