鼓室内灌注醋酸泼尼松龙治疗主观性耳鸣的临床观察

Transtympanic Prednisolone Treatment for Subjective Tinnitus

目的探讨鼓室内灌注激素时主观性耳鸣的治疗效果。方法选择病史在1月以上已接受过口服药物治疗的耳鸣患者49例(55耳),随机分为治疗组29例(30耳),鼓室内注入醋酸泼尼松龙,同时口服扩血管药及维生素;对照组20例(25耳),仅口服扩血管药及维生素,观察两组治疗前后耳鸣的变化。结果治疗组中,耳鸣伴突发性聋14耳、老年性聋3耳、噪声性聋2耳、耳硬化症1耳,原因尚不能明确的感音性聋5耳,混合性聋2耳及传导性聋1耳,特发性耳鸣2耳。经过一个疗程的治疗后,耳鸣消失5耳,减轻11耳,有效率53.3%(16/30)。对照组中,仅6耳耳鸣响度减轻,有效率24%(6/25)。结论鼓室内应用皮质类固醇激素能改善主观性耳鸣。

Objective To determine whether transtympanic steroid administration may be an effective treatment for subjective tinnitus （ST） in patients for whom routine systemic drug treatment has failed over four weeks after onset. Methods A prospective study was designed to evaluate the tinnitus outcomes in ST patients treated with transtympanic prednisolone. 29 cases （30 ears） in the study group received transtympanic prednisolone and oral vitamin B and vasodilator agent. 25 ears in the control group only received above drugs orally for one month. Transtympanic prednisolone was administered through tympanic puncture under local anesthesia. Prednisolone adminis- tration was performed twice in the first week and once a week in the next three weeks. Loudness of tinnitus was assessed immediately before the injection and within one week after the injection. Results In the study group there were 14 cases with idiopathic sudden hearing loss, 4 cases with presbycusis, 3 cases with noise-induced hearing loss, 1 case with otosclerosis, 2 cases with idiopathic tinnitus, the others whose etiology were unclear were 5 cases with sensorineural hearing loss, 2 cases with mixed hearing loss and 1 case with conductive hearing loss. Tinnitus improvement was obtained in 16 of 30 ears who underwent the completion of therapy. The intensity of tinnitus was only lowered in the 6 ears in the control group. Conclusion Transtympanic prednisolone therapy may be an alternative choice for patients with ST in whom routine systemic therapy had failed.