经圆窗膜应用甲强龙治疗常规治疗失败的突发性耳聋的临床研究

Clinical effect of methyllprednisolone on refractory sudden hearing loss through round window membrane

目的探讨经圆窗膜应用甲强龙（甲泼尼龙琥珀酸钠）治疗常规治疗失败的突发性耳聋的疗效。方法经常规治疗后2周以上无效的突发性聋患者23例耳，分为圆窗膜给药组和对照组；圆窗膜给药组12例耳，其中伴有顽固性耳鸣7例耳；对照组11例耳，其中伴有顽固性耳鸣6例耳。经圆窗膜应用甲强龙的治疗方法即鼓膜局麻后从鼓膜后下方穿刺注入甲强龙，3d注射1次，4次为1个疗程。对照组给予口服都可喜（阿米三嗪＋萝巴新）和弥可保2周。所有患者在治疗前和治疗结束后1周查电测听。结果圆窗膜给药组听力恢复显效2例耳（16．7％）、有效3例耳（25．0％），对照组听力恢复显效0例耳、有效2例耳（18．2％）。经治疗后圆窗膜给药组7例耳顽固性耳鸣中耳鸣消失1例耳（14．3％）、改善3例耳（42．9％），对照组6例耳顽固性耳鸣中无耳鸣消失、改善2例耳（33．3％）。两组比较疗效差异有统计学意义（P〈0．01）。结论经圆窗膜应用甲强龙治疗常规治疗失败的突发性耳聋仍可取得一定的疗效。

Objective To investigate the therapeutic effect of methyllprednisolone on refractory sudden hearing-loss in patients through round window membrane. Methods Twenty-three ears in patients suffering from refractory sudden hearing-loss were divided into treatment group and control group. There were seven ears accompanied with refractory tinnitus among 12 ears in treatment group, and six ears among 11 ears in control group. Patients in treatment group was injected methylpredinisolone sodium succinate through round window membrane after local anesthesia once a time every three days and four times treatments were determined one course of treatment. The patients in control group were treated with almitrine and raubasine/mecobalamin by oral administration for two weeks. Brainstem electric response audiometry of all patients were examined before and one week after treatment. Results In the treatment group, the significant effect cases and the effect cases were two ears （ 16.7% ） and three cases （25.0%）, respectively. In the control group, there was no significant effect ear and the effect cases were 2 ears （ 18.2% ）. After treatment, the disappearance and the improvement tinnitus were one ear （ 14.3% ） and three ears （42.9%） respectively among seven ears accompanied with refractory tinnitus in treatment group, while the disappearance and the improvement, zero and two ears （33.3%） respectively among six ears accompanied with refractory tinnitus in control group. There was siatistical difference between two groups （ P 〈 0.01 ）. Conclusions It is effective to treat refractory sudden hearing loss with methylpredinisolone sodium succinate, which it is no effective to treat with conventional method.