不同途径给地塞米松治疗突发性聋的临床研究

Clinical investigation of different routes of administration of dexamethasone on sudden deafness

目的:探讨不同途径给地塞米松治疗对突发性聋(SD)疗效的影响。方法:将84例SD患者随机分为4个治疗组,每组21例,第1组采用常规疗法加口服地塞米松治疗;第2组常规疗法加静脉注射地塞米松治疗;第3组常规疗法加鼓室注射地塞米松治疗;第4组常规疗法加耳咽鼓管鼓室注射地塞米松治疗。比较治疗后各组在0.5、1.0、2.0、4.0kHz听力提高的平均值。结果:治疗后4组在4个频率的平均听阈提高分别为21.3、27.5、43.2、48.1dB,组3、组4和组1、组2比较,听力提高均差异有统计学意义(均P<0.05);组1与组2及组3与组4比较,听力提高均差异无统计学意义(均P>0.05)。在PTA≤70dB患者中,治疗后4组在0.5、1.0、2.0、4.0kHz4个频率的平均听阈提高均差异无统计学意义(均P>0.05),而在PTA>70dB患者中,治疗后4组在0.5、1.0、2.0、4.0kHz的平均听阈提高的比较,组1与组2之间比较及组3与组4之间比较听阈提高均差异无统计学意义(均P>0.05),组3、组4平均听阈提高明显高于组1和组2(P<0.05)。结论:常规疗法加全身给地塞米松治疗对PTA>70dB的SD患者的治疗效果提高不明显,而常规疗法加鼓室内注射地塞米治疗能提高SD的治疗效果;和全身给药相比,鼓室给药使用方便,禁忌证和并发症较少,对PTA>70dB的患者,更应早期用鼓室注射地塞米松治疗。

Objective：To investigate the therapeutic effects of conventional treatment with different routes of administration of dexamethasone on sudden deafness. Method： Eighty-four patients with sudden deafness were included in this prospective randomized study. Twenty one patients（group 1）were treated with taking dexamethasone orally combined with conventional methods. Another 21 patients （group 2） were treated with intravenous dexamethasone injection combined with conventional methods. Group 3 （21 patients） were treated with intratympanic dexamethasone injection by the way of external ear combined with conventional methods. The other 21 pa tients （group 4） were treated with intratympanic dexamethasone injection by the way of pharyngotympanic tube combined with conventional methods. The hearing gains at 0. 5, 1.0. 2. 0, .t. 0 kHz and the mean values were compared among four groups. Result：The average hearing gains of 1, 2. 3 and 4 group was 21. 3 dB, 27. 5 dB, 43.2 dB and 48.1 dB respectively. Group 3 and group 4 had statistical difference compared with group 1 and group 2 in the average hearing gains. There was no obviously statistical difference between group 1 and group 2 and between group 3 and group 4. In patients with PTA≤70 dB, the average hearing gains at 0.5, 1.0, 2.0, 4.0 kHz had no obvious difference （P〉0.05） among four groups. However, in patients with PTA〉70 dB, there was sta tistical difference between group 1, 2 and group 3, 4 （P〈 0.05）. the hearing gains of group 3.4 were apparentlyhigher than that of group 1, 2. However, there was no significant difference of hearing gains between group 1 and group 2 （P〉0.05） and between group 3 and group 4 （P〉0.05）. Conclusion：The conventional drug treatment with taking dexamethasone orally or intravenous dexamethasone injection had no obvious effect on sudden deafness with PTA〉70 dB, but the conventional drug treatment with intratympanic dexamethasone injection is a useful treatment for sudden deafness. Comparison with whole body administration, intratympanic dexamethasone injection is more convenient to use in clinic, and with less prohibitions and complications. Patients with PTA〉70 dB should take intratympanic dexamethasone injection in early days.