鼓室内注射甲泼尼龙治疗难治性突发性感音神经性聋的疗效观察

Methylprednisolone of Intratympanic Injection for Refractory Sudden Sensorineural Hearing Loss

目的观察鼓室内注射甲泼尼龙对难治性突发性耳聋的治疗效果,探索常规治疗无效的突发性聋的挽救治疗手段。方法对47例(47耳)常规治疗无效的突聋患者经鼓膜穿刺向鼓室内注入甲泼尼龙混悬液约0.5 ml(20 mg),使药液进入圆窗龛1次/3 d,共4次。在治疗开始前和治疗结束后3 d,分别测试受治疗耳的纯音听阈,比较语言频率纯音听阈均值(PTA),下降15 dB HL以上为有效。结果47例经治患者14例有效,33例无效,有效率为29.8%。治疗前PTA为(67.59±16.57)dB HL,治疗后为(53.65±18.75)dB HL,治疗后比治疗前明显降低(P=0.000)。治疗时间短、不伴有眩晕的患者治疗效果好;听力下降的程度和听力下降的类型以及是否伴有耳鸣、糖尿病对治疗效果无明显影响。结论鼓室内注射甲泼尼龙可作为常规治疗无效的突聋患者的挽救治疗手段,亦可作为避免全身大剂量使用激素的副作用的常规治疗手段之一。

Objective To observe the clinical efficacy of intratympanic Methylprednisolone injection （IMI） for patients with sudden sensorineural hearing loss（SSHL）and we will investigate the effective treatment for SSHL patients who failed to respond to systemic corticosteroid treatment. Methods 47 SSHL cases （47 ears） which failed to respond to regular treatments were injected methylprednisolone 0. 5 ml （20 nag） to the tympanic cavity every three days,4 times in all,make sure the round window niches were involved. Pure-tone average （PTA） was tested before and 3 days after the IMI and it was considered to be effective when the improvement of PTA was more than 15 dB HL. Results PTA of post-injection （67.59 ± 16.57 ） dB HL was lower than the pre-injection （53.65 ± 18.75 ） dB HL （P = 0. 000）. All of 47 patients, 14 patients showed improvement,and 33 patients failed,the effective rate was 29.8%. Promising results of IMI were found in eases with shorter duration or/ and without vertigo. Tiunitus and diabetes have no impaction on the treatment. Conclusion IMI can be applied to SSHL patients who failed to respond to systemic corticosteroid treatment and it can avoid the side-effects brought on by high dose systemic corticosteroid treatment.