鼓室内与全身应用糖皮质激素治疗突发性聋的Meta分析

Intratympanic versus systemic steroid treatment for idiopathic sudden hearing loss：a Meta-analysis

目的系统评价比较鼓室内和全身应用糖皮质激素对于突发性聋初始治疗的有效性和安全性。方法用国际Cochrane协作网方法，检索鼓室内和全身糖皮质激素用于突发性聋初始治疗的随机对照试验，对符合入选标准的文献提取资料进行Meta分析。结果突发性聋不伴糖尿病患者鼓室内应用糖皮质激素的有效率与全身应用的有效率相比较，组间差异无统计学意义（RR=1．11，95％CI=0．96—1．28，P=0．15），治愈率差异有临界性统计学意义（RR=1．30，95％CI=0．99—1．71，P=0．05）；突发性聋合并糖尿病患者鼓室内应用糖皮质激素的有效率高于全身应用的有效率（RR=1．24，95％CI=1．02—1．50，P=0．03）。全身应用糖皮质激素的主要并发症为血糖升高，鼓室内给药的并发症包括疼痛、一过性眩晕、中耳感染、永久性鼓膜穿孔等。结论对于突发性聋合并糖尿病的患者初始治疗优先考虑鼓室内应用糖皮质激素，不伴糖尿病者仍首选全身应用糖皮质激素。

Objective To assess the effectiveness and safety of intratympanic versus systemic steroid therapy in the initial treatment of idiopathic sudden hearing loss. Methods An extensive search of the literature was performed in Pubmed and other available database from January, 1980 to November, 2011. After filtering by the criteria of Cochrane Collaboration, a meta-analysis was conducted. Results Nine studies met the criteria for recta-analysis, for idiopathic sudden hearing loss patients without diabetes received intratympanic steroid therapy, the improvement rate（RR = 1.11,95% CI = 0. 96 - 1.28, P = 0. 15） did not show any significance when compared with the patients received systemic therapy. While a significant difference of improvement rate occurred between intratympanic and systemic steroid therapy in the idiopathic sudden heating loss patients with diabetes （ RR = 1.24 , 95% CI = 1.02 - 1.50, P = 0.03 ）. Conclusion For the initial therapy of idiopathic sudden hearing loss patients without diabetes, systemic steroid treatment still remains the first choice, but for the idiopathic sudden hearing loss patients with diabetes, intratympanic steroid treatment should be used for the initial treatment.