急性低频感音神经性听力损失的临床疗效观察

The Outcome in Patients with Acute Low-Tone Sensorineural Hearing Loss

目的探讨脱水剂和鼓室内注射皮质类固醇激素对急性低频感音神经性听力损失的疗效。方法选取153例(153耳)急性低频感音神经性听力损失患者作为研究对象,根据耳蜗电图和速尿试验的检查结果将所有患者分为2组,耳蜗电图及速尿试验均正常的A组76例(耳)与耳蜗电图异常和/或速尿试验异常的B组77例(耳),每组患者随机分别应用3种治疗方法,一种是单独应用鼓室内注射皮质类固醇激素(激素组),一种是单独应用脱水剂(脱水组),第三种是鼓室内注射激素联合应用脱水剂(联合组),2周后观察疗效,并随访半年。结果 A组三组之间听力恢复的有效率、治愈率、耳鸣改善有效率及症状改善起始天数比较均有统计学意义,其中,激素组(A)和脱水组(A)、脱水组(A)和联合组(A)之间比较亦有统计学意义,激素组(A)和联合组(A)比较无统计学意义;B组三组之间有效率、治愈率、耳鸣改善有效率及症状改善起始天数比较均有统计学意义,其中,脱水组(B)和联合组(B)、激素组(B)和联合组(B)比较亦有统计学意义,激素组(B)和脱水组(B)比较无统计学意义;复发率在A组三组之间、B组三组之间的比较均无统计学意义。结论鼓室内注射皮质类固醇激素治疗急性低频感音神经性听力损失疗效确切、副作用小,然后,需根据耳蜗电图和速尿试验的检查结果,决定是否加用脱水剂,以获取更佳的治疗效果。

To investigate the effectiveness of diuretics and intratympanic steroids in treating patients with acute low-tone sensorineu- ral hearing loss （ALHL）. Methods We retrospectively reviewed medical records of 153 patients with a diagnosis of ALHL. The patients were divided into two groups based upon electrocochleogram （ECochG） and furosemide test results： group A （normal on both tests, n=76）and group B （abnormal on either ECochG and/or furosemide test, n=77）. Patients in each group were ran- domly selected to receive one of the following three therapes： intratympanic steroids alone （the steroid group）, diuretic treat- ment alone （the diuretic group） and steroid/diuretic combination treatment （the combination group）. All patients were treated for 14 days and followed up for 6 months. Results The differences in the rates of complete hearing recovery, hearing improve- ment, tinnitus improvement and time to improvement were statistically significant among different therapies for both groups A and B. Within Group A, the differences were statistically significant between the steroid and diuretic groups and between the combination and diuretic groups, but not between the steroid and combination groups; whereas within Group B, the differences were statistically significant between the combination and steroid groups and between the combination and diuretic groups, but not between the steroid and diuretic groups. The recurrence rate was not significantly different among all groups. Conclusion Our results indicate that intratympanic steroid is effective in ALHL with minimal side effects. Addition of a diuretic can be de- termined based upon ECochG and furosemide test results to augment treatment effectiveness.