全聋型突发性聋患者鼓室注射激素时机的前瞻性对照研究

A prospective controlled study on the proper time of intratympanic steroid for profound sudden sensorineural hearing loss of total frequency type

目的探讨鼓室注射激素治疗全聋型突发性聋的用药时机。方法2017年6月至2018年2月重庆医科大学附属第一医院收治的全聋型突发性耳聋患者共50例,分为A组(即刻鼓室注射组:泼尼松1mg/kg,晨起顿服,连用5d;同时鼓室注射甲泼尼龙40mg,每天1次,连用5d)和B组(1周后鼓室注射组:泼尼松1mg/kg,晨起顿服,连用5d;1周后疗效不佳者鼓室注射甲泼尼龙40mg,每天1次,连用5d)。所有患者均同时静脉给予金纳多及巴曲酶治疗。分别检测患者治疗前后纯音听阈值,利用SPSS 20.0统计软件比较两组患者治疗后听力改善情况和有效率。结果两组患者治疗后听阈值都有显著下降,A组(20例)听阈改善值为(29.2±22.7)dB,总有效率为65.0%;B组(22例)听阈改善值为(27.3±22)dB,总有效率为68.2%;组间比较,差异均无统计学意义(听阈改善值,P=0.793;总有效率,P=0.827)。结论对于全聋型突发性聋患者,口服激素同时联合鼓室注射与口服激素1周后行鼓室注射疗效相当,故推荐口服激素1周后疗效不佳者再行鼓室注射,以减少并发症和降低医疗费用。

Objective To investigate the proper time of intratympanic steroid as combination therapy in treatment of patients with profound sudden sensorineural hearing loss ( SSNHL ) of total frequency type.Methods This prospective study included 50 patients with SSNHL in the First Affiliated Hospital of Chongqing Medical University from June 2017 to February 2018.All these patients had profound hearing loss averaged more than 81 dB at all frequencies (250 -8000 Hz).They were divided into two groups.The patients in group A were treated with simultaneous oral prednisone ( 1 mg/kg, qd ) and intratympanic methylprednisolone (40 mg, qd) for 5 days.The patients in group B were treated with oral prednisone for 5 days as in group A, and then those who had no significant improvement were subsequently treated with intratympanic methylprednisolone (40 mg, qd) for further 5 days.All patients were treated with additional intravenous batroxobin and ginkgo biloba leaves extract .Following examination of pure tone audiogram , hearing gains and effective rates were statistically analyzed in both groups with SPSS software package (version 20.0).Results Hearings in both groups were improved significantly after treatment .In group A (20 cases), hearing gain was (29.2 ±22.7) dB and total effective rate was 65.0%, while in group B (22 cases), they were (27.3 ±22) dB and 68.2% respectively.There were no significant differences in hearing gain and recovery rate between two groups (hearing gain, P=0.793;total effective rate, P=0.827). Conclusions For patients with profound SSNHL of total frequency type , the efficacies of intratympanic steroid as simultaneous and subsequent therapy are equivalent . Therefore , subsequent intratympanic glucocorticoid is recommended for SSNHL patient of total frequency type to reduce complications and medical expenses.