听神经病的皮质类固醇试验性治疗

Therapeutic trial with corticosteroid for auditory neuropathy

目的 探讨皮质类固醇用于治疗听神经病的可行性。方法 1998年 7月～ 2 0 0 1年 12月对 6例确诊为听神经病的患者进行为期 1个月的皮质类固醇试验性治疗 :强的松 30～ 4 0mg/d ,分2、3次口服 ,连用 15d后减为半量 ,再用 15d。 1个月后如主诉听力改善 ,且任意 2个纯音测听频率听力提高≥ 15dB为有效。结果 试验性治疗期内 ,2例患者双耳各频率纯音听阈基本恢复到正常范围(30dBHL以内 ) ,言语识别率分别由治疗前的 4 8%和 72 %提高到 95 %和 10 0 %。继续治疗 2个半月和 3个月停药。门诊分别随访 3年和 4个月 ,听力稳定在正常范围。另 4例试验性治疗无明显效果。结论 部分听神经病可能与听神经传导系统的免疫性损伤有关 。

Objective To explore the feasibility of corticosteroid for the treatment of auditory neuropathy Methods Six patients with auditory neuropathy, diagnosed in the first affiliated hospital of Nanjing medical university between July 1998 and December 2001, were treated with corticosteroid therapy for one month (30～40 mg of prednisone daily for the first fifteen days, and 20 mg daily for following fifteen days) Prednisone was tapered gradually if a positive response to therapy was obtained Hearing improvement was defined as 15 dB or more threshold drops in at least two of the standard audiometric frequencies in the same ear during the trial period Results After one month′s steroid treatment, significant hearing improvement was evident in two patients with raised speech discrimination scores from 48% to 95% and from 72% to 100%, respectively In these two cases, prednisone was used continually up to 14 and 16 weeks, respectively, and the patients still had excellent pure tone hearing abilities and speech discriminations during follow up of three years and four months, respectively In other four patients, positive response for corticosteroid was not found within the period of one month trail Conclusion Immunological damages of hearing system might play part role in the pathophysiological mechanisms of auditory neuropathy, and corticosteroids are potentially useful drugs for these cases