全身联合鼓膜置管鼓室给予地塞米松治疗重度特发性突聋的疗效分析

Efficacy of Combination Therapy with Intratympanic and Systemic Dexamthasone for Treatment of Patients with Severe-to-Profound Idiopathic Sudden Sensorineural Hearing Loss

目的分析鼓膜置管后鼓室给予地塞米松联合全身激素治疗重度特发性突聋的效果和影响其预后的因素。方法回顾性分析49例重度特发性突聋患者临床资料。49例重度特发性突聋患者依治疗方式分为2组:A组,29例,接受全身激素治疗;B组,20例,接受鼓膜置管鼓室给予地塞米松联合全身激素治疗。两组在发病年龄、性别、患耳、伴随耳鸣或眩晕症状等均经良好配对。比较两种治疗方法的疗效,并分析伴随耳鸣和眩晕症状对预后的影响。结果 A组治疗总有效率为69.0%(20/29),痊愈率为6.9%(2/29),B组总有效率为70.0%(14/20),痊愈率为15.0%(3/20),两组总有效率经卡方检验差异无统计学意义(P=0.938)。耳鸣或眩晕症状对治疗效果没有显著影响(均P>0.05)。治疗后各频率平均听阈改善经ANOVA分析显示,差异亦无统计学意义。结论在重度特发性突聋患者的治疗中,全身联合鼓膜置管鼓室给予地塞米松治疗与单纯全身给药的疗效相比没有明显差异。耳鸣或眩晕等伴随症状对重度特发性突聋患者的预后无明显影响。

Objective To examine the therapeutic efficacy of combination therapy with intratympanic and systemic dexamthasone for the treatment of patients with severe-to-profound idiopathic sudden sensorineural hearing loss（ISSNHL）and the prognostic factors of this disease.Methods Clinical data of 49severe-to-profound patients with ISSNHL were retrospectively analyzed.These patients were divided into two groups in terms of different therapeutic strategies：group A,in which 29 patients received the systemic high-dose dexamethasone tapering therapy;group B,in which,20 patients were given not only systemic high-dose dexamesthasone tapering therapy but also the trans-tympanic dexamethasone therapy.Patients in both groups were well matched for age,sex,affected part,initial pure tone average（PTA）,dizziness,and tinnitus.The curative effect was compared between the two groups and the influence of accompanying tinnitus and dizziness was analyzed on prognosis.Results The total effective rate was 69.0%（20/29）in group A and 70.0%（14/20）in group B.The recovery rate was 6.9%（2/29）in group A and 15.0%（3/20）in group B.Chi-square test revealed no significant difference in the total effective rate between the two groups（P=0.938）.Additionally,tinnitus or dizziness had no obvious impact on the treatment efficacy.ANOVA also showed no significant difference in the improvement of PTA at each frequency between the two groups.Conclusion There is no significant difference in therapeutic efficacy for patients with severe-to-profound ISSNHL between combined therapy with intratympanic and systemic dexamethasone and treatment with systemic dexamethasone alone.The accompanying tinnitus and dizziness have no effects on the prognosis of ISSNHL.