早期鼓室注射联合全身应用糖皮质激素对突发性耳聋的疗效探讨

The efficacy of early intratympanic steroid of high concentration combined with systemic steroid on idiopathic sudden sensorineural hearing loss

目的研究早期鼓室注射不同种类、不同浓度糖皮质激素联合全身应用糖皮质激素对重度以上突发性耳聋的治疗效果。方法收集2012年1月至2016年6月于该院耳鼻咽喉科住院治疗的单侧突发性耳聋患者的临床资料进行分析,共收集95例,根据所接受的糖皮质激素不同分成3组进行比较。A组:全身应用糖皮质激素组(30例);B组:鼓室注射低浓度糖皮质激素+全身应用糖皮质激素组(32例);C组:鼓室注射高浓度糖皮质激素+全身应用糖皮质激素组(33例);比较不同组的治疗效果。结果 A组总有效率46.67%,B组总有效率56.25%,C组总有效率78.79%,3组患者的总有效率两两比较,C组高于A组及B组,差异有统计学意义(P<0.05);3组患者治疗后的听力改善值两两比较,C组(46.67±9.32)高于A组(20.53±8.83)及B组(20.53±8.83),差异有统计学意义(P<0.01)。结论对于重度以上突发性耳聋应早期鼓室注射高浓度糖皮质激素联合全身应用糖皮质激素积极抢救听力效果良好。

Objective To evaluate the therapeutic effects of early intratympanic steroid of different concentrations and types combined with systemic steroid on severe idiopathic sudden sensorineurl hearing loss（ISSNHL）.Methods We reviewed 95 patients with unilateral ISSNHL from January 2012 to June 2016 in the Department of Otolaryngology of the People′s Hospital of Changshou and according to the steroid treatment methods,Patients were divided into systemic steroid therapy alone group（group A,30cases）,early intratympanic steroid of low concentration combined with systemic steroid group（group B,32cases）and early intratympanic steroid of high concentration combined with systemic steroid group（group C,33cases）.Results Total effective rates of the group A,group B and group C were 46.67%,56.25%,78.79%.Group C was significantly higher than that of group A and group B（P〈0.05）;the average pure tone threshold improvement was（46.67±9.32）in group C which was better than group A（20.53±8.83）and group B（25.19±7.46）,the differences were stastically significant（P〈0.01）.Conclusion Severe ISSNHL should be treated by intratympanic steroid of high concentration combined with systemic steroid as early as possible in order to rescue the hearing,the efficacy of which is much better than other steroid treatments so far.