不同时间窗内鼓室注射地塞米松治疗突发性聋的临床疗效分析

Analysis of clinical effects of intratympanic injection of dexamethasone in treatment of sudden deafness in different time windows

目的 探讨不同时间窗内鼓室注射地塞米松治疗突发性聋的临床疗效.方法 选取突发性聋患者60例（60耳）,按照随机数字表法分为对照组和观察组,对照组30例（30耳）,观察组30例（30耳）.两组均给予全身性基础治疗,静脉滴注长春西汀、前列地尔改善微循环,同时高压氧治疗,12 d为1个疗程,治疗2个疗程.对照组患者入院静脉滴注地塞米松,共静脉滴注12 d,从第7天开始鼓室内注射地塞米松,隔天1次注射9次,观察组在静脉滴注地塞米松的同时综合给予鼓膜注射地塞米松,治疗方法及时间同对照组.治疗结束时比较两组临床疗效,观察两组治疗前后平均听阈变化,观察两组眩晕、耳鸣及听力恢复时间.结果观察组临床疗效总有效率96.67%,对照组临床疗效为93.33%,差异无统计学意义（x2=0.97,P＞0.05）.治疗后两组平均听阈较治疗前均明显改善（t=7.69、8.23,均P＜0.05）.观察组平均听阈改善程度高于对照组,治疗前后两组平均听阈差值差异均有统计学意义（t=2.34、2.67,均P＜0.05）.观察组眩晕、耳鸣及听力恢复时间均短于对照组（t=3.32、3.14、3.67,均P＜0.05）.结论 同时给予鼓室内注射地塞米松联合全身性治疗突发性聋相比较前期静脉给予地塞米松后局部鼓室内注射地塞米松的患者,虽临床疗效无明显差异,但治疗后听阈改善程度较后者明显,且平均症状消失时间较后者短,因此值得临床推广.

Objective To investigate the clinical effect of intratympanic injection of dexamethasone in treatment of sudden deafness in different time windows.Methods 60 patients （60 ears） with sudden deafness were selected.Sixty patients were divided into control group and observation group according to the random number table method,30 cases （30 ears） in the control group and 30 cases （30 ears） in the observation group.The two groups were given systemic basic therapy, intravenous vinpocetine, alprostadil improve microcirculation, while hyperbaric oxygen therapy,12 days for a course of treatment, treatment for 2 courses.In the control group, dexamethasone was intravenously administered for 12 days.From the 7th day, dexamethasone was injected into the tympanic cavity and injected once every other day.The observation group was treated with dexamethasone at the same time.Injection of dexamethasone, treatment method and time were the same as the control group.At the end of the treatment, the clinical curative effect of the two groups was compared.The average hearing thresholds of the two groups were observed before and after treatment.The dizziness, tinnitus and hearing recovery time of the two groups were observed.Results The total effective rate was 96.67% in the observation group and 93.33% in the control group, the difference was not statistically significant （x2 =0.97,P〉 0.05）.After treatment, the average hearing threshold of the two groups was significantly improved （t=7.69,8.23,all P〈0.05）,the average hearing threshold of the observation group was higher than that of the control group, the average hearing threshold before and after treatment had statistically significant differences （t=2.34,2.67,all P〈0.05）.In the observation group, dizziness, tinnitus and hearing recovery time were shorter than those in the control group （t=3.32,3.14,3.67,all P〈0.05）.Conclusion The effect of dexamethasone combined with systemic treatment of sudden deafness in patients compared with intratympanic injection of dexamethasone after intravenous administration of dexamethasone is not significantly different, but the improvement of hearing threshold after treatment compared with the latter is obvious, and the average time to disappear symptoms is shorter than the latter, and therefore worthy of clinical promotion.