鼓室注射地塞米松与耳后骨膜下注射甲强龙治疗突发性聋的疗效及不良反应对比

Intratympanic dexamethasone vesus post-auricular subperiosteal injection of methylprednisolone treatment for sudden hearing loss

目的:研究对比鼓室注射地塞米松与耳后骨膜下注射甲强龙治疗突发性聋的有效性及相关并发症。方法:将108例单侧突发性聋患者随机分为A组和B组各54例,分别行鼓室注射地塞米松(10mg/ml)和耳后骨膜下注射甲强龙(40mg/ml)治疗,均隔天给药1次,共5次,随访3个月,研究分析治疗前后纯音听阈值改变情况、耳鸣致残量表(THI)评分、眩晕障碍量表(DHI)评分、有无鼓膜穿孔、局部感染及血糖改变情况。结果:(1)两组间总体有效率及纯音听阈值好转程度无统计学差异(P>0.05),两组间低频型突发性聋患者纯音听阈好转程度有统计学差异(P<0.05);(2)两组间THI分值减少无统计学差异(P>0.05),两组间高频型突发性聋患者THI减少程度有统计学差异(P<0.05);(3)两组间DHI分值减少无统计学差异(P>0.05);(4)两组治疗前、后空腹血糖均无统计学差异(P>0.05);(5)A组治疗结束后2周有2例出现鼓膜穿孔,随访结束时穿孔愈合,两组均无耳部感染患者。结论:两种治疗方法均能改善单侧突发性聋患者的纯音听阈值,能有效减轻眩晕及耳鸣对患者的影响,鼓室注射地塞米松能更好地减小高频型突发性聋患者THI评分,耳后骨膜下注射可更好地改善低频型患者的纯音听阈,两种给药方式均对患者血糖无明显影响,但鼓室注射地塞米松存在鼓膜穿孔的风险。

Objective：To compare the efficacy and side effect between intratympanic dexamethasone and subperiosteal injection of methylprednisolone treatment for sudden hearing loss.Method：One hundred and eight unilateral sudden hearing loss patients were enrolled in this study,randomly divided into A group,which was accepted intratympanic dexamethasone（10mg/ml）,and B group,which was accepted post-auricular subperiosteal injection of methylprednisolone（40 mg/ml）by every 3days intotal 5times.After 3 months follow-up,analysis of the differences of pure tone threshold,tinnitus handicap inventory（THI）,dizziness handicap inventory（DHI）,blood glucose between pretreatment and postreatment was made.Side effect such as perforation of tympanic membrane,infection of post-auricular skin was also observed.Result：（1）Both in A and B group,there was no statistical changes in total efficiency and pure tone threshold decrease（P〉0.05）,whereas the pure tone threshold statistical change was observed in the low-frequency sudden deafness between A and B group（P〈0.05）.（2）Both in A and B group,there was no statistical changes in THI（P〉0.05）,whereas the THI statistical decrease was observed in the high-frequency sudden deafness between A and B group（P〈0.05）.（3）There was no statistical change in THI both in A and B group（P〉0.05）.（4）Both in A and B group,there was no statistical changes in fasting plasma glucose between pretreatment and postreatment（P〉0.05）.（5）There was no patient who had gotten tympanitis or postauricular infection,although in A group,there were 2patients had gotten perforation of tympanic membrane,but they all healed after the follow-up.Conclusion：Both topical injection of glucocorticoid can improve pure tone threshold and reduce the score of THI and DHI for sudden hearing loss patients.Intratympanic dexamethasone can reduce more score of THI for high-frequency sudden deafness patients whereas subperiosteal injection of methylprednisolone can improve pure tone threshold more for low-frequency sudden deafness patients.None of the two administrations elevate blood glucose,but intratympanic dexamethasone have the risk of perforation of tympanic membrane.