鼓膜切开置管联合鼓索神经切断术治疗梅尼埃病的疗效分析

Efficacy of tympanostomy tube plus chorda tympanectomy on the treatment of Meniere's disease

目的总结鼓膜切开置管联合鼓索神经切断术治疗梅尼埃病的临床疗效。方法 45例单侧梅尼埃病患者,患耳听力分期为Ⅱ~Ⅲ期,经常规药物治疗3个月其眩晕症状未能缓解者,随机分为2组,A组22例,仅给予患侧鼓膜切开置管及鼓室注射甲强龙(甲强龙注射液12 mg/0.3 ml,每周1次,共4周);B组23例,给予患侧鼓膜切开置管联合鼓索神经切断术,同时鼓室注射甲强龙(同置管组),随访24个月。通过对治疗后第18~24个月和治疗前6个月患者眩晕发作次数的比较,评价2组患者的治疗效果。结果与治疗前6个月相比,治疗后第18~24个月,A组22例患者中眩晕控制的总有效率为72.7%,B组为73.9%,2组有效率差异无统计学意义。结论鼓膜切开置管术、鼓室注射甲强龙是治疗梅尼埃病的一种有效的方法,可显著减少患者的眩晕发作,其操作简便、微创,联合鼓索神经切断术对其眩晕控制有效率无进一步提高作用。

Objective To evaluate the efficacy of tympanostomy tube plus chorda tympanectomy in the treatment of Meniere＇s disease. Methods Forty-five patients with unilateral Meniere＇s disease, who had received conventional treat- ments for three months with poor effectiveness, were divided into two groups： Group A （n=22） were patients who under- went tympanostomy tube with intratympanic methylprednisolone （12mg, once a week, for 4 weeks）; group B （n=23） were patients who received additional chorda tympanectomy in addition to tympanostumy tube with intratympanic methylpred- nisolone. All patients were followed up for 2 years after treatment. Resolution of vertigo was used as the main outcome measures to evaluate the effectiveness of treatments. Results Within 18-24 months after treatment, complete or partial resolution of vertigo was obtained in 16 （72.7%） cases of grotlp A, and in 17 （73.9%） cases of group B, with no significant difference. Conclusion Tympanostomy tube with intratympanic methylprednisolone is effective for the treatment of Meniere＇s disease, with a higher resolution rate of vertigo. Additional benefits are not obtained from chorda tympanectomy.