不同局部应用糖皮质激素方式在治疗难治性突发性聋的疗效观察

Rescue Glucocorticoid Treatments for Refractory Sudden Sensorineural Hearing Loss

目的观察不同局部糖皮质激素(Glucocorticoid,GC)方法治疗常规治疗无效的突发性聋患者的临床疗效。方法回顾性分析2013年3月至2017年3月在南京鼓楼医院常规治疗至少1个疗程无效的难治性突发性聋的患者,共305例(305耳)。根据患者治疗方案不同将病人分为治疗组(277耳)和对照组(D组,28耳),其中,治疗组分为鼓室灌注甲强龙联合静脉全身给药组(A组,216耳),耳后注射甲强龙联合静脉全身给药(B组,42耳),耳后注射组(C组,19耳)。A组患者鼓室置管,每天鼓室灌注甲强龙20mg,并予银杏叶提取物注射液105mg、单唾液酸四己糖神经节苷脂钠40mg静脉滴注;B组每3天予患耳后乳突骨膜下注射甲强龙40mg治疗,共4次,联合静脉应用银杏叶提取物注射液105mg、单唾液酸四己糖神经节苷脂钠40mg;C组每3天予患耳后乳突鼓膜下注射甲强龙40mg治疗,共4次,并口服银杏叶片和甲钴胺。对照组为常规治疗失败后每天继续静脉给予银杏叶提取物注射液105mg、单唾液酸四己糖神经节苷脂钠40mg常规治疗。所有患者治疗结束后均口服银杏叶片和甲钴胺片12月。按照中华医学会突发性聋的疗效标准比较发病后第3个月末各组的听阈。结果治疗组中ABC三组的有效率分别为35.2%、50%、42.1%,对照组有效率为7.14%,治疗组比对照组患者疗效显著(χ~2=14.11,P=0.003),四组平均PTA改善分别为11.63⊥16.75 d B、17.78⊥18.12 d B、18.38⊥22.9d B、4.85⊥9.10d B,治疗组比对照组PTA改善值明显(t=2.75,P=0.043)。发病至就诊时间为影响听力预后的重要因素,选取发病至就诊时间在3周以内的患者,鼓室置管灌注GC与耳后注射GC疗效相近(χ~2=1.21,P=0.247)。结论不同方式局部应用GC治疗难治性突发性聋较继续常规治疗具有明显疗效,发病至就诊时间为听力预后的主要影响因素,鼓室灌注GC、耳后注射GC之间疗效无明显差异。由于本组耳后注射GC的病例资料明显少于鼓室内给药,有待于进一步增加病例数,以及多中心前瞻性随机对照研究。

Objective To report outcomes of various rescue glucocorticoid treatment regimens for refractory sudden sensorineural hearing loss(SSNHL). Methods Three hundred and five cases(305 ears) of SSNHL that had failed more than 10 days of conventional therapy were divided into a study group(SG, 277 ears) and a comparison group(CG,28 ears). Patients in the SG received glucocorticoids via a micro-catheter inserted into the tympanum qd for 10 consecutive days plus i.v. transfusion of gingko extracts and monosialotetrahexosylganglioside(group A, 206 ears), 4 doses of postaural injection of glucocorticoids every 3 days plus i.v. transfusion of gingko extracts and monosialotetrahexosylganglioside(group B, 42 ears) or 4 does of postaural injection of glucocorticoids every three days plus oral(group C, 19 ears). Patients in the CG received only i.v. transfusion of gingko extracts and monosialotetrahexosylganglioside. All patients in both SG and CG were maintained on oral gingko extracts and vitamin B12 following rescue therapy and followed up for 3 months. Results The effective rate in the SG was significantly higher than in the CG(χ2=14.11,P=0.003). The average PTA improvement was 11.63 ⊥ 16.75 d B(Group A), 17.78 ⊥ 18.12 d B(Group B) and 18.38 ⊥22.9 d B(Group C) respectively for the SG, but only 4.85 d B for the CG(t=2.75,P=0.043). When treatment was started within 3 weeks post-disease onset, effective rates showed no statistically significant difference between intratympanic and postaural injection of glucocorticoids(P>0.05). Conclusion The rescue glucocorticoids injection treatments employed in the SG in this study appear to be beneficial as compared to no rescue treatments. While the interval from disease onset to therapy can affected treatment efficacy, when started within 3 weeks from disease onset, intratympanic glucocorticoid perfusion appears to be similarly effective as postauricular glucocorticoids injection only.