局部联合全身注射糖皮质激素治疗青、少年重度及极重度突发性聋的临床疗效

Local combined with systemic glucocorticoid treatment of young and middle-aged patients with severe and profound hearing loss

目的:探讨局部联合全身注射糖皮质激素治疗青、少年重度及极重度突发性聋的临床疗效。方法:对93例青、少年突发性聋患者进行回顾性分析。根据患者接受治疗方式的不同将其分为对照组和观察组,对照组(46例)采用全身注射糖皮质激素进行治疗,观察组(47例)则采用局部联合全身注射糖皮质激素疗法。以疗效评价、平均听阈改变值、不良反应发生率为评价指标。结果:观察组总有效率为68.09%,明显高于对照组(45.65%)(P<0.05);治疗后观察组在0.5、1.0、2.0、4.0kHz平均听阈改变值分别为(35.77±13.28)dB HL、(39.71±14.09)dB HL、(32.99±10.73)dB HL、(30.17±9.29)dB HL,均明显高于对照组的(26.30±14.03)dB HL、(25.14±13.28)dB HL、(20.54±9.27)dB HL、(20.98±8.71)dB HL(P<0.05);所有患者均采用全身注射地塞米松磷酸钠注射液,除1例出现血压不稳经停药处理得到缓解外未见其他并发症。观察组在全身注射基础上加以鼓室内注射甲泼尼松龙琥珀酸钠,未发生鼓室内感染、鼓膜穿孔等严重并发症,1例主诉耳痛,1例主诉耳内有轻微烧灼感,均在休息后自行缓解。结论:局部联合全身注射糖皮质激素治疗青、少年重度与极重度突发性聋可明显提高有效率,提升0.5、1.0、2.0、4.0kHz平均听阈改变值,未发现有严重不良反应的发生。

Objective：To investigate the clinical effect of local combined with systemic glucocorticoid injection on young and middle-aged patients with severe and profound hearing loss.Method：Ninety-three cases of young and middle-aged patients with severe and profound hearing loss admitted to our hospital from May 2013 to May 2017 were retrospectively analyzed.Patients were divided into two groups according to the different treatment.Fortysix cases in control group were treated with systemic injection of glucocorticoids.Forty-seven cases in observation group were treated with local administration combined with systemic glucocorticoid therapy.The efficacy,changes of average hearing threshold and the incidence of adverse reactions were evaluated.Result：The total effective rate in the observation group was 68.09%,which was significantly higher than that in the control group（45.65%,P〈0.05）.After treatment,the average hearing thresholds in the observation groups of 0.5,1.0,2.0 and 4.0 kHz were（35.77±13.28）dB HL,（39.71±14.09）dB HL,（32.99±10.73）dB HL and（30.17±9.29）dB HL respectively,which were significantly higher than that in the control group（26.30±14.03）dB HL,（25.14±13.28）dB HL,（20.54±9.27）dB HL,and（20.98±8.71）dB HL（P〈0.05）.Among all the patients received systemic injection of dexamethasone sodium phosphate injection,there was no other complications were found except for one patient whose blood pressure instability was relieved after treatment stopping.In the observation group,intratympanic methylprednisolone sodium succinate did not cause serious complications such as tympanic cavity infection and perforation of the tympanic membrane on the basis of systemic injection.While in the observation group,one case complained of earache and one case complained of a slight burning sensation in the ear,and both of them eased after rest.Conclusion：Local combined with systemic glucocorticoid treatment of young and middle-aged patients with severe and profound hearing loss can significantly improve the efficiency and increase the average hearing threshold changes at 0.5,1.0,2.0 and 4.0 kHz,and there was no serious adverse reactions.