鼓室内与静脉注射地塞米松治疗突发性聋疗效比较

Efficacy Analysis of Intratympanic and Intravenous Dexamethasone in Idiopathic Sudden Sensorineural Hearing Loss

目的探讨鼓室内与静脉注射激素治疗突发性聋的疗效。方法 121例单耳突发性聋患者进行前瞻性随机对照研究,分为治疗组(60例,地塞米松3~5mg鼓室内注射,1次/天,连续7d)和对照组(61例,地塞米松10mg/d静脉滴注,持续3~5d),并于治疗前及治疗后第1、4及8w行纯音听阈测试,比较两组治疗后的有效率;并分别比较两组低频下降型、高频下降型及全频下降型患者之间治疗后气导听力提高值及3型之间总体听力提高值。结果 (1)治疗后1周治疗组痊愈11例,显效15例,有效20例,总有效率76.7%(46/60);对照组痊愈9例,显效16例,有效18例,总有效率71.67%(43/60),两组间总有效率比较差异无统计学意义(P>0.05)。治疗后4w及8w,两组间总有效率比较差异均无统计学意义(P>0.05)。(2)治疗后8w治疗组低频下降型及高频下降型突聋患者听力提高值分别为26.35±4.77及17.04±9.60dB,对照组分别为20.60±3.60及14.08±7.43dB,治疗组疗效较对照组更优(P<0.05)。(3)两组合计治疗后低频下降型突发性聋患者听力提高值(23.48±4.52dB)明显优于高频下降型(15.39±8.97dB)及全频下降型(10.73±7.11dB)(P<0.01)。结论连续1周每日鼓室内注射地塞米松治疗突发性聋是一种安全有效的方法,对于低频及高频下降型突发性聋患者,其较静脉给药疗效更优,值得临床推广。

Objective To compare and analyze the effects of intratympanic or intravenous dexamethasone in the treatment of idiopathic sudden sensorineural hearing loss(ISSHL).Methods A prospective randomized study was conducted from January 2014 to October 2017 in our hospital.A total of 121 consecutive patients with ISSHL were divided into treatment group(dexamethasone 3~5 mg/d,intratympanic injection,1 times/d and for 7 days;60 cases)and control group(dexamethasone 10 mg/d,intravenous drip,lasting 3~5 days;61 cases).Pure tone audiometry was performed before and after treatment(1w,4w and 8w).At the same time,the ISSHL was divided into 3 types(low-frequency descending type,high-frequency descending type and full-frequency descending type),according to the type of hearing loss,the average hearing improvement of the damage frequency between the two groups of each type was compared before and after the treatment.And also,the hearing improvement values were compared among the 3 types.Results①1 weeks after treatment,all patients underwent pure tone audiometry,of treatment group 11 cases were cured,15 cases had markedly effective,20 cases effective,the total efficiency rate was 76.7%(46/60).Of the control group,9 cases were cured,16 cases markedly effective,18 cases effective,the total efficiency rate was 71.67%(43/60),there was no statistical significance between two groups(P>0.05).The total effective rate was improved to a certain extent at 4w and 8w post-treatment,but no statistical significance was found between two groups(P>0.05).②The post-treatment PTA enhancement values of low-frequency and high-frequency descent types in the treatment group were 26.35±4.77 and 17.04±9.60 dB HL,respectively,had better effect than the control group which the enhancement values were 20.60±3.60 and 14.08±7.43 dB(P<0.05).③In general(two groups of cases were merged according to different types),post-treatment PTA values improvement of low-frequency descent ISSHL was better than the high-frequency and full-frequency descent types(23.48±4.52,15.39±8.97 and 10.73±7.11 dB,respectively,P<0.01).Conclusion The treatment of continuity daily intratympanic dexamethasone for 7d is a safe and effective method for ISSHL,and has a better hearing values improvement in low-frequency and high-frequency descent types than intravenous administration.So it deserved promotion and application in clinical work.