鼓室内注射庆大霉素治疗单侧难治性梅尼埃病的临床效果及安全性

Clinical effect and safety of intratympanic gentamicin injection in treatment of unilateral refractory Meniere disease

目的观察鼓室内注射小剂量庆大霉素治疗难治性梅尼埃病的临床效果及安全性。方法回顾性分析接受鼓室内注射小剂量庆大霉素治疗的单侧难治性梅尼埃病37例患者的临床资料,对治疗前后患者眩晕、纯音听阈及耳鸣的变化进行对比分析。结果治疗后眩晕控制率91.9%(34/37),其中A级17例、B级11例、C级6例、D级3例、E级0例。治疗后眩晕发作的严重程度及对日常生活的影响显著改善,分级全部下降,有效率100%(37/37)。治疗后言语听阈提高>15 d B者3例,占8.1%,治疗后言语听阈下降>10 d B者4例,占10.8%。治疗前患者言语听阈为(60±11)d B,治疗后为(59±11)d B,治疗前后差异无统计学意义(t=0.576,P=0.569)。耳鸣痛苦分级治疗前后差异无统计学意义(Z=1.640,P=0.110)。结论鼓室内注射小剂量庆大霉素治疗单侧难治性梅尼埃病,可以有效的控制眩晕的发作,降低眩晕发作的严重程度及对生活的影响,且对听力影响小,不会加重耳鸣的程度。

Objective To observe the clinical effect and safety of intratympanic gentamicin injection in treatment of unilateral refractory Ménière disease.Methods Clinical data of 37 patients with unilateral refractory Ménière disease treated with intratympanic gentamicin injection in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed.Changes of vertigo,pure tone hearing threshold and tinnitus were analyzed before and after treatment.Results After treatment,the vertigo control rate was 91.9%(34/37),including 17 cases of grade A,11 cases of grade B,6 cases of grade C,3 cases of grade D and 0 case of grade E.Severity of vertigo attack and the impact on daily life were significantly improved and the severity grade decreasing rate was 100%(37/37).After treatment,pure tone audiometry threshold was improved more than 15 d B in3 cases(8.1%)and it declined over 10 d B in 4 cases(10.8%).Pure tone audiometry threshold showed no significant difference before and after treatment[(60±11)d B vs(59±11)d B](t=0.576,P=0.569).There was no significant change in pain classification of tinnitus before and after treatment(Z=1.640,P=0.110).Conclusion Intratympanic gentamicin injection treating unilateral refractory Meniere disease can effectively control vertigo onset,reduce the severity of vertigo and the adverse impact on life;it rarely causes hearing loss and does not aggravate tinnitus.