高剂量激素对突发性聋的挽救性治疗分析

Efficacy of high dose glucocorticoid in the salvage treatment of sudden deafness

目的:观察鼓室内注入高剂量地塞米松对全聋型突发性聋常规治疗无效患者的临床疗效及安全性。方法:单侧全聋型突发性聋患者43例,均为耳内科常规综合治疗无效者,其中21例应用高剂量地塞米松鼓室内通风管注药治疗(地塞米松组),22例继续常规耳内科治疗(常规治疗组)。治疗前均进行听力检查,描记6个频率(0.25、0.5、1.0、2.0、4.0、8.0 kHz)听力阈值,治疗1周后重新记录上述6个频率,综合比较两组之间气导纯音听阈均值差异,以下降15 dB以上为有效。结果:1周后地塞米松组治疗前后平均听阈(t=11.749)、常规治疗组治疗前后平均听阈(t=7.364)、两组治疗后平均听阈(t=-2.628)、两组听力改善平均听阈(t=2.717)差异均有统计学意义(P<0.01或0.05)。地塞米松组有效16例(76.2%),常规治疗组有效10例(45.5%),两组比较差异有统计学意义(χ~2=3.058,P<0.05)。地塞米松组治疗前18例伴有眩晕症状,治疗后随访6个月,14例眩晕消失或减轻,眩晕好转率为77.8%;常规治疗组治疗前17例伴有眩晕症状,治疗后随访6个月,6例眩晕消失或减轻,眩晕好转率为35.3%,两组比较差异有统计学意义(P=0.018)。结论:鼓室内注入高剂量地塞米松用于挽救性治疗全聋型突发性聋较常规治疗效果更好,可帮助改善眩晕。

Objective:To observe the efficacy and safety of high dose dexamethasone injection in the tympanic cavity in the patients with sudden and severe deafness who failed conventional treatment.Method:A total of 43 patients with unilateral sudden and severe deafness were recruited in this study.All patients were not cured with conventional comprehensive treatment in the department of otology.They were divided into two groups:21 cases were treated with high dose dexamethasone injection into the tympanic cavity by ventilation tube(dexamethasone group),while routine treatment was continued in 22 cases(conventional control group).Each patient underwent a hearing test before treatment,the hearing thresholds of 6 frequencies(0.25,0.5,1.0,2.0,4.0,8.0 kHz)were recorded.After one week of treatment,the above-mentioned six frequencies were re-recorded.A decrease of the pure tone threshold average(PTA)more than 15 dB was set for effective.Result:After 1 week treatment,comparison of the PTA value before and after treatment in dexamethasone group(t=11.749)and in conventional control group(t=7.364),comparison of the PTA value of the two groups(t=-2.628),comparison of the PTA value of hearing improvement between the two groups(t=2.717),the differences were statistically significant(P<0.01 or 0.05).Sixteen cases in dexamethasone group were effective,the effective rate was 76.2%;10 cases in conventional control group was effective,the effective rate was 45.5%,the difference of the two curative effects was statistically significant(χ~2=3.058,P<0.05).Eighteen patients in dexamethasone group had vertigo before treatment.The patients were followed up for 6 months after treatment.The vertigo disappeared or decreased in 14 cases,the improve rate is 77.8%.17 patients in the conventional control group had vertigo before treatment,the patients were followed up for 6 months after treatment,the vertigo disappeared or decreased in 6 cases,the improve rate is 35.3%,the difference was statistically significant(P=0.018).Conclusion:High dose dexamethasone injection into the tympanic cavity is more effective than conventional therapy in the salvage treatment of sudden and severe deafness,and it is helpful to improve vertigo.