地塞米松麻黄素混合液滴鼻预防高压氧治疗突发性聋继发的中耳气压伤

The Application of Dexamethasone and Ephedrine in the Prevention of Secondary MiddleEar Barotraumain the Hyperbaric Oxygen Treatment for Sudden Deafness

目的探讨地塞米松麻黄素混合液滴鼻预防高压氧治疗突发性聋继发中耳气压伤的应用价值。方法回顾性分析2016年1月~2019年12月确诊为突发性聋并接受高压氧治疗的368例(392耳)患者的临床资料,其中190例(204耳)为观察组,高压氧治疗前给予地塞米松麻黄素混合液滴鼻联合山楂、陈皮咀嚼;178例(188耳)为对照组,治疗前不给予地塞米松麻黄素滴鼻,比较两组患者治疗效果、继发中耳气压伤情况。结果治疗后两组纯音听阈均较治疗前改善,差异有统计学意义(均为P<0.05),但观察组与对照组间总有效率(分别为91.18%和88.30%)差异无统计学意义(P>0.05)。两组共38例(42耳)发生中耳气压伤,观察组中耳气压伤发生率(6.8%,14/204)和损伤程度均低于对照组(14.8%,28/188),差异有统计学意义(P<0.05)。38例继发中耳气伤病例中,32例(84.21%,32/38)存在鼻腔鼻咽部或/和咽后壁不同程度病变(下鼻甲肥大、鼻息肉、鼻咽部淋巴组织增生等),28例(73.68%,28/38)(30耳)有中耳功能异常(鼓室导抗图As型8耳,Ad型6耳,B型6耳,C型10耳)。结论地塞米松麻黄素混合液滴鼻联合山楂陈皮咀嚼可有效降低突发性聋患者高压氧治疗继发中耳气压伤的发生率及损伤程度。

Objective To study the value of dexamethasone and ephedrine in combination with hawthorn peel chewing in the prevention of middle ear barotrauma in the hyperbaric oxygen treatment for sudden deafness.Methods The clinical data of 368 cases(392 ears)who were diagnosed as sudden deafness and received hyperbaric oxygen treatment in our department from January 2016 to December 2019 were analyzed retrospectively.Among them,178 cases(188 ears)were included in the control group(routine intervention),and 190 cases(204 ears)were included in the observation group(dexamethasone ephedrine mixed solution nose combined with hawthorn peel chewing).The treatment effect and secondary middle ear air pressure injury of the two groups were compared and analyzed.Results①After intervention,the pure tone audiometry in the two groups improved(P<0.05).There was no significant difference between the two groups(P>0.05).②The incidence of secondary middle ear barotrauma in the observation group was lower than that in the control group(P<0.05),and the degree of secondary middle ear barotrauma in the observation group was lower than that in the control group(P<0.05).③In 38 cases of secondary middle ear gas injury,about 84.21%(32/38)of them had different degrees of pathological changes in the nasal cavity,nasopharynx and/or posterior pharyngeal wall.73.68%(28/38)had abnormal middle ear function.Conclusion Dexamethasone and ephedrine combined with hawthorn peel chewing can effectively reduce the incidence and degree of secondary middle ear barotrauma in the hyperbaric oxygen treatment for sudden deafness.