平坦型突发性聋患者鼓室注射激素时机的前瞻性对照研究

A Prospective Controlled Study on Sequential and Concurrent Oral/Intratyumpanic Steroid Treatments for Sudden Deafness with Flat Frequency Patterns

目的探讨平坦型突发性聋患者激素序贯治疗与联合治疗的疗效差异。方法2019年7月-2020年1月于重庆医科大学附属第一医院就诊的平坦型突发性耳聋患者共60例,分为A组(序贯治疗组:先口服泼尼松片1mg/Kg连用5天,继续治疗2天即治疗一周时复查听力,治疗效果不佳者再鼓室注射甲泼尼龙40mg隔日一次)和B组(联合治疗组:口服泼尼松片1mg/kg连用5天+同时鼓室注射甲泼尼龙40mg隔日一次)。余治疗方案均相同。对比两组患者一周及出院时的听力改善情况、有效率、痊愈率及各个频率听力改善值。结果A组患者一周及出院时的听力改善值分别为17.38±20.48dBHL、24.29±19.65dBHL,有效率为55.56%、74.07%,痊愈率为18.52%、40.74%;B组患者一周及出院时的听力改善值分别为15.94±23.55dBHL、24.02±21.06dBHL,有效率为62.5%、66.67%,痊愈率为20.83%、37.50%。两组患者的听力改善情况、有效率、痊愈率及各个频率听力改善值均无统计学差异。结论对于平坦型突聋患者,激素序贯治疗与联合治疗疗效相当。激素序贯治疗可避免不必要的鼓室注射,达到经济、高效的目的。

Objective To report outcomes of sequential and concurrent oral/intratympanic steroid treatments in patients with sudden deafness of flat frequency patterns.Methods Sixty patients with sudden deafness of flat frequency patterns seen at the First Affiliated Hospital of Chongqing Medical University from July 2019 to January 2020 were assigned to receive oral prednisone at 1 mg/kg for 5 days and additional five sessions of intratympanic methylprednisolone injection at 40 mg every other day if showing poor treatment responses at one week(sequential treatment group,group A);or oral prednisone at 1 mg/kg for 5 days with concurrent five sessions of intratympanic methylprednisolone injection at 40 mg every other day(concurrent treatment group,group B).Non-steroid therapeutics were the same in both groups.Hearing gain,effectiveness rate,rate of complete resolution and frequency-specific hearing gains were compared between the two groups.Results For group A,average hearing gain was 17.38±20.48 dB at one week and 24.29±19.65 dB at discharge,with the effectiveness rate at 55.56%and 74.07%,and the rate of complete resolution at 18.52%and 40.74%,respectively;whereas for group B,average hearing gain was 15.94±23.55 dB at one week and 24.02±21.06 dB at discharge with the effectiveness rate at 62.5%and 66.67%,and the rate of complete resolution at 20.83%and 37.50%,respectively,showing no statistically significant difference between the two groups.Conclusion For patients with sudden deafness of flat frequency patterns,sequential and concurrent oral/intratympanic steroid treatments yield similar outcomes,although one advantage of sequential treatment over concurrent treatment may be avoidance of unnecessary intratympanic injection and thus better cost-effectiveness.