半导体激光鼓膜造口鼓室注入地塞米松治疗突发性聋

Methodological Study of the Treatment of Sudden Hearing Loss by Intratympanic Injection Dexamethasone after Laser Diode Myringostomy

目的通过分析耳内镜下半导体激光鼓膜造口鼓室注入地塞米松治疗突发性聋的优缺点,探讨最为快捷、安全的且给药及药物停留时间最长的鼓室内给药方法。方法以307例单侧突发性聋患者为研究对象,分为四组经鼓膜穿刺术组(A组,16例)、鼓膜切开置管术组(B组,64例)、激光鼓膜造口术前上象限组(C1组,176例)与前下象限组(C2组,51例),分别行鼓室内注射地塞米松治疗,分析四组手术中及术后治疗过程疼痛得分(疼痛程度分为1~10分,得分越高程度越重)、手术操作时间及鼓室内药物停留时间的差异,并比较各种鼓室给药方式的疗效。结果A组、B组、C1组和C2组术中疼痛得分分别为3.88±0.72、5.06±0.97、3.54±0.67与3.76±0.84分,其中A组与B组、B组与C1/C2组差异有统计学意义(P<0.05);治疗过程总疼痛得分四组分别为3.69±0.70、3.23±1.11、2.53±0.64与2.64±0.65分,A、B组与C1、C2组差异有统计学意义(P<0.001),术中与术后治疗过程B组疼痛变化最明显,A组变化最小;四种方式手术时间分别为2.31±0.48、10.14±2.28、1.63±0.62与1.63±0.69 min,仅C1组与C2组差异无统计学意义(P>0.05),C1组耗时最短;四种方式药物停留时间分别为0.97±0.34、0.82±0.31、1.67±0.45与1.00±0.30 h,其中C1组药物停留时间最久,A组与B组药物停留短且无明显差异(P>0.05)。A、B、C1、C2组治疗后听力提高有效率分别为68.75%、73.44%、88.07%及80.39%(P>0.05)。结论激光鼓膜造口是一种安全快捷、接受度高的鼓室内给药方法,造口鼓膜前上象限可增加鼓室内药物维持时间,利于延长圆窗与药物接触时间,使耳蜗外淋巴液中药物浓度维持更久。

Objective To investigate the clinical advantages and disadvantages of intratympanic injection of dexamethasone semiconductor laser tympanostomy in the treatment of sudden hearing loss,and the most rapid and safe method of intratympanic administration with the longest drug residence time.Methods A total of 307 patients with sudden hearing loss who received intratympanic injection of dexamethasone through tympanocentesis(group A,16 cases),tympanotomy and tympanostomy tube insertion(group B,64 cases),laser myringostomy at anterosuperior quadrant(group C1,176 cases)and at anteroinferior quadrantwere(group C2,51 cases)were retrospectively studied.The intraoperative pain score,postoperative pain score,the operation time,and drug residence time in the tympanic cavity were analyzed respectively.Results The intraoperative pain scores of the 4 groups were 3.88±0.72,5.06±0.97,3.54±0.67 and 3.76±0.84,respectively.There was statistical significance between group A and B,and between group B and C1/C2(P>0.05).The intraoperative pain scores were 3.69±0.70,3.23±1.11,2.53±0.64 and 2.64±0.65,respectively.Group A and B,C1 and C2 had no statistical significance(P>0.05).The pain score changes before and after operation was biggest in group B,while smallest in group A.The operation time of the 4 groups were 2.31±0.48,10.14±2.28,1.63±0.62 and 1.63±0.69 min,respectively.Group C1 and group C2 showed no statistical significance.Group C1 had the shortest operation time.The drug residence time were 0.97±0.34,0.82±0.31,1.67±0.45 and 1.00±0.30 h in A,B,C1 and C2 group,respectively.The drug residence time in group C1 was the longest,and there was no significant difference between group A and group B.After treatment,the effective rates of postoperative hearing improvement in the four groups were 68.75%,73.44%,88.07%and 80.39%,respectively,with no significant difference(P>0.05).Conclusion Laser myringostomy is an efficient and safe method for intratympanic drug injection.Tympanostomy at anterosuperior quadrant can increase the drug residence time in the tympanic cavity,prolong the drug contact time with the round window membrane,and maintain the drug concentration in the extracochlear lymph for a longer time.