初始及挽救性鼓室注射糖皮质激素治疗中重度以上突发性耳聋的对照研究

A controlled study of initial or salvage treatment with intratympanic glucocorticoids in the treatment of moderate to severe sudden deafness

目的探讨初始及挽救性鼓室注射糖皮质激素治疗中重度以上突发性耳聋的效果。方法60例中重度以上突发性耳聋患者,根据激素鼓室注射的时间不同分成实验组及对照组,每组30例。实验组为初始治疗组,入院后给予常规治疗(包括静脉注射糖皮质激素+血液流变学治疗)的同时即刻给予鼓室注射地塞米松;对照组为挽救性治疗组,即使用常规治疗7 d疗效欠佳者,给予挽救性鼓室注射地塞米松。比较两组治疗前后的纯音听力阈值(PTA)、心理情绪[抑郁自评量表(SDS)、焦虑自评量表(SAS)评分]评分及世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评分,疗效。结果两组治疗1、2周后的PTA均低于本组治疗前,且实验组治疗1周后的PTA(61.84±4.05)dB低于对照组的(65.66±3.88)dB,差异具有统计学意义(P<0.05)。两组治疗1、2周后的SAS、SDS评分均低于本组治疗前,且实验组治疗1周后的SAS评分(26.48±3.58)分、SDS评分(43.60±4.08)分低于对照组的(30.96±4.51)、(48.33±5.19)分,差异具有统计学意义(P<0.05)。两组治疗1、2周后的WHOQOLBREF评分均高于本组治疗前,且实验组治疗1周后的WHOQOL-BREF评分(65.48±5.87)分高于对照组的(60.66±4.94)分,差异具有统计学意义(P<0.05)。两组总有效率比较差异无统计学意义(P>0.05)。结论对于中重度以上突发性耳聋患者,初始或挽救性鼓室注射糖皮质激素疗效相当,但初始治疗起效快,患者情绪更加稳定。

Objective To discuss the effect of initial or salvage treatment with intratympanic glucocorticoids in the treatment of moderate to severe sudden deafness.Methods A total of 60 patients with moderate-to-severe sudden deafness were divided into experimental group and control group according to the timing of intratympanic injection,with 30 patients in each group.The experimental group was the initial treatment group,which was given conventional treatment(including intravenous glucocorticoid and blood rheology treatment)along with intratympanic dexamethasone injection immediately after admission;the control group was the salvage treatment group,which was given salvage intratympanic dexamethasone injection after 7 d of conventional treatment with poor efficacy.Both groups were compared in terms of pure tone audiometry(PTA),psychological emotion[self-rating depression scale(SDS)score,self-rating anxiety scale(SAS)score]and World Health Organization Quality of Life-BREF(WHOQOL-BREF)score before and after treatment,and efficacy.Results After 1 and 2 weeks of treatment,PTA in both groups was lower than that before treatment in this group,and PTA of(61.84±4.05)dB in the experimental group after 1 week of treatment was lower than that of(65.66±3.88)dB in the control group.The differences were statistically significant(P<0.05).After 1 and 2 weeks of treatment,SAS and SDS scores in both groups were lower than those before treatment in this group;after 1 week of treatment,SAS score of(26.48±3.58)points and SDS score of(43.60±4.08)points in the experimental group were lower than those of(30.96±4.51)and(48.33±5.19)points in the control group;the differences were statistically significant(P<0.05).After 1 and 2 weeks of treatment,WHOQOL-BREF score in both groups was higher than that before treatment in this group,and WHOQOL-BREF score of(65.48±5.87)points in the experimental group after 1 week of treatment was higher than that of(60.66±4.94)points in the control group.The differences were statistically significant(P<0.05).There was no statistically significant difference in the total effective rate between the two groups(P>0.05).Conclusion For patients with moderate to severe sudden deafness,initial or salvage treatment with intratympanic glucocorticoids is equally effective,but the initial treatment works quickly and the patients are more emotionally stable.