Modified intratympanic steroid therapy for sudden sensorineural hearing loss via tympanic tube and gelfoam as a salvage treatment

Background: Sudden sensorineural hearing loss(SSNHL) is a prevalent emergency in ear, nose, and throat practice. Previous studies have demonstrated that intratympanic steroid therapy(IST) can serve as a salvage treatment for SSNHL after the failure of systemic steroid therapy(SST).Objective: This study aimed to analyze the efficacy of modified IST involving the insertion of a tympanic tube and gelfoam as a salvage treatment for patients with SSNHL, and to explore its associated factors.Methods: Totally, 74 patients who were aged 22–81 years with SSNHL were enrolled and allocated to either the control group(n = 25) or the treatment group(n = 49) based on their treatment modalities. All patients received SST lasting for at least 7 days. Subsequently, patients in the treatment group, after SST failure, underwent IST twice a week for 2–6 weeks, while the control group did not. Efficacy was assessed by the improvement in pure tone average at the affected frequency at the beginning and end of IST.Results: Hearing improvement in all patients after IST in the treatment group was 9.71 ± 14.84 dB, with significant improvement at affected frequencies(250-8000 Hz) compared with the control group(P < 0.05). The findings indicated the duration from the onset of SSNHL to the beginning of IST as an independent factor for pure tone average improvement after treatment(P = 0.002), whereas age, duration of SST, and time of IST were not(P > 0.05).Conclusion: The modified IST was demonstrated to be a safe and effective method as a salvage treatment for SSNHL. This study explored the efficacy of a modified IST approach, incorporating the utilization of tympanic tubes and gelfoam as key components. The findings underscore the advantages of gelfoam as a strategic drug carrier placed in the round window niche. By minimizing drug loss, extending action time, and increasing perilymph concentration, gelfoam enhances the therapeutic impact of IST, contributing to improved hearing outcomes in patients with SSNHL.

Idiopathic sudden sensorineural hearing loss:Effectiveness of salvage treatment with low-dose intratympanic dexamethasone

Objectives:To evaluate hearing outcome of salvage treatment with intratympanic steroids(ITS)in idiopathic sudden sensorineural hearing loss(ISSNHL)refractory to initial systemic steroid(SS)therapy.Material and methods:A retrospective medical chart review was conducted on 54 consecutive patients with ISSNHL refractory to SS.Salvage treatment with a low dose intratympanic dexamethasone(4 mg/ml)was offered after one week of primary treatment.Patients were divided into two groups:25 patients accepted ITS(treatment group)and 29 patients did not undergo additional treatment(control group).A pure tone average(PTA)gain of at least 10 dB was considered hearing improvement.Results:Hearing improvement rate was higher in ITS group compared to control group(40%vs.13.8%,p=0.035).A mean PTA improvement of 8.6±9.8 dB was observed in the ITS group and,whereas the control group had an average hearing gain of 0.7±2 dB(p<0.001).Audiometric analysis revealed a significant hearing gain in ITS group at all tested frequencies compared to control group(p<0.05).Analysis of the selected variables,identified intratympanic steroid treatment as the only independent prognostic factor for hearing improvement(OR=4.2,95%CI:1.1e15.7;p=0.04).Conclusion:Intratympanic low dose dexamethasone is effective in patients with incomplete hearing recovery after primary systemic steroid treatment.

Sudden sensorineural hearing loss treated with intratympanic dexamethasone injection

Objective To evaluate the effect of different protocols of intratympanic dexamethasone injection in patients with unilateral sudden sensorineural hearing loss (SSNHL) who have failed to respond to typical medical treatment (including systemic steroid treatment). Methods From January 2005 to January 2008, 71 patients who were diagnosed with unilateral SSNHL and failed typical medical treatment received intratympanic dexamethasone injection. Four injection protocols were employed: injection of 0.3 ml dexamethasone(5 mg / ml) three times a week for 3 weeks for a total dose of 13.5 mg (Group I, n=16); injection of 0.6 ml (5 mg / ml) dexamethasone three times a week for 3 weeks for a total dose of 27 mg (Group II, n=18); injection at 0.3 ml(5 mg/ml) week for 6 weeks for a total dose of 9 mg (Group III, n=18); injection at 0.3 ml (5 mg / ml) / 2 days for a total dose of 4.5 mg (Group IV n=19). Hearing recovery was assessed by pure tone audiogram. Results The total effective rate was 37.5%, 38.89%, 33.33% and 36.84% for each treatment protocol, respectively, with no statistical difference between them (P > 0.05). The results suggest that a total dose of 4.5 mg (injected once a week for 3 weeks) is the most adequate protocol, and increasing dose or injection frequency yields no additional benefits. Conclusion Intratympanic dexamethasone significantly improves the prognosis of SSNHL. Small dose at low injection frequency is sufficient. Further multicenter studies are needed to determine the standard treatment protocol.

Intratympanic dexamethasone injection for sudden sensorineural hearing loss in pregnancy

BACKGROUND As sudden sensorineural hearing loss(SSNHL)rarely occurs in pregnant women,there is a lack of knowledge and relevant research on its management.AIM To investigate the effect of intratympanic dexamethasone injection in the treatment of pregnant patients with SSNHL.METHODS A retrospective chart review was made for the period between June 2017 and August 2019 at our Department of Otorhinolaryngology-Head and Neck Surgery.Pregnant women who met the criteria for SSNHL were included and grouped based on the therapeutic modalities.The treatment group received intratympanic dexamethasone(2.5 mg)q.o.d.for a total of four times,while the control group received no medication other than bed rest and medical observations.All the patients were under close care of obstetricians.Pure-tone audiograms were performed before and after treatment.RESULTS Eleven patients who met the inclusion criteria were assigned to the treatment group(n=7)and the control group(n=4).The mean age of patients was 31.2±3.8 years;the right ear was affected in seven(63.64%)cases.Two patients(18.2%)suffered from vertigo,10(90.9%)suffered from tinnitus and 6(54.5%)suffered from aural fullness.The time from onset to clinic visit was relatively short,with a mean time of 1.3±0.9 d.All the women were within the second or third trimester;the average gestation period was 26.0±6.2 wk.The pure-tone averages at onset between the two groups were similar.After one wk of therapy,the treatment group had a curative rate of 57.1%and a significantly better hearing threshold and greater improvement compared to the control group(all P<0.05).Some patients experienced transient discomfort from intratympanic injections that disappeared after getting rest,while none had permanent complications.All patients delivered healthy full-term neonates with an average Apgar score of 9.7±0.5.CONCLUSION Intratympanic dexamethasone injections can be used as a first-line therapy in pregnant women with SSNHL.

A comparison of effects of systemic and intratympanic steroid therapies for sudden sensorineural hearing loss:A meta-analysis

Objective:To evaluate the efficacy and safety of intratympanic and systemic steroid therapies in the initial treatment of Sudden Sensorineural Hearing Loss (SSNHL) patients. Methods:A comprehensive search of PubMed, Wanfang database and CNKI (China National Knowledge Infrastructure) was performed covering the period from January 1990 to July 2014. A meta-analysis was conducted after filtering by the criteria of Cochrane Collaboration. Three hundred fifty six subjects in nine studies allocated to the group of intratympanic steroid therapies and 343 controls receiving systemic steroid therapies met the criteria for meta-analysis. The data were extracted and analyzed using the RevMan 5.3 meta-analysis software. Results: The total effectiveness rate in SSNHL patients receiving intratympanic steroid therapies did not differ statistically from patients receiving systemic therapies (RR ? 1.08, 95%CI ? 0.99e1.99, P ? 0.10), although the rate of full hearing recovery in this group differed significantly from patients receiving systemic therapies (RR ? 1.29, 95%CI ? 1.00e1.66, P ? 0.05). Conclusion: Local steroid therapy appears to generate higher rate of complete hearing recovery than systemic steroid treatment as an initial treatment for SSNHL, which may be especially useful for patients in whom systemic steroids are contraindicated.

Controlled release of dexamethasone from fibrin sealant for intratympanic administration in inner ear therapy

The aim of the present work was to show the sustainability of fibrin sealant in releasing dexamethasone and adjust the protocol for clinical application of the novel method in the treatment of Meniere’s disease (MD) and sudden sensorineural hearing loss (SSHL).Gelation occurred shortly after mixing dexamethasone-containing fibrinogen with thrombin.Dexamethasone was constantly released for at least 16 d at a stable level after 7d in protocol 1 (low-dose),while it was robustly released within 4 d and slowed afterward until 10 d in protocol 2(high-dose).There were significant differences among the time points in Protocol 2 (p<0.01,ANOVA),and the exponential model with the formula y=15.299*e~(-0.483*t) fits the association.The estimated concentration of dexamethasone released on 7 d in protocol 2 was slightly lower than that observed in protocol 1.The fibrin sealant is capable of constantly releasing dexamethasone with adjustable dynamics.Targeted and minimally invasive administration of the material can be achieved in the clinic by sequential injections of the fluids using a soft-tipped catheter.

Evaluation of intratympanic dexamethasone for treatment of refractory sudden sensorineural hearing loss

Objective: To observe and compare the efficacy of intratympanic application of dexamethasone (DXM) for the treatment of refractory sudden sensorineural hearing loss (SSNHL), the DXM was given in three different ways: by tympanic membrane injection, by drip through a ventilation tube, and by perfusion through a round window catheter. Methods: We conducted a nonrandomized retrospective clinical trial involving 55 patients with refractory SSNHL. For 21 patients (the perfusion group), DXM (2.5 mg/0.5 ml) was perfused transtympanically through a round window catheter using an infusion pump for 1 h twice a day for 7 d giving a total amount of 35.0 mg. For 23 patients (the injection group), DXM (2.5 mg/time) was injected by tympanic membrane puncture at intervals of 2 d on a total of four occasions giving a total amount of 10.0 mg. For 11 patients (the drip group), DXM (2.5 mg/0.5 ml) was dripped via a ventilation tube placed by myringotomy, once on the first day and twice a day for the remaining 6 d giving a total amount of 32.5 mg. Thirty-two patients with refractory SSNHL who refused to undertake further treatments were defined as the control group. Hearing recovery and complications were compared among the groups. Hearing results were evaluated based on a four-frequency (0.5, 1.0, 2.0, 4.0 kHz) pure tone average (PTA). Results: Post-treatment audiograms were obtained one month after treatments were completed. The improvements in average PTA for the perfusion, injection, and drip groups were 9.0, 8.6, and 1.7 dB, respectively. Hearing improvement was significantly greater in the perfusion and injection groups than in the control group (1.4 dB) (P<0.05). In the perfusion group, 8 out of 21 patients (38.1%) had a PTA improvement of 15?56 dB (mean 29.8 dB); in the injection group, 8 out of 23 patients (34.8%) had a PTA improvement of 16?54 dB (mean 24.9 dB); in the drip group, 1 of 11 patients (9.1%) had a PTA improvement of 26.0 dB; in the control group, 3 out of 32 patients (9.4%) had a PTA improvement of 15?36 dB (mean 14.9 dB). Conclusions: Topical intratympanic application of DXM is a safe and effective method for the treatment of SSNHL cases that are refractory to conventional therapies.

Role of Intratympanic Steroids in the Management of Idiopathic Sudden Sensori Neural Hearing Loss— Our Experience of 67 Cases

Objective: To assess the outcomes of intratympanic steroids in the management of idiopathic sudden sensorineural hearing loss. Study Design: Retrospective study. Setting: Academic tertiary care medical centre. Materials and Methods: A total of 67 patients with idiopathic sudden sensorineural hearing loss were included in our study. Pre- and post-injection audiograms were taken to assess the outcomes in improvement in hearing. Hearing outcomes were assessed with respect to duration of onset of treatment and age of the patient. Improvement in the speech discrimination score was also assessed. Results: A total of 67 patients were included in our study of which unilateral cases were 59 and bilateral cases were 8. Subjectively 35 patients reported improvement in hearing after the therapy while objectively we found 44 ears [41 patients] had improvement. The mean PTA pre ITS was 62.7 and after ITS it was 56.3. Maximum improvement was noted at 2000 Hz and 1000 Hz. Conclusion: Intratympanic steroids can be offered as a first line therapy for idiopathic sudden sensorineural hearing loss as it is minimally invasive, and can be performed as an office based procedure with no systemic side effects. No major complications have been reported in our study and results have been satisfactory.

Sudden sensorineural hearing loss-A contemporary review of management issues

Sudden sensorineural hearing loss(SSNHL)is an enigmatic entity,with obscure pathophysiology and debatable efficacy of the treatment agents used.An underlying cause is identified in only 10-15%of cases.The management of the remaining patients,classified as‘idiopathic’,is empirical,and is conventionally with systemic steroids,vasodilator therapy,rheological agents,and antioxidants,to list a few amongst the host of the agents employed for the treatment.The availability of conflicting outcomes and lack of conclusive evidence has resulted in the propagation of consensus-based treatment protocols.In the present review,we discuss the various controversial issues and newer developments in the management of idiopathic SSNHL.The current review aims to present a narrative outlook of the updated evidence base available from PUBMED,augmented with relevant designated publications.

Intratympanic vs systemic use of steroids as first-line treatment for sudden hearing loss:A meta-analysis of randomized,controlled trials

Background Sudden sensorineural hearing loss(SSNHL)is a common disease in otology,and steroids play an important role in its treatment.Steroids can be administered systemically or locally,and the efficacies of different administration routes remain controversial.Methods We searched the Cochrane,EMBASE,PubMed,Web of Science,CNKI,Wanfang and Weipu databases for randomized controlled trials(RCTs)on glucocorticoid treatments for SSNHL to compare the efficacy of topical and systemic steroid administration.The Review Manager 5.4 software was used for synthesis of data:the rate of reported hearing improvement and change in pure-tone audiometry(PTA).Results In all the included studies,when intratympanic administration was compared to systemic therapies,the risk difference(RD)using reported hearing improvement as an outcome measure was 0.08(95%CI:0.01–0.14,I2=45%).Using PTA changes as an outcome measure in 4 studies,the mean difference(MD)was 10.43 dB(95%CI:3.68–17.18,I2=81%).Hearing improvement RD was also compared among different types of steroid,recovery criteria,follow-up times and diagnostic criteria,and showed no significant differences exception for recovery criteria(>10 dB)(RD-0.06,95%CI:0.14-0.2,I2=0%).Conclusion As the initial treatment for SSNHL,topical steroids seem to be superior to systemic steroid administration,especially in patients with contraindications to systemic steroids usage.However,further verification based on high-quality research is needed.

鼓室注射糖皮质激素和高压氧治疗对特发性突发性感音神经性耳聋的疗效

目的 本研究旨在探究鼓室注射糖皮质激素(ITS)和高压氧治疗(HBOT)对全身糖皮质激素(SS)治疗失败的特发性突发性感音神经性耳聋(ISSNHL)患者的临床疗效。方法 回顾性收集2020年1月至2023年1月杭州市临平区第一人民医院耳鼻喉科收治的ISSNHL患者。根据治疗方案,ISSNHL患者分为SS组、HBOT组和ITS组。观察并比较治疗前(T_(0))、治疗第5天(T_(1))、治疗3个月后(T_(2))ISSNHL患者的听力水平[纯音听阈均值(PTA)]和听力增益改变,比较不同组别治疗总有效率。采用单因素分析探索不同治疗方式ISSNHL患者疗效的影响因素。结果 共纳入156例ISSNHL患者,SS组70例、HBOT组33例和ITS组53例。T_(0)时,3组患者在PTA上差异无统计学意义(P>0.05)。T_(2)时,3组ISSNHL患者PTA水平较治疗前显著下降(P<0.05);HBOT组和ITS组PTA水平显著低于SS组(P<0.05);HBOT组PTA水平显著低于ITS组(P<0.05)。HBOT组和ITS组听力增益显著高于SS组(P<0.05),HBOT组听力增益显著高于ITS组(P<0.05)。HBOT组治疗总有效率显著高于ITS组(P<0.05),ITS组治疗总有效率显著高于SS组(P<0.05)。此外,无论何种治疗方案,眩晕均是ISSNHL患者听力恢复不良的影响因素(P<0.05)。结论 ITS和HBOT均可提升SS治疗失败ISSNHL患者的治疗有效率,促进ISSNHL听力恢复。较IST而言,HBOT疗效更为显著,建议临床治疗优先考虑。眩晕均是SS治疗失败ISSNHL患者听力恢复不良的影响因素,应在临床实践中重点关注。

耳后乳突骨膜下注射甲泼尼龙琥珀酸钠与地塞米松磷酸钠治疗突发性聋患者的效果比较

目的:比较耳后乳突骨膜下注射甲泼尼龙琥珀酸钠(MPS)与地塞米松磷酸钠治疗突发性聋(SSNHL)患者的效果。方法:回顾性分析2020年1月至2021年1月该院收治的104例SSNHL患者的临床资料,按照治疗方法不同将其分为对照组和观察组各52例。两组均行常规治疗,在此基础上,对照组于耳后乳突骨膜下注射地塞米松磷酸钠治疗,观察组于耳后乳突骨膜下注射MPS治疗,两组均连续治疗10 d。比较两组治疗前后纯音听阈值、临床疗效、血清学指标[可溶性血管细胞黏附分子-1(sVCAM-1)、细胞间黏附分子-1(ICAM-1)、血管内皮生长因子(VEGF)]水平及不良反应发生率。结果:治疗后,观察组纯音听阈值低于对照组,差异有统计学意义(P<0.05);观察组治疗总有效率为92.31%(48/52),高于对照组的76.92%(40/52),差异有统计学意义(P<0.05);观察组sVCAM-1、ICAM-1水平均低于对照组,VEGF水平高于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:耳后乳突骨膜下注射MPS治疗SSNHL患者可提高治疗总有效率,改善血清学指标水平,降低纯音听阈值,效果优于耳后乳突骨膜下注射地塞米松磷酸钠治疗。

鼓室灌注地塞米松治疗难治性突发性感音神经性聋临床分析

目的观察和比较鼓膜穿刺、鼓膜置管和圆窗置管微泵灌注地塞米松3种方法治疗难治性突发性感音神经性聋的疗效。方法55例常规方法治疗无效的突聋患者作为研究对象,其中圆窗置管微泵灌注用药治疗21例(置管组),每次2.5mg/0.5ml,维持1小时,每天两次,连续给药7天,总剂量35mg;鼓膜穿刺注药23例(穿刺组),首次剂量为2.5mg,此后,每2天重复注药1次(每次2.5mg),共4次,总剂量10mg;鼓膜切开置管滴药11例(滴药组),首次剂量为0.5%地塞米松0.5ml,经通气管滴入鼓室,每天重复滴药2次(每次2.5mg),共7天,总剂量32.5mg。同期常规方法治疗无效的32例突聋患者,且拒绝鼓室用药者随访作为对照(对照组),比较各组听力恢复及并发症情况。4组治疗前听力无显著差异(P>0.05)。结果治疗完成后1月纯音测听检查:置管组、穿刺组和滴药组平均PTA分别提高9dB、8.6dB和1.7dB,前2组明显高于对照组1.4dB(P<0.05),置管组8例(38.1%)听力改善约15～56dB,无效13例;穿刺组8例(34.8%)听力改善约16～54dB,无效15例;滴药组1例(9.1%)听力改善约26dB,无效10例;对照组3例(9.4%)听力改善约15～36dB,无效29例。结论鼓室灌注地塞米松治疗难治性突聋方法安全有效,为用常规方法治疗无效的突聋患者,提供了再次治疗的机会。

鼓室注射糖皮质激素治疗伴持续耳鸣的难治性突发性聋疗效观察

目的比较鼓室注射甲泼尼龙琥珀酸钠与甲泼尼龙琥珀酸钠加利多卡因治疗伴持续耳鸣的难治性突发性聋的疗效。方法选择经常规全身用药治疗两周无效的伴持续耳鸣的难治性突发性聋患者84例84耳,随机分为治疗组和对照组,每组42例42耳。治疗组鼓室注射甲泼尼龙琥珀酸钠0.4ml和利多卡因注射液0.1ml,对照组注射甲泼尼龙琥珀酸钠0.4ml,每2天注药1次,共5次,治疗10天后比较两组患者耳鸣疗效及0.5~4kHz气导纯音平均听阈差异。结果治疗10天后两组气导平均听阈都较治疗前下降,治疗组由63.27±15.35dB HL下降至47.83±14.58dB HL,对照组由65.24±13.46dB HL下降至53.56±15.79dB HL,治疗组听力改善总有效率(61.90%,26/42)优于对照组(42.86%,18/42),差异有统计学意义(P<0.05);两组耳鸣程度均较治疗前减轻,治疗组有效率73.81%(31/42),对照组有效率52.38%(22/42),差异有统计学意义(P<0.05)。结论激素鼓室给药可以作为挽救性治疗应用于伴持续耳鸣的难治性突发性聋患者,且甲泼尼龙琥珀酸钠和利多卡因联合注射效果更显著。

鼓室内联合全身应用糖皮质激素治疗全聋型突发性聋

目的探讨早期鼓室内联合全身应用糖皮质激素治疗全聋型突发性聋的疗效情况。方法选取我院自2011年3月至2015年3月间收治的130例全聋型突发性聋患者,按照治疗方案分不同为治疗组与对照组,对照组给予糖皮质激素全身给药、营养神经及改善微循环类药物治疗,而治疗组在对照组用药基础之上加用糖皮质激素鼓室内注射治疗,观察和分析各组疗效情况。结果糖皮质激素联合治疗组听力改善的总有效率达到88.7%,而糖皮质激素全身治疗组听力改善的总有效率为70.6%,治疗组与对照组差异比较有统计学意义(P<0.05)。糖皮质激素联合治疗组耳鸣改善的总有效率达到82.5%,而糖皮质激素全身治疗组耳鸣改善的总有效率为77.2%,但是两组之间的差异没有统计学意义(P>0.05)。两组患者眩晕改善的总有效率均为100%。结论鼓室内联合全身应用糖皮质激素治疗全聋型突发性聋能够取得较好的疗效。

鼓室联合耳后局部应用糖皮质激素治疗难治性突发性聋的临床研究

目的探讨鼓室内联合耳后局部应用糖皮质激素治疗常规治疗无效的难治性突发性聋的疗效。方法收治的难治性突发性聋患者237例,根据甲泼尼龙治疗方案的不同,患者分为鼓室内注射组(A组,75例)、耳后注射组(B组,93例)和鼓室内联合耳后注射的联合注射组(C组,69例);依据患者听力曲线测试结果的听力下降的频率和程度,难治性突发性聋患者分成低频下降型、高频下降型、平坦下降型和全聋型四种类型。其中,A组耳内镜下鼓膜穿刺,鼓室内注入甲泼尼龙0.4 ml;B组在耳后乳突骨膜下注射甲泼尼龙1 ml;C组先在鼓室内注射甲泼尼龙0.4 ml,紧接着于耳后乳突骨膜下注射甲泼尼龙0.6 ml。3组均隔天注射1次,4次为1个疗程,同时均给予患者营养神经、改善微循环的药物配合治疗10~14 d。观察3组患者疗效和各分型患者三种治疗方法的有效率。结果 A组、B组和C组难治性突聋的有效率分别为44.00%、34.41%和53.62%,3组间有效率差异有统计学意义(χ2=6.01,P=0.0496),而显效率分别为33.33%、29.03%和42.03%,3组间显效率差异无统计学意义(χ2=3.01,P=0.222)。四种类型难治性突发性聋中,高频下降型曲线患者,3组间有效率有统计学差异(χ2=6.24,P=0.044),联合注射的C组有效率最高且显著高于B组(χ2=6.23,P=0.013);其他听力曲线类型患者,3组间的有效率差异无统计学意义(P>0.05),C组有效率最高且显著高于B组(χ2=3.99,P=0.046)。3组间不良反应发生率差异无统计学意义(χ2=3.32,P=0.190)。结论鼓室内联合耳后注射局部应用糖皮质激素挽救性治疗难治性突发性聋安全有效,三种局部治疗方法中联合注射有效率最高并且显著高于耳后注射;鼓室内联合耳后注射糖皮质激素对于高频下降型和全频损伤较重的全聋型难治性突发性聋患者更为有效。

鼓室置管灌注甲泼尼龙治疗难治性突发性聋的听力疗效再分析

目的探讨经耳道鼓室置管灌注甲泼尼龙治疗难治性突发性聋(sudden sensorineural hearing loss,SSNHL)的安全性和有效性。方法对常规治疗至少一个疗程(10天)无效的SSNHL,根据病人的意愿分成灌注组和对照组分别继续治疗10天。灌注组给予鼓室置管灌注甲泼尼龙+常规治疗,对照组继续常规治疗,比较治疗结束后3个月时两组的听力改善结果。结果灌注组26例和对照组23例,两组的有效率分别是50.0%和21.7%,继续治疗前后PTA改善分别是16.7dB和9.2dB,两组比较灌注组的有效率高于对照组(P=0.041);若仅将发病至继续治疗的时间间隔≤60天的病例纳入分析,则灌注组为21例,对照组仍为23例,有效率分别是61.9%和21.7%,PTA改善分别为20.2dB和9.2dB,灌注组均优于对照组(P有效率=0.007,PPTA改善=0.011);鼓室灌注前后低频区(0.25kHz,0.5kHz)、中频区(1kHz、2kHz)和高频区(4kHz、8kHz)的听阈分别改善19.8dB、16.0dB和13.4dB,低频区听力改善大于高频区(P=0.046)。结论鼓室置管灌注甲泼尼龙联合常规治疗用于难治性SSNHL是安全的、有效的,疗效优于继续常规治疗,且低频区的听力改善优于高频区,发病后宜尽早采用。

全身应用联合鼓室注射糖皮质激素治疗重度和极重度突发性聋

目的比较全身应用联合鼓室注射糖皮质激素与单独全身应用糖皮质激素治疗重度和极重度突发性聋的疗效。方法回顾性比较47例(47耳)重度和极重度突聋患者的临床资料和治疗效果,将患者分为口服糖皮质激素组(口服组,19例,晨起顿服强的松片1mg.kg-1.d-1,5天后每2天递减10mg)、口服加鼓室内注射糖皮质激素组[口服加鼓室给药组,9例,在口服强的松片(用法同口服组)的同时鼓室内注入地塞米松5mg,隔2天一次,平均4次]、静脉滴注糖皮质激素组(静滴组,12例,静脉滴注地塞米松10mg,每日一次,每隔5日减半量)和静脉滴注加鼓室内注射糖皮质激素组(静滴加鼓室给药组,7例,方法、剂量同静滴组及上述鼓室给药法)。疗程结束后,比较各组的疗效。结果口服组和口服加鼓室给药组的总有效率分别为52.63%和66.67%,显效率分别为36.84%和22.22%,两组间的总有效率和显效率差异均无统计学意义(P>0.05)。静滴组和静滴加鼓室给药组的总有效率分别为83.33%和71.43%,显效率分别为66.67%和71.43%,两组间的总有效率和显效率差异均无统计学意义(P>0.05)。结论全身应用(口服或静滴)联合鼓室内注射糖皮质激素治疗重度和极重度突聋并不能得到较全身单独用药更好的疗效。

前列地尔联合鼓室注射地塞米松治疗突发性耳聋的临床疗效及对血液流变学的影响

目的探讨前列地尔联合鼓室注射地塞米松治疗突发性耳聋的临床疗效及对血液流变学的影响。方法选取2016年1~11月我院收治的88例突发性耳聋患者,将其按照随机数字法随机分为观察组和对照组,每组44例,两组均给予常规治疗,对照组在常规治疗基础上给予前列地尔进行治疗,观察组在常规治疗基础上给予前列地尔联合鼓室注射地塞米松进行治疗,观察比较两组治疗前后纯音听阈(pure tone audiometry,PTA)的变化,检测比较治疗前后血液流变学指标(全血高切黏度、全血低切黏度、血浆黏度),并对治疗前后两组的临床疗效及安全性进行评价。结果治疗后两组PTA均显著下降(t=2.874、6.695,P均<0.05),但观察组下降更为明显(t=3.981,P<0.05)。治疗后两组全血高切黏度、全血低切黏度、血浆黏度均显著下降(P<0.05),但观察组下降更为明显(t=18.511、17.823、8.145,P均<0.05)。治疗后观察组总有效率高于对照组。两组治疗期间均未出现眩晕、短暂性眩晕等不良反应。结论前列地尔联合鼓室注射地塞米松治疗突发性耳聋临床疗效显著,安全性高,可促进患者听力恢复,并改善患者血液流变学指标,值得临床推广。

鼓室内注射地塞米松联合强的松治疗突发性聋33例

目的:观察鼓室内注射地塞米松联合强的松治疗突发性聋的疗效。方法:71例(71耳)突发性聋患者分成2组,A组38例(38耳)口服强的松,B组33例(33耳)在A组用药的基础上,加用鼓室注射地塞米松治疗,4周后比较两组疗效。结果:B组总有效率(81.8%)显著高于A组(55.3%),差异有统计学意义(P<0.05)。结论:鼓室注射地塞米松联合强的松治疗突发性聋疗效显著。