山东大学耳鼻喉眼学报 ›› 2014, Vol. 28 ›› Issue (5): 23-26.doi: 10.6040/j.issn.1673-3770.0.2014.045
严小玲, 毛敏, 翟锦明, 陈观贵, 张建国, 刘绮明, 薛进平
YAN Xiao-ling, MAO Min, ZHAI Jin-ming, CHEN Guan-gui, ZHANG Jian-guo, LIU Qi-ming, XUE Jin-ping
摘要: 目的 探讨鼓室内注射激素作为难治性突发性耳聋的补救治疗措施的临床疗效。方法 重度及极重度突发性耳聋患者96例,接受常规治疗加全身应用激素2周效果不佳,其中52例接受鼓室注射激素,另外44例拒绝鼓室内注射而继续口服药物治疗。纯音测听法(PTA)检测患者补救治疗前后听力,比较气导听阈(0.5、1.0、2.0、4.0 kHz四个频率气导之平均值),分析两组患者补救治疗前后听力结果。结果 鼓室注射组听力提高10 dB以上的患者16例,有效率为30.8%;而对照组仅有3例,有效率为6.8%。两组听力改善值之间的差异有统计学意义(P<0.01)。结论 鼓室内激素注射对突发性耳聋常规治疗无效的患者有良好的疗效,可以作为一种补救治疗措施。
中图分类号:
[1] Khaimook W, Jantarapattana K.Therapy of idiopathic sudden sensorineural hearing loss with intratympanic steroid injection[J]. J Med Assoc Thai, 2011, 94(12):1495-1499. [2] Filipo R, Covelli E, Balsamo G, et al. Intratympanic prednisolone therapy for sudden sensorineural hearing loss: a new protocol[J]. Acta Otolaryngol, 2010, 130(11):1209-1213. [3] Hughes G B, Freedman M A, Haberkamp T J, et al. Sudden sensorineural hearing loss[J]. Otolaryngol Clin North Am, 1996, 29(3):393-405. [4] Lazarini P R, Camargo A C. Idiopathic sudden sensorineural hearing loss: etiopathogenic aspects[J]. Braz J Otorhinolaryngol, 2006, 72(4):554-561. [5] Wang Y W, Ren J H, Lu Y D, et al. Evaluation of intratympanic dexamethasone for treatment of refractory sudden sensorineural hearing loss[J]. J Zhejiang Univ Sci B, 2012, 13(3):203-208. [6] Lee J D, Park M K, Lee C K, et al. Intratympanic steroids in severe to profound sudden sensorineural hearing loss as salvage treatment[J]. Clin Exp Otorhinolaryngol, 2010, 3(3):122-125. [7] Silverstein H, Choo D, Rosenberg S I, et al. Intratympanic steroid treatment of inner ear disease and tinnitus (preliminary report)[J]. Ear Nose Throat J, 1996, 75(8):468-471, 474, 476 passim. [8] Xenellis J, Papadimitriou N, Nikolopoulos T, et al. Intratympanic steroid treatment in idiopathic sudden sensorineural hearing loss: a control study[J]. Otolaryngol Head Neck Surg, 2006, 134(6):940-945. [9] Ho H G, Lin H C, Shu M T, et al. Effectiveness of intratympanic dexamethasone injection in sudden-deafness patients as salvage treatment[J]. Laryngoscope, 2004, 114(7):1184-1189. [10] Choung Y H, Park K, Shin Y R, et al. Intratympanic dexamethasone injection for refractory sudden sensorineural hearing loss[J]. Laryngoscope, 2006, 116(5):747-752. [11] Hong S M, Park C H, Lee J H. Hearing outcomes of daily intratympanic dexamethasone alone as a primary treatment modality for ISSHL[J]. Otolaryngol Head Neck Surg, 2009, 141(5):579-583. [12] Baysal E, Tun O, Baglam T, et al. Systemic steroid versus combined systemic and intratympanic steroid treatment for sudden sensorineural hearing loss[J]. J Craniofac Surg, 2013, 24(2):432-434. [13] Wen Y H, Chen P R, Wu H P. Prognostic factors of profound idiopathic sudden sensorineural hearing loss[J]. Eur Arch Otorhinolaryngol, 2014, 271(6):1423-1429. [14] Moon I S, Lee J D, Kim J, et al. Intratympanic dexamethasone is an effective method as a salvage treatment in refractory sudden hearing loss[J]. Otol Neurotol, 2011, 32(9):1432-1436. [15] Erdur O, Kayhan F T, Cirik A A. Effectiveness of intratympanic dexamethasone for refractory sudden sensorineural hearing loss[J]. Eur Arch Otorhinolaryngol, 2014, 271(6):1431-1436. [16] Salt A N, Ma Y. Quantification of solute entry into cochlear perilymph through the round window membrane[J]. Hear Res, 2001, 154(1-2):88-97. [17] Saijo S, Kimura R S. Distribution of HRP in the inner ear after injection into the middle ear cavity[J]. Acta Otolaryngol, 1984, 97(5-6):593-610. [18] She W, Dai Y, Du X, et al. Hearing evaluation of intratympanic methylprednisolone perfusion for refractory sudden sensorineural hearing loss[J]. Otolaryngol Head Neck Surg, 2010, 142(2):266-271. [19] Ferri E, Frisina A, Fasson A C, et al. Intratympanic steroid treatment for idiopathic sudden sensorineural hearing loss after failure of intravenous therapy[J]. ISRN Otolaryngol, 2012, 19:647271. [20] Tsai Y J, Liang J G, Wu W B, et al. Intratympanic injection with dexamethasone for sudden sensorineural hearing loss[J]. J Laryngol Otol, 2011, 125(2):133-137. [21] Alatas N. Use of intratympanic dexamethasone for the therapy of low frequency hearing loss[J]. Eur Arch Otorhinolaryngol, 2009, 266(8):1205-1212. [22] Sha S H, Taylor R, Forge A, et al. Differential vulnerability of basal and apical hair cells is based on intrinsic susceptibility to free radicals[J]. Hear Res, 2001, 155(1-2):1-8. [23] Parnes L S, Sun A H, Freeman D J. Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application[J]. Laryngoscope, 1999, 109(7 Pt 2):1-17. [24] Bird P A, Begg E J, Zhang M, et al. Intratympanic versus intravenous delivery of methylprednisolone to cochlear perilymph[J]. Otol Neurotol, 2007, 28(8):1124-1130. [25] Kakehata S, Sasaki A, Oji K, et al. Comparison of intratympanic and intravenous dexamethasone treatment on sudden sensorineural hearing losswith diabetes[J]. Otol Neurotol, 2006, 27(5):604-608. [26] Li L, Ren J, Yin T, et al. Intratympanic dexamethasone perfusion versus injection for treatment of refractory sudden sensorineural hearing loss[J]. Eur Arch Otorhinolaryngol, 2013, 270(3):861-867. [27] Chou Y F, Chen P R, Kuo I J, et al. Comparison of intermittent intratympanic steroid injection and near-continual transtympanic steroid perfusion as salvage treatments for sudden sensorineural hearing loss[J]. Laryngoscope, 2013, 123(9):2264-2269. |
[1] | 黄凯丰. 糖皮质激素短疗程雾化吸入对嗜酸粒细胞性鼻窦炎伴鼻息肉患者鼻部症状及肾上腺皮质功能的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 28-31. |
[2] | 李华斌, 赖玉婷. 慢性鼻-鼻窦炎的发病机制及诊疗进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 4-9. |
[3] | 谢洪彬,杨美娜,陈青山,刘旭阳,樊宁. IgG4相关性眼病伴继发性青光眼病例分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 99-102. |
[4] | 高进良,年婉清,李烁. 鼻内镜手术联合鼻用糖皮质激素治疗腺样体肥大性[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 38-42. |
[5] | 钟琦. 甲状腺手术中甲状旁腺的识别和保护[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 9-11. |
[6] | 史丽,赵莉,张红萍. 变应性鼻炎的长期抗炎治疗[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 9-12. |
[7] | 张革化,李文婷. 变应性鼻炎的药物治疗策略[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 10-14. |
[8] | 张运波,习国平,靳红芳,王彩君. 非手术序列化治疗单侧梅尼埃病48例[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 73-76. |
[9] | 刘新杰,许楠,蔡炜,高恒元,罗民,邓慧仪,周冬仙. 术中甲状旁腺激素测定评判继发性甲状旁腺功能亢进手术成功的标准构想[J]. 山东大学耳鼻喉眼学报, 2016, 30(2): 65-70. |
[10] | 王增智. 免疫抑制对非感染性葡萄膜炎的治疗作用及对细胞因子的影响[J]. 山东大学耳鼻喉眼学报, 2015, 29(6): 64-67. |
[11] | 蒋路云, 谢慧, 谢艳, 李昕蓉. 鼓室注射布地奈德混悬液治疗合并2型糖尿病的突发性耳聋42例[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 20-23. |
[12] | 姜海华. S-100蛋白和HLA-DR在鼻息肉组织中的表达[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 43-45. |
[13] | 卢娜. 三种不同给药途径治疗突发性感音神经性耳聋的效果对比[J]. 山东大学耳鼻喉眼学报, 2015, 29(2): 24-27. |
[14] | 陈曦, 李进让. 鼻用激素治疗儿童阻塞性睡眠呼吸暂停低通气综合征疗效的Meta分析[J]. 山东大学耳鼻喉眼学报, 2015, 29(2): 9-11. |
[15] | 张彩霞, 刘阳云, 陈志喜, 江文, 李正贤, 陈琼, 常恩格. 鼓室激素注射为初始治疗的突发性聋听力恢复的时间规律[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 15-18. |
|