山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (5): 1-10.doi: 10.6040/j.issn.1673-3770.0.2021.010

• •    下一篇

鼓室与全身应用激素治疗突发性耳聋的系统评价与Meta分析

钟丽萍1,2,官希龙1,2,王晶晶1,2,汤勇1,3   

  1. 1. 长春中医药大学 临床医学院, 吉林 长春 130117;
    2. 吉林省人民医院 耳鼻咽喉科, 吉林 长春 130021;
    3. 长春中医药大学第三附属医院 耳鼻咽喉科, 吉林 长春 130117
  • 发布日期:2021-09-29
  • 通讯作者: 汤勇. E-mail:15943012058@163.com

Intratympanic injections and systemic glucocorticoid treatment for sudden hearing loss: a systematic review and Meta-analysis

ZHONG Liping1,2, GUAN Xilong1,2, WANG Jingjing1,2, TANG Yong1,3   

  1. 1. Clinical Medical College of Changchun University of Chinese Medicine, Changchun 130117, Jilin, China;
    2. Department of Otorhinolaryngology, Jilin Province People's Hospital, Changchun 130021, Jilin, China;
    3. Department of Otorhinolaryngology, The Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130117, Jilin, China
  • Published:2021-09-29

摘要: 目的 利用Meta分析的方法评价及分析鼓室注射与全身应用激素初始治疗突发性耳聋的有效性,痊愈率及安全性。 方法 计算机搜索 Web of science、Pubmed、Embase、Cochrane library、中国知网、万方医学网、维普信息资源系统,系统收集2020年7月之前的随机对照研究,经筛选后对符合纳入标准的文献进行方法学的评价,并且利用RevMan5.3软件对所得研究数据进行Meta分析。 结果 纳入了9篇随机对照研究,其中中文3篇、英文6篇,共757例患者,其中经鼓室注射组共396例,全身应用激素组共361例。Meta分析显示两组患者在总有效率、痊愈率、平均阈值提高方面未见明显差别,其相对应危险度(RR值)、95%可信区间(CI值)分别为:1.05(0.65~1.23)、1.01(0.79~1.30)、1.18(-0.60~2.96)。亚组分析显示:在平均阈值提高方面,中重度组、重度组间差异无统计学意义。在有效率方面,国外研究显示组间差异无统计学意义,国内研究显示出鼓室注射组则有更高的有效率。鼓室注射的不良反应主要有一过性眩晕、耳鸣,全身不良反应较全身用激素组低,全身用药组的不良反应主要为血压、血糖的升高,失眠等。 结论 鼓室注射与全身应用激素在有效率,痊愈率等方面无明显差异,鼓室注射组不良反应低于全身应用激素组。

关键词: 突发性耳聋, 激素, 鼓室注射, 有效率, Meta分析

Abstract: Objective To assess the efficacy, healing rate, and safety of intratympanic injections and systemic glucocorticoids in the initial treatment of sudden hearing loss. Methods The Web of Science, PubMed, Embase, Cochrane Library, CNKI, Wanfang and VIP databases were searched, and all RCTs involving intratympanic injection and systemic glucocorticoids in the treatment of sudden hearing loss before July 2020 were extracted. The literature was analyzed according to their inclusion and exclusion criteria, and their quality was evaluated using the Cochrane Handbook 5.1. Data were extracted and analyzed using RevMan 5.3 Meta-analysis software. Results Nine randomized controlled trials were identified, comprising three papers in Chinese and six in English.A total of 757 cases were included, of which 396 had been treated with intratympanic injections and 361 with systemic glucocorticoids. The Meta-analysis revealed no differences in the total effectiveness rate, healing rate, and mean pure tone average(PTA)gain between intratympanic injections and systemic glucocorticoid treatment(Relative Risk(RR)=1.05, 95% Confidence Interval(CI)=0.65-1.23; RR=1.01, 95%CI=0.79-1.30; and RR=1.18, 95%CI=-0.60-2.96, respectively). The subgroup analysis revealed no significant difference in PTA gain between the severe group and the moderate-to-severe group, and internal research revealed that intratympanic injections were more efficient than systemic glucocorticoids, while foreign research reported no significant difference between them. The major complications of intratympanic injection were transient vertigo and tinnitus, while the incidence of local complications was lower than that observed with systemic steroid treatment, which included high blood glucose, high blood pressure, and insomnia. Conclusion This study revealed no difference in the effectiveness and cure rates of sudden sensorineural hearing loss between intratympanic injections and systematic steroid use. Fewer side effects are associated with postauricular injections than systematic steroid therapy.

Key words: Sudden hearing loss, Glucocorticoids, Intratympanic injection, Efficacy, Meta-analysis

中图分类号: 

  • R764.43+7
[1] 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会. 突发性聋的诊断和治疗指南(2005年, 济南)[J]. 中华耳鼻咽喉头颈外科杂志, 2006, 41(8): 569. doi:10.3760/j.issn: 1673-0860.2006.08.003. Chinese Otorhinolaryngology Head and Neck Surgery Society of Chinese Medical Association, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery. Guideline of diagnosis and treatment of sudden deafness(2005, Jinan)[J]. Chin J Otorhinolaryngol Head Neck Surg, 2006, 41(8): 569. doi:10.3760/j.issn: 1673-0860.2006.08.003.
[2] Seggas I, Koltsidopoulos P, Bibas A, et al. Intratympanic steroid therapy for sudden hearing loss: a review of the literature[J]. Otol Neurotol, 2011, 32(1): 29-35. doi:10.1097/mao.0b013e3181f7aba3.
[3] Sennaro glu L, Dini FM, Sennaro glu G, et al. Transtympanic dexamethasone application in Ménière's disease: an alternative treatment for intractable Vertigo[J]. J Laryngol Otol, 1999, 113(3): 217-221. doi:10.1017/s0022215100143610.
[4] HIGGINS JPT, GREEN S(editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March2011]. The Cochrane Collaboration, 2011. Available from www.co-chrane-handbook.org.
[5] 陈声伟, 陈伟东, 林楚标, 等. 地塞米松不同途径给药治疗突发性聋的临床效果比较[J]. 中国当代医药, 2019, 26(26): 123-126. doi: 10.3969/j.issn.1674-4721.2019.26.037. CHEN Shengwei, CHEN Weidong, LIN Chubiao, et al. Clinical effect comparison of Dexamethasone on sudden deafness treated by different administration routes[J]. China Mod Med, 2019, 26(26): 123-126. doi: 10.3969/j.issn.1674-4721.2019.26.037.
[6] 付丽艳, 刘卓慧, 龙瑞清. 鼓室内与静脉注射地塞米松治疗突发性聋疗效比较[J]. 听力学及言语疾病杂志, 2018, 26(4): 350-353. doi: 10.3969/j.issn.1006-7299.2018.04.004. FU Liyan, LIU Zhuohui, LONG Ruiqing. Efficacy analysis of intratympanic and intravenous dexamethasone in idiopathic sudden sensorineural hearing loss[J]. J Audiol Speech Pathol, 2018, 26(4): 350-353. doi: 10.3969/j.issn.1006-7299.2018.04.004.
[7] 李晖, 刘莉, 郭筠芳. 鼓室注射地塞米松治疗突发性聋的疗效及影响因素分析[J]. 听力学及言语疾病杂志, 2013,21(5): 539-541. doi: 10.3969/j.issn.1006-7299.2013.05.028.
[8] Seok Ming Hong. Hearing outcomes of daily intratympanic dexamethasone alone as a primary treatment modality for ISSNL[J]. Otolaryngology-Head and Neck Surgery, 2009, 141:579-583.
[9] Lim HJ, Kim YT, Choi SJ, et al. Efficacy of 3 different steroid treatments for sudden sensorineural hearing loss[J]. Otolaryngol Head Neck Surg, 2013, 148(1): 121-127. doi:10.1177/0194599812464475.
[10] Tsounis M, Psillas G, Tsalighopoulos M, et al. Systemic, intratympanic and combined administration of steroids for sudden hearing loss. A prospective randomized multicenter trial[J]. Eur Arch Otorhinolaryngol, 2018, 275(1): 103-110. doi:10.1007/s00405-017-4803-5.
[11] Tong B, Wang Q, Dai Q, et al. Efficacy of various corticosteroid treatment modalities for the initial treatment of idiopathic sudden hearing loss: a prospective randomized controlled trial[J]. Audiol Neurootol, 2021, 26(1): 45-52. doi:10.1159/000508124.
[12] Rauch SD, Halpin CF, Antonelli PJ, et al. Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial[J]. JAMA, 2011, 305(20): 2071-2079. doi:10.1001/jama.2011.679.
[13] Swachia K, Sharma D, Singh J. Efficacy of oral vs. intratympanic corticosteroids in sudden sensorineural hearing loss[J]. J Basic Clin Physiol Pharmacol, 2016, 27(4): 371-377. doi:10.1515/jbcpp-2015-0112.
[14] Rajati M, Azarpajooh MR, Mouhebati M, et al. Is sudden hearing loss associated with atherosclerosis?[J]. Iran J Otorhinolaryngol, 2016, 28(86): 189-195. PMID: 27429947.
[15] Mohammed AAM. Lipid profile among patients with sudden sensorineural hearing loss[J]. Indian J Otolaryngol Head Neck Surg, 2014, 66(4): 425-428. doi:10.1007/s12070-014-0744-0.
[16] 施典羽, 杨凯, 敬光怀, 等. 特发性突聋患者外周血ET、CGRP和NO的检测分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2012, 20(4): 246-248, 245. doi: CNKI:SUN:XYJH.0.2012-04-004. SHI Dianyu, YANG Kai, JING Guanghuai, et al. The Detection and analysis of ET, CGRP, NO in the ISSHL Patients' peripheral blood[J]. 2012, 20(4): 246-248, 245. doi: CNKI:SUN:XYJH.0.2012-04-004.
[17] 赵鹏举, 刘阳, 王庆军, 等. 突发性耳聋患者内淋巴积水的客观影像检测[J]. 中华耳科学杂志, 2016,14(6): 764-768. doi: 10.3969/j.issn.1672-2922.2016.06.013. ZHAO Pengju, LIU Yang, WANG Qingjun, et al. MRI detction of endolymphatic Hydrops in patients with sudden sensorineural hearing loss[J]. Chin J Otol, 2016, 14(6): 764-768. doi: 10.3969/j.issn.1672-2922.2016.06.013.
[18] 李和清, 任基浩, 卢永德. 突聋血清病毒特异性IgM抗体及NO检测的初步研究[J]. 中国耳鼻咽喉颅底外科杂志, 2002, 6(2): 133-134. doi: 10.3969/j.issn.1007-1520.2002.02.023.
[19] 刘瑶, 管国芳, 孙开, 等. 突发性耳聋与巨细胞病毒感染关系初探[J]. 吉林医学, 2011,32(13): 2513-2514. doi: 10.3969/j.issn.1004-0412.2011.13.006. LIU Yao, GUAN Guofang, SUN Kai, et al. Preliminary research on relationship between sudden deafness and Cytomegalovirus infection[J]. Jilin Med J, 2011, 32(13): 2513-2514. doi: 10.3969/j.issn.1004-0412.2011.13.006.
[20] 原晶晶,鲍诗平,张帆,等.慢性乙型肝炎病毒感染与听力相关性初步研究[J]. 中国听力语言康复科学杂志,2016, 14(6):428-431. doi:10.3969/j.issn.1672-4933.2016.06.008. YUN Jingjing, BAO Shiping, ZHANG Fan, et al. A preliminary study on the correction between chronic hepatitis B virus infection and hearing status [J]. Chinese Scientific Journal of Hearing and Speech Rehabilitation, 2016, 14(6):428-431. doi:10.3969/j.issn.1672-4933.2016.06.008.
[21] Rossini BAA, Penido NO, Munhoz MSL, et al. Sudden sensorioneural hearing loss and autoimmune systemic diseases[J]. Int Arch Otorhinolaryngol, 2017, 21(3): 213-223. doi:10.1055/s-0036-1586162.
[22] 衡伟伟, 后婕, 魏先梅, 等. TNF-α和IL-8在突发性聋患者血清及外周血单个核细胞中的表达及其意义[J]. 山东大学耳鼻喉眼学报, 2016,30(2): 40-45. doi: 10.6040/j.issn.1673-3770.0.2015.473. HENG Weiwei, HOU Jie, WEI Xianmei, et al. Expressions and significance of TNF-α and IL-8 in serum and peripheral blood mononuclear cells from patients with sudden sensorineural hearing loss[J]. J Otolaryngol Ophthalmol Shandong Univ, 2016, 30(2): 40-45. doi: 10.6040/j.issn.1673-3770.0.2015.473.
[23] 梁敏, 吴悔, 陈建勇, 等. 前庭诱发肌源性电位预测突聋患者疗效的临床价值[J]. 山东大学耳鼻喉眼学报, 2020,34(5): 27-32. doi: 10.6040/j.issn.1673-3770.1.2020.063. LIANG Min, WU Hui, CHEN Jianyong, et al. Clinical value of vestibular evoked myogenic potential to predict prognosis of unilateral idiopathic sudden sensorineural hearing loss[J]. J Otolaryngol Ophthalmol Shandong Univ, 2020, 34(5): 27-32. doi: 10.6040/j.issn.1673-3770.1.2020.063.
[24] Silverstein H, Thompson J, Rosenberg SI, et al. Silverstein MicroWick[J]. Otolaryngol Clin N Am, 2004, 37(5): 1019-1034. doi:10.1016/j.otc.2004.04.002.
[25] 孙爱华, LorneS.Parnes, DavidJ. Freeman, 等. 不同用药途径地塞米松在内耳液中的分布[J]. 中华耳鼻咽喉科杂志, 2001, 36(1): 62-63. doi: 10.3760/j.issn:1673-0860.2001.01.021.
[26] Parnes LS, Sun AH, Freeman DJ. Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application[J]. Laryngoscope, 1999, 109(7 pt 2): 1-17. doi:10.1097/00005537-199907001-00001.
[27] 李穗, 龚树生, 陈建国, 等. 3种糖皮质激素经圆窗膜给药在内耳的药代动力学研究[J]. 临床耳鼻咽喉科杂志, 2005, 19(1): 24-26. doi: 10.3969/j.issn.1001-1781.2005.01.010. LI Sui, GONG Shusheng, CHEN Jianguo, et al. Pharmacokinetics of the methylprednisolone,dexamethasone and hydrocortisone in the inner ear after administered via round window[J]. Journal of Clinical Otorhinolaryngology, 2005, 19(1): 24-26. doi: 10.3969/j.issn.1001-1781.2005.01.010.
[28] Plontke SK, Biegner T, Kammerer B, et al. Dexamethasone concentration gradients along Scala tympani after application to the round window membrane[J]. Otol Neurotol, 2008, 29: 401-406. doi: 10.1097/MAO.0b013e318161aaae.
[29] 严小玲, 毛敏, 翟锦明, 等. 鼓室内注射治疗难治性突发性耳聋52例[J]. 山东大学耳鼻喉眼学报, 2014, 28(5): 23-26. doi: 10.6040/j.issn.1673-3770.0.2014.045. YAN Xiaoling, MAO Min, ZHAI Jinming, et al. Intratympanic steroids to treat refractory sudden sensorineural hearing loss(52 cases report)[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2014, 28(5): 23-26. doi: 10.6040/j.issn.1673-3770.0.2014.045.
[30] Marx M, Younes E, Chandrasekhar SS, et al. International consensus(ICON)on treatment of sudden sensorineural hearing loss[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2018, 135(1s): S23-S28. doi:10.1016/j.anorl.2017.12.011.
[1] 许嘉, 李欣, 陈雯婧, 高娟娟, 卢星星, 伊海金. 联合应用内淋巴囊减压和局部激素治疗难治性梅尼埃病的短期与长期疗效分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 17-21.
[2] 石安妮,张佳佳,白鹏,张重阳. 浅析“颈部七线法”针刺治疗突发性耳聋的内涵[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 103-107.
[3] 王欢,胡俐,余洪猛. 慢性鼻窦炎相关嗅觉功能障碍研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 43-49.
[4] 资昊坤,肖旭平,李云秋. 口服糖皮质激素在慢性鼻窦炎伴鼻息肉围手术期的应用现状[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 98-103.
[5] 陈世琴,卫平存,胡云龙,胡金旺. 糖皮质激素三种不同鼻用法对鼻内镜术后黏膜转归的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 195-201.
[6] 林曼青,周敏,陈腾宇,李丹,方彩珊,王睿智,朱锦祥,阮岩,徐慧贤,王培源. 中药鼻腔冲洗治疗慢性鼻窦炎术后有效性和安全性的Meta分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 209-225.
[7] 姜雪莲, 张静月, 卫旭东. 基于Meta分析桥接网络药理学的鼻渊通窍颗粒治疗慢性鼻窦炎的疗效评价及潜在机制研究[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 226-236.
[8] 黄开月,李雪情,韩国鑫,张勤修. 基于“肺脾”理论指导穴位埋线治疗变应性鼻炎的Meta分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 266-274.
[9] 朱正茹, 张小兵. 中药汤剂结合常规西药治疗变应性鼻炎疗效的Meta分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 281-289.
[10] 刘艺,于明坤,孙伟,邵震,胡媛媛,毕宏生. 角膜塑形术控制儿童近视有效性与安全性的Meta分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 92-100.
[11] 庄佩耘,刘昀逸. 内分泌激素与嗓音[J]. 山东大学耳鼻喉眼学报, 2021, 35(3): 5-9.
[12] 林小燕,李静,马志祺,李依琳,高馨怡,李勇. 益生菌治疗变应性鼻炎的临床疗效及抗变态反应作用Meta分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(3): 70-80.
[13] 谷婷婷,刘岩,张悦,于丹,文连姬. 内舒拿联合孟鲁司特钠治疗腺样体肥大的Meta分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(1): 47-55.
[14] 林育珊,卢标清. 从心脾论治突发性耳聋的疗效观察[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 6-11.
[15] 谭凤武,邓亚萍,黎可华. 低温等离子射频消融与CO2激光手术治疗早期声门型喉癌疗效的Meta分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 63-71.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 杨长亮,黄治物,姚行齐,诸勇,孙艺 . 正常气骨导听性脑干反应及其应用[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 9 -13 .
[2] 曹忠良 . 颌面复合伤155例临床分析[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 89 -89 .
[3] 毕景云 . 鼻中隔矫正术后血肿的处理[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 90 -91 .
[4] 刘大昱,潘新良,雷大鹏,许风雷,张立强,栾信庸 . 梨状窝内侧壁癌的手术治疗[J]. 山东大学耳鼻喉眼学报, 2007, 21(1): 8 -11 .
[5] 楼正才 . 掌拳击伤鼓膜损伤机制及临床特点分析[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 188 -188 .
[6] 刘 艳,刘新义,王金平,李大健 . 后鼓室解剖结构测量观察及临床意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 218 -221 .
[7] 赵 敏,王守森,甄泽年,陈贤明,王茂鑫 . 鼻内镜联合显微镜行蝶窦及经蝶鞍区微创手术[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 244 -245 .
[8] 伦 杰,吕心红 . 鼻部脂溢性角化病1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 252 -252 .
[9] 王红霞,王鹏程 . NSE、S100及GFAP在视网膜母细胞瘤中的表达及意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 263 -264 .
[10] 黄 方,黄海琼,黄建强,何荷蕃 . 支气管内镜视频监视系统在小儿气管-支气管异物诊治中的应用[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 276 -277 .