难治性突聋耳后注射神经节苷脂联合鼓室内注射甲泼尼龙治疗前后言语识别率及影响因素分析

doi:10.6040/j.issn.1673-3770.0.2023.083

摘要/Abstract

摘要： 目的分析单侧难治性突发性耳聋患者耳后注射神经节苷脂联合鼓室内注射甲泼尼龙后言语识别率(word recognition score, WRS )变化及其影响因素。方法收集58例行耳后注射神经节苷脂联合鼓室内注射甲泼尼龙治疗的难治性突发性耳聋患者资料,包括患者年龄、性别、病程持续时间、耳别、伴随症状、纯音听力及言语测听等数据。对治疗前后患者患耳的纯音测听(pure tone audiometry, PTA)结果和最大言语识别率(maximum speech recognition rate, WRSmax )进行统计分析,Logistic回归分析分析影响WRS愈后的因素。结果与治疗前比较,耳后注射神经节苷酯联合鼓室内注射甲泼尼龙治疗的患者治疗后患耳PTA和WRS有显著改善(P=0.027,P=0.038),两者呈负相关(r=-0.682, P<0.05 )。同时,采用单因素分析法发现年龄、性别、诱发因素、患侧耳别、伴随症状与WRS 无明显相关性,差异无统计学意义(P=0.693、P=0.208、P=0.079、P=0.335、P=0.331),而发病至首次就诊时间、听力损害程度及听力曲线类型是影响WRS疗效的重要因素(P=0.010,P=0.033,P=0.026)。结论难治性突发性耳聋患者经耳后注射神经节苷脂联合鼓室内注射甲泼尼龙治疗后WRS疗效为41.38%,影响其疗效的因素包括:发病至首次就诊时间、听力损害程度及听力曲线类型。发病至首次就诊时间长者疗效显著差于病程短者,低频听力下降者经上述方法治疗后WRS疗效明显较平坦型及高频听力下降者好;听力损害程度越重,疗效越差。

关键词: 难治性突聋, 鼓室内及耳后注射, 言语识别率, 纯音测听

Abstract: Objective This study aimed to analyze the impact of postauricular injection of ganglioside combined with intratympanic injection of methylprednisolone on word recognition score(WRS)and its influencing factors in patients with unilateral refractory sudden deafness. Methods This study included 58 patients with refractory sudden deafness who were treated with postauricular ganglioside injection combined with intratympanic methylprednisolone injection. Data was collected on the patients' age, sex, disease duration, ear category, concomitant symptoms, and pure tone audiometry(PTA)and speech audiometry results pre- and post-treatment. The PTA results and the maximum speech recognition rate(WRSmax)were statistically analyzed pre- and post-treatment. Logistic regression analysis was applied to identify factors that improve WRS. Results Patients with refractory sudden deafness showed significant improvements in PTA and WRS in the affected ear after treatment(P=0.027,P=0.038). Furthermore, a negative correlation was observed between PTA and WRS(r=-0.682, P<0.05). Univariate analysis revealed that age, sex, precipitating factors, affected ear, concomitant symptoms, and WRS were not significantly correlated(P=0.693, P=0.208,P=0.079, P=0.335, P=0.331)), and the differences were not statistically significant. However, time from onset to the first visit, degree of hearing damage, and type of hearing curve were identified as important factors that influenced improvement in WRS(P=0.010, P=0.033, P=0.026). Conclusion Administration of postauricular ganglioside combined with intratympanic methylprednisolone resulted in a 41.38% improvement in WRS for patients with refractory sudden deafness. Improvement in WRS was also influenced by the time from onset to the first visit, degree of hearing impairment, and type of hearing curve. The improvement in WRS was significantly worse in those with a longer time from onset to first visit than in those with a shorter duration; however, it was significantly better in those with low-frequency hearing loss than in those with flat and high-frequency hearing loss after treatment with the aforementioned methods. The severity of hearing impairment negatively impacted improvement in WRS.

Key words: Refractory idiopathic sudden sensorineural hearing loss, Intratympanic and postauricular injection, Word recognition score, Pure-tone average

中图分类号:

R764.5

曹影,邱月,陈智斌,费兵,李东,张晓凤,王惠,康欣乐,王海旭,怀德,李秀婷,束明阳. 难治性突聋耳后注射神经节苷脂联合鼓室内注射甲泼尼龙治疗前后言语识别率及影响因素分析[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 15-21.

CAO Ying, QIU Yue, CHEN Zhibin, FEI Bing, LI Dong, ZHANG Xiaofeng,WANG Hui,KANG Xinle, WANG Haixu,HUAI De,LI Xiuting, SHU Mingyang. Comparative analysis of speech recognition ability before and after treatment of intractable sudden deafness using retroaural injection of ganglioside and intratympanic injection of methylprednisolone[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(4): 15-21.

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