山东大学耳鼻喉眼学报 ›› 2013, Vol. 27 ›› Issue (1): 26-30.doi: 10.6040/j.issn.1673-3770.0.2012.213

• 论著 • 上一篇    下一篇

鼓室联合静脉地塞米松+传统方法治疗突发性耳聋的近期疗效

 刘冬梅1，徐开伦1，罗晓1，贾全凡1，任贤灵1，袁龙1，罗通勇1，刘军2，马殿伟2， 岳胜清1，文晓蛟1，付誉颖2   

  1. 1. 川北医学院附属广元市中心医院耳鼻喉科, 四川 广元 628000； 2. 武警成都医院眼耳鼻喉科， 成都 610000
  • 收稿日期:2012-07-07 发布日期:2013-02-16
  • 通讯作者: 通讯作者：徐开伦。E-mail:gyxukailun@yahoo.cn
  • 作者简介:刘冬梅。E-mail:meiyanyuliu@163.com
  • 基金资助:

    四川省卫生厅科研立项课题(120405)

Short-term effectiveness of intratympanic plus intravenous Dexamethasone injection and conventional regimen for sudden sensorineural hearing loss

LIU Dong-mei1, XU Kai-lun1, LUO Xiao1, JIA Quan-fan1, REN Xian-ling1, YUAN Long1, LUO Tong-yong1, LIU Jun2, MA Dian-wei2, YUE Sheng-qin1, WEN Xiao-jiao1, FU Yu-ying2   

  1.  1. Department of Otolaryngological of Guangyuan Affiliated Hospital of North Sichuan Medical College, Guangyuan 628000, Sichuan China; 2. Department of Eye Otolaryngology of Chengdu Hospital of Armed Police Forces, Chengdu 610000,   China
  • Received:2012-07-07 Published:2013-02-16

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摘要：

目的   观察鼓室地塞米松灌注(ITD)联合静脉地塞米松+传统方法治疗突发性耳聋(SSNHL)的近期疗效，比较此方法与“单纯静脉地塞米松+传统治疗”方法的差别。方法   将住院患者按入院时间分为治疗A组（11例，11耳）、治疗B组 （11例，13耳）、对照A组（11例，11耳）、对照B组（11例，13耳）。签署同意书后，对照A组、B组给予静脉输地塞米松磷酸钠注射液、高氧液（A组）/高压氧（B组）、活血化瘀类中药、维生素类等药物；治疗A组、B组在此基础上给予ITD。于ITD结束和一个疗程（10d）结束当天或第2天复查纯音测听，记录检查结果并计算500Hz、1kHz、2kHz、4kHz的纯音气导平均听阈（PTA），比较4个组治疗前后PTA及250Hz、8kHz纯音听阈的差异。以提高15dB HL为有效，比较各组有效率的差异，并观察 ITD的并发症。结果   治疗A组治疗后PTA提高（25.73±6.07）dB HL（P<0.01）；治疗B组治疗后PTA提高（24.15±4.86）dB HL（P<0.01）；对照A组治疗后PTA提高（16.36±3.36）dB HL（P<0.01）；对照B组治疗后PTA提高（19.46±6.01）dB HL（P<0.01）。4个组治疗前后PTA差异均有统计学意义。除治疗A组外，各组治疗前后250Hz改善的差异均有统计学意义。除治疗B组外，各组治疗前后8kHz改善差异均无统计学意义。对于250Hz和8kHz，治疗A组与对照A组、治疗B组与对照B组之间听力改善差异均无统计学意义（P>0.05）。治疗A组有效9耳（81.8%）,对照A组有效4耳（36.4%），两组有效率差异具有统计学意义（P<0.05）；治疗B组有效8耳（61.5%），对照B组有效5耳（38.5%），两组有效率差异无统计学意义（P>0.05）。治疗A组、B组22例患者穿刺耳均未见鼓室内感染，无效但听力未见继续下降1例。注射过程中出现一过性眩晕5例、轻微水肿2例，余20例均未出现全身不良反应。结论   ITD联合静脉地塞米松及传统的活血化瘀类、维生素类、高氧液或高压氧等治疗突发性耳聋方法有效，疗效可能比单纯运用全身地塞米松及传统的活血化瘀类、维生素类、高氧液或高压氧等更为明显，但并不是对每个患者都有效；安全易行，患者依从性高；低频听力提高较高频听力显著。两种治疗方法对低频听力的改善无明显区别。

关键词: 地塞米松, 鼓室, 突发性耳聋

Abstract:

Objective   To observe the the short-term effectiveness of intratympanic dexamethasone(ITD) plus intravenous dexamethasone injection and conventional regimen for sudden sensorineural hearing loss(SSNHL).  Methods   The SSNHL cases were divided into treatment group A (11cases,11ears), treatment group B (11cases,13ears), control group A(11cases,11ears), and control group B(11cases,13ears) based on the admitted time. With informed consent signed, the patients in control group A and B were given intravenous injection of dexamethasone, highly oxygenized liquid(group A) or hyperbaric oxygen treatment (group B), accompanied by circulation booster/stasis elimination agents, vitamin and so on. Besides the above, ITD was performed in the treatment group A and B. Assessment of hearing function was carried out on the exact day or next day after one 10-day course. The results of pure tone average（PTA）were recorded and calculated at 500Hz, 1kHz, 2kHz, 4kHz, respectively. Meanwhile, the results at 250Hz and 8kHz were compared. Hearing improvement was defined as a 15 dB HL decrease. Results   The treatment group A showed an average increase of (25.73±6.07)dB HL(P<0.01). The treatment group B showed an average increase of (24.15±4.86)dB HL(P<0.01). The control group A showed average increase of (16.36±3.36) dB HL(P<0.01). The control group B showed an average increase of (19.46±6.01)dB HL(P<0.01). The PTA of four groups before and after the treatment all demonstrated statistical significance. Except for the treatment group A, the pure tone threshold at 250 Hz of all the three other groups before and after treatment showed statistical significance. Except for the treatment group B, the pure tone threshold at 8kHz of all the other three groups before and after treatment showed no statistical significance. No significant difference at 250 Hz was noted between the treatment group A and the control group B, while the same result was found at 8kHz between the treatment group A and control group B (P>0.01). Overall improvement was observed in 9 ears (81.8%) in the treatment group A and 4 ears (36.4%) in the control group A (P<0.05). Overall improvement were observed in 8 ears(61.5%) in the treatment group B and 5 ears(38.5%) in the control group B (P>0.05).There were no middle ear infection. The treatment was invalid for 1 case, but her hearing level stopped falling. In the process of injection, vertigo happened in 5 cases, temporary mild edema in 2 cases, while the rest 20 patients did not show any adverse reaction. Conclusion   Four kinds of treatments are effective for sudden sensorineural hearing loss. However, intratympanic joint intravenous dexamethasone plus conventional regimen is more effective, safer and simpler. Curative effect is better for low frequency than the high. Two treatment strategies have no obvious difference in the improvement of low frequency.

Key words: Intratympanic, Dexamethasone, Sudden sensorineural hearing loss

中图分类号: 

  • R763
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