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

doi:10.6040/j.issn.1673-3770.0.2021.272

摘要/Abstract

摘要： 目的探讨内淋巴囊减压联合经面隐窝鼓室内激素注射以及内淋巴囊表面覆盖激素明胶海绵治疗难治性梅尼埃病的短期与长期临床效果。方法回顾分析针对难治性梅尼埃病进行手术治疗的23例患者资料。手术方式在传统内淋巴囊减压的基础上,开放面隐窝,并在圆窗周围放置明胶海绵,鼓室内注射激素,同时在内淋巴囊表面放置明胶海绵并在乳突内注射激素。比较患者治疗前6个月与术后6~12个月(短期疗效),以及术后18~24个月(长期疗效)的眩晕发作次数以及平均听阈水平(500、1 000、2 000 Hz)。结果 23例患者完成短期疗效评价,术后眩晕发作次数由(5.7±5.9)次(术前6个月)降至(0.4±1.0)次(术后6~12个月),眩晕控制率为87.0%。术后听力维持率为95.7%。13例患者完成长期疗效评价,术后眩晕发作次数由(4.2±2.6)次(术前6个月)降至(0.1±0.3)次(术后18~24个月),眩晕控制率为92.3%,术后听力维持率为100%。结论内淋巴囊减压联合局部激素治疗对于保守治疗无效的难治性梅尼埃病具有良好的眩晕控制率和听力维持率,值得推广。

关键词: 梅尼埃病, 内淋巴囊减压术, 鼓室内注射激素, 眩晕, 听力下降

Abstract: Objective To investigate the short-term and long-term effects of endolymphatic sac decompression with instillation of local steroids for intractable Meniere's disease. Methods Twenty-three patients who underwent surgery for intractable Meniere's disease were enrolled. The surgical strategy included traditional endolymphatic sac decompression, opening of the facial recess, placement of gelatin sponge around the round window, and injection of steroids into the tympanic cavity and onto the surface of the endolymphatic sac. Frequency of vertigo episodes and hearing function(pure tone averages)were compared before surgery, 6~12 months after surgery, and 18~24 months after surgery. Results Twenty-three patients completed the short-term effect evaluation at 12 months after surgery. The frequency of vertigo episodes decreased from(5.7±5.9)to(0.4±1.0)times. The vertigo control rate was 87.0%, while the hearing maintenance rate was 95.7%. Thirteen patients completed the long-term effect evaluation at 24 months after surgery. The frequency of vertigo episodes decreased from(4.2±2.6)to(0.1±0.3)times. The vertigo control rate was 92.3%, while the hearing maintenance rate was 100%. Conclusion Endolymphatic sac decompression with instillation of local steroids for the treatment of intractable Meniere's disease had favorable effects on vertigo control and the maintenance of hearing function.

Key words: Meniere's disease, Endolymphatic sac decompression, Intratympanic injection of steroids, Vertigo, Hearing loss

中图分类号:

R764.33

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.

XU Jia, LI Xin, CHEN Wenjing, GAO Juanjuan, LU Xingxing, YI Haijin. Short-term and long-term outcomes of endolymphatic sac decompression with instillation of local steroids for intractable Meniere's disease[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 17-21.

参考文献

[1] Sajjadi H, Paparella MM. Meniere's disease [J]. The Lancet, 2008, 372(9636):406-414. doi: 10.1016/S0140-6736(08)61161-7.
[2] 侯小兵, 任同力, 张毅博. 69例梅尼埃病伴耳鸣的发病特点及影响因素[J]. 山东大学耳鼻喉眼学报, 2018,32(5): 37-40. doi: 10.6040/j.issn.1673-3770.0.2017.205. HOU Xiaobing, REN Tongli, ZHANG Yibo. Characteristics of tinnitus and the related influencing factors in patients with Meniere's disease[J]. J Otolaryngol Ophthalmol Shandong Univ, 2018,32(5): 37-40. doi: 10.6040/j.issn.1673-3770.0.2017.205.
[3] 黄巧, 尹时华. 内耳上皮钠通道、水通道蛋白与内淋巴代谢相关性的研究进展[J]. 山东大学耳鼻喉眼学报, 2019,33(4): 145-148. doi: 10.6040/j.issn.1673-3770.0.2018.301. HUANG Qiao, YIN Shihua. Correlation between endolymphatic Hydrops and inner ear epithelial sodium channels and aquaporins[J]. J Otolaryngol Ophthalmol Shandong Univ, 2019,33(4): 145-148. doi: 10.6040/j.issn.1673-3770.0.2018.301.
[4] van Esch BF, van der Zaag-Loonen HJ, Bruintjes TD, et al. Interventions for meniere's disease: Protocol for an umbrella systematic review and a network meta-analysis [J]. BMJ Open, 2016, 6(6):e010269. doi: 10.1136/bmjopen-2015-010269.
[5] Kitahara T. Evidence of surgical treatments for intractable meniere's disease [J]. Auris Nasus Larynx, 2018, 45(3): 393-398. doi.org/10.1016/j.anl.2017.07.016.
[6] 金昕, 孔维佳, 冷杨名, 等. 梅尼埃病诊断和治疗指南(2017)[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(3): 167-172. doi: 10.3760/cma.j.issn.1673-0860.2017.03.002. JIN Xin, KONG Weijia, LING Yangming, et al. Guideline of diagnosis and treatment of meniere disease(2017). Chin J Otorhinolaryngol Head Neck Surg, 2017, 52(3): 167-172. doi: 10.3760/cma.j.issn.1673-0860.2017.03.002.
[7] 樊兆民, 张道宫. 内淋巴囊手术[J]. 中国耳鼻咽喉头颈外科, 2015, 22(5): 246-248. doi: 10.16066/j.1672-7002.2015.05.010. FAN Zhaomin, ZHANG Daogong. Endolymphatic sac surgery [J]. Chin Arch Otolaryngol Head Neck Surg, 2015, 22(5):246-248. doi: 10.16066/j.1672-7002.2015.05.010.
[8] Lim MY, Zhang M, Yuen HW, et al. Current evidence for endolymphatic sac surgery in the treatment of meniere's disease: A systematic review[J]. Singapore Med J, 2015, 56(11):593-598. doi: 10.11622/smedj.2015166.
[9] Sood AJ, Lambert PR, Nguyen SA, et al. Endolymphatic sac surgery for meniere's disease: a systematic review and meta-analysis [J]. Otol Neurotol, 2014,35(6):1033-1045. doi: doi: 10.1097/MAO.0000000000000324.
[10] Convert C, Franco-Vidal V, Bebear JP, et al. Outcome-based assessment of endolymphatic sac decompression for ménière's disease using the ménière's disease outcome questionnaire: A review of 90 patients [J]. Otol Neurotol, 2006, 27(5):687-696. doi: 10.1097/01.mao.0000227661.52760.f1.
[11] Nevoux J, Barbara M, Dornhoffer J, et al. International consensus(icon)on treatment of meniere's disease [J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2018, 135(1S):S29-S32. doi: https://doi.org/10.1016/j.anorl.2017.12.006.
[12] Froehlich MH, Lambert PR. The physiologic role of corticosteroids in meniere's disease: an update on glucocorticoid-mediated pathophysiology and corticosteroid inner ear distribution [J]. Otol Neurotol, 2020, 41(2):271-276. doi: 10.1097/MAO.0000000000002467.
[13] Salt AN, Plontke SK. Pharmacokinetic principles in the inner ear: Influence of drug properties on intratympanic applicatio ns [J]. Hear Res, 2018, 368:28-40. doi: 10.1016/j.heares.2018.03.002.
[14] Bird PA, Begg EJ, Zhang M, et al. Intratympanic versus intravenous delivery of methylprednisolone to cochlear perilymph [J]. Otol Neurotol, 2007,28(8):1124-1130. doi: 10.1097/MAO.0b013e31815aee21.
[15] Lee JJ, Jang JH, Choo OS, et al. Steroid intracochlear distribution differs by administration method: Systemic versus intratympanic in jection [J]. Laryngoscope, 2018,128(1):189-194. doi: 10.1002/lary.26562.
[16] Kitahara T, Kubo T, Okumura S, et al. Effects of endolymphatic sac drainage with steroids for intractable meniere's disease: a long-term follow-up and randomized controlled study [J]. Laryngoscope, 2008,118(5):854-861. doi: 10.1097/MLG.0b013e3181651c4a.
[17] Sakagami M, Kitahara T, Ito T, et al. Effects of posterior tympanotomy with steroids at round window on hearing recovery after revision surgery for intractable meniere's disease [J]. Acta Otolaryngol, 2015, 135(7):667-672. doi: 10.3109/00016489.2015.1009161.
[18] Wick CC, Manzoor NF, McKenna C, et al. Long-term outcomes of endolymphatic sac shunting with local steroids for meniere's disease [J]. Am J Otolaryngol, 2017, 38(3): 285-290. doi: 10.1016/j.amjoto.2017.01.023.

相关文章 15

[1]	黄岚,高伟综述陈钢钢审校. 内耳疾病继发BPPV的发病机制和临床特征的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 108-113.
[2]	张瑶瑶综述王海涛审校. 内耳钆造影磁共振成像技术在梅尼埃病诊疗中的应用[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 101-107.
[3]	蒋黎娜,于倩如,于杰,关本岭,鹿玉,于淑东. 前庭性眩晕疾病患者焦虑和抑郁状况研究[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 1-5.
[4]	杨军, 郑贵亮. 外周前庭疾病的诊断和治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 1-6.
[5]	刘宇鹏, 梁敏, 何景春, 郑贵亮, 李姝娜, 张青, 杨军. 梅尼埃病前庭功能分级的探讨[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 14-19.
[6]	何白慧, 张帆, 孙夏雨, 陈建勇, 王璐, 李姝娜, 陈向平, 杨军. 外耳道耳蜗电图对梅尼埃病患者的诊断价值[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 20-26.
[7]	刘宇鹏, 吴文瑾, 何景春, 郑贵亮, 张青, 杨军. 迷路后径路前庭神经切断术治疗难治性梅尼埃病75例[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 46-50.
[8]	陈建勇, 孙夏雨, 沈佳丽, 汪玮, 王璐, 贺宽, 张勤, 马孝宝, 沈敏, 陈向平, 杨军. 原发性良性阵发性位置性眩晕患者VEMP异常率的临床观察[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 51-55.
[9]	邓巧媚,王巍,温超,刘强,毛翔,韩曦,李姗姗,陈太生,徐开旭,林鹏. 头晕眩晕与眼震强度的关系研究[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 56-60.
[10]	郑贵亮, 刘凌峰, 陈建勇, 张青, 杨军. 基于移动互联网的前庭康复训练指导平台的开发与应用[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 78-81.
[11]	赵欢娣,成颖综述杨军,张青审校. 3D-FLAIR MRI在内耳出血所致的SSNHL诊断中的作用[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 97-101.
[12]	魏馨雨,杨方园综述杨军,张青审校. 耳源性细菌性迷路炎研究进展[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 102-107.
[13]	王玥, 上官翰京综述蔡成福审校. 睡眠对良性阵发性位置性眩晕影响的研究进展[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 108-112.
[14]	伊海金,杨仕明. 重视耳部外伤诊疗工作[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 1-3.
[15]	许嘉,伊海金. 正确处理颞骨骨折耳科并发症[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 4-8.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed