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

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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
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