鼓室置管灌注甲泼尼龙治疗难治性突发性聋的听力疗效再分析  

Revisiting efficacy of intratympanic methylprednisolone perfusion on hearing in refractory sudden sensorineural hearing loss:a prospective,control study

作　　者：戴艳红[1] 佘万东[1] 杜小平 俞晨杰[1] 陈峰[1] 王俊国[1] 秦小明[1] 

机构地区：[1]南京大学医学院附属鼓楼医院耳鼻咽喉头颈外科,南京210008 [2]美国俄克拉荷马市Hough耳研究所

出　　处：《中华耳科学杂志》2010年第1期68-74,共7页Chinese Journal of Otology

基　　金：南京市医学科技发展项目(YKK05098)

摘　　要：目的探讨经耳道鼓室置管灌注甲泼尼龙治疗难治性突发性聋(sudden sensorineural hearing loss,SSNHL)的安全性和有效性。方法对常规治疗至少一个疗程(10天)无效的SSNHL,根据病人的意愿分成灌注组和对照组分别继续治疗10天。灌注组给予鼓室置管灌注甲泼尼龙+常规治疗,对照组继续常规治疗,比较治疗结束后3个月时两组的听力改善结果。结果灌注组26例和对照组23例,两组的有效率分别是50.0%和21.7%,继续治疗前后PTA改善分别是16.7dB和9.2dB,两组比较灌注组的有效率高于对照组(P=0.041);若仅将发病至继续治疗的时间间隔≤60天的病例纳入分析,则灌注组为21例,对照组仍为23例,有效率分别是61.9%和21.7%,PTA改善分别为20.2dB和9.2dB,灌注组均优于对照组(P有效率=0.007,PPTA改善=0.011);鼓室灌注前后低频区(0.25kHz,0.5kHz)、中频区(1kHz、2kHz)和高频区(4kHz、8kHz)的听阈分别改善19.8dB、16.0dB和13.4dB,低频区听力改善大于高频区(P=0.046)。结论鼓室置管灌注甲泼尼龙联合常规治疗用于难治性SSNHL是安全的、有效的,疗效优于继续常规治疗,且低频区的听力改善优于高频区,发病后宜尽早采用。Objective To investigate the effectiveness and safety of intratympanic methylprednisolone perfusion （IMP） through a micro-catheter in patients with sudden sensorineural hearing loss （SSNHL） who have failed conventional treatments.Methods This is prospective,controlled clinical trial involving patients who failed at least 10-days of conventional treatments.A total 26 patients （study group） received a micro-catheter into the tympanum for methylprednisone perfusion once a day for 10 consecutive days in addition to simultaneous administration of a conventional treatment （no systemic steroid）.Twenty three patients in a control group were treated with a second conventional treatment only （no systemic steroid）.At 3-month follow-up,the treatment response rate and improvement of pure-tone average （PTA） were compared.Results The treatment response rate was 50% and 21.7%,and the mean PTA improvement was 16.7dB and 9.2 dB,for the study and control groups respectively.The difference in treatment response rate was statistically significant （P=0.041）.When the time period from disease onset to IMP was limited to ≤60 days,the treatment response rate and PTA improvement in the study group were 61.9% and 20.2 dB,respectively,both higher than the control group（P=0.007 and P=0.011 respectively）.The mean PTA improvement at low frequencies （0.25 and 0.5 kHz）,middle frequencies （1 and 2 kHz） and high frequencies （4 and 8 kHz） after IMP were 19.8 dB,16.0 dB 和 13.4 dB,respectively.The mean PTA improvement at low frequencies was better than that at high frequencies （P=0.046）.Conclusion Daily IMP through a micro-catheter as a salvage treatment for refractory SSNHL is safe and effective.Its efficacy is better than that of the conventional treatment.IMP treatment should be recommended as early as possible when the patient has failed a conventional treatment.

关 键 词：鼓室灌注 突发性聋 甲泼尼龙 

分 类 号：R764.437[医药卫生—耳鼻咽喉科] R452[医药卫生—临床医学]