鼓室置管灌注甲泼尼龙治疗难治性梅尼埃病的疗效观察  

Clinical evaluation of intratympanic methylprednisolone perfusion for intractable Meniere's disease

作　　者：陆玲[1] 戴艳红[1] 佘万东[1] 俞晨杰[1] 陈峰[1] 王俊国[1] 麻晓峰[1] 秦小明[1] 高下[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

出　　处：《临床耳鼻咽喉头颈外科杂志》2010年第22期1012-1015,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：南京市医学科技发展项目(No:YKK05098)

摘　　要：目的:探讨鼓室置管灌注甲泼尼龙治疗难治性梅尼埃病(MD)的临床疗效。方法:回顾性分析2008-01-2010-01在南京大学医学院附属鼓楼医院住院的10例难治性MD患者,行患侧鼓室内置管灌注甲泼尼龙的疗效。随访(15.4±5.4)个月。根据MD诊断依据及疗效评估分级标准判定眩晕、听力及活动能力的治疗效果,依据耳鸣致残量表分析耳鸣的治疗效果。结果:7例患者眩晕完全控制(A级),2例患者分别于灌注后9、11个月复发眩晕(B级),但发作频率、眩晕程度、持续时间较前明显减轻,1例患者于灌注后18个月复发,眩晕程度较前无明显减轻(C级)。2例患者纯音听阈改善达A级,4例患者听力较前提高达B级,4例患者听力较前无明显变化(C级)。10例患者活动能力完全改善(A级)。灌注前患者THI得分为48.80±7.25,灌注后患者THI得分为41.90±7.78。无一例发生不可愈合的鼓膜穿孔。结论:鼓室置管灌注甲泼尼龙能有效控制MD患者的眩晕、耳鸣,改善部分患者的听力。对于常规饮食控制及药物治疗无效的MD患者,选择鼓室置管灌注甲泼尼龙是创伤小、安全、有效的治疗方法。Objective：To evaluate the clinical efficacy of the intratympanic methylprednisolone perfusion for patients of intractable Meniere＇s disease（MD）.Method：Ten cases（10 ears）,collected from Janu 2008 to Janu 2010,of intractable MD were studied retrospectively.The micro-catheter was placed into the tympanum of the affected ear,then methylprednisolone was imported into the tympanum once a day for 10 days.The average followed-up duration was（15.4±5.4）months after the perfusion.The treatment effect of vertigo,hearing loss and activity capacity was evaluated with Diagnostic Criteria for MD set Nby the Guiyang Meeting in 2006.The efficacy of tinnitus was analyzed by comparing the score of tinnitus handicap inventory（THI） before and after treatment.Result：The vertigo was absolutely controlled in 7 patients（grade A）,partially controlled in 2 patients（grade B） and no efficiency in 1 patient（grade C）.The 2 patients in grade B had a vertigo again in 9 months and 11 months after intratympanic perfusion,respectively,while the frequency,severity and duration of their vertigo softened obviously.Pure-tone threshold average（PTA） at the affected frequencies was decreased to within the level of 20 dB in one patient and was improved more than 30 dB in another one（grade A）,improved 15 dB to 30 dB in 4 patients（grade B）,and improved less than 15 dB in the other 4 patients.The average score of THI was 48.80±7.25 and 41.9±7.78 before and after perfusion respectively.The ability capacity of all the 10 patients after treatment was as normal（grade A）,i.e.All of them could lead an independent life.There was no irreversible tympanic perforation in the operated ear and there was no other complications left.Conclusion：Intratympanic methylprednisolone perfusion through the micro-catheter is a safe and effective method for the intractable Meniere＇s disease.

关 键 词：梅尼埃病 甲泼尼龙 鼓室灌注 

分 类 号：R764[医药卫生—耳鼻咽喉科]