鼓室置管灌注甲泼尼龙治疗突发性聋的听力疗效分析  

Efficacy of Intratympanic Methylprednisolone Perfusion for the Treatment of Sudden Sensorineural Hearing Loss

作　　者：戴艳红[1] 后婕 陆玲[1] 杨霞[1] 李惠[1] 杨烨[1] 佘万东[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]南京大学医学院

出　　处：《听力学及言语疾病杂志》2015年第2期147-151,共5页Journal of Audiology and Speech Pathology

基　　金：国家自然科学基金项目(81271074);第十批江苏省"六大人才高峰"项目(2013年);南京市国际联合研究项目(2012sd311038);南京市医学科技发展项目(YKK13054);中央高校苗圃项目(021414340101)联合资助

摘　　要：目的观察鼓室置管灌注甲泼尼龙治疗突发性聋的听力疗效。方法回顾性分析2008年1月至2012年12月因常规治疗疗效欠佳行鼓室置管灌注甲泼尼龙的87例（87耳）突发性聋患者的听力疗效，均为单耳发病，其中全聋型67例，平坦型16例，低中频下降型2例，中高频下降型2例。发病至鼓室灌注的时间≤15天（A组）、16～30天（B组）和≥31天（c组）组分别为33、33和21例。结果87例中总有效率为34．48％（30／87），A、B、C三组有效率分别66．67％（22／33），21．21％（7／33）和4．76％（1／z1）；三组平均PTA改善分别为18．53±13．54、5．92±15．18和3．69±7．00dB，A组疗效优于B组和C组（P〈0.01）。不同听阈曲线类型突聋患者的有效率和PTA改善值之间差异无统计学意义，有效的30例中，1例为低中频下降型，其余29例均为全频听力下降（全聋型或平坦型），灌注前后0．25、0．5、1、2、4和8kHz平均听阈改善分别为35．17±18．15、35．38±15．90、31．28±19．74、21．31±17．34、14．97±16．00和13．80±16．35dB，低中频（0．25、0．5和1kHz）的听阈改善程度优于中高频（2、4和8kHz）（P〈0．01）。结论常规治疗疗效不佳的突发性聋患者，尽早鼓室置管灌注甲泼尼龙可能会获得更好的听力恢复，且低中频的听力恢复效果优于中高频。Objective To investigate the efficacy of intratympanic methylprednisolone perfusion （IMP） for the treatment of sudden sensorineural hearing loss （SSNHL） which failed to be fully responsive to conventional treatment. Methods The hearing outcomes of 87 patients with unilateral SSNHL were retrospectively analyzed. All of the patients received IMP after not fully responsive to conventional treatment of varying periods of time. They were hospitalized in our department between January 2008 and December 2012 and were followed up for at least one year to exclude recurrent hearing loss. Results The effective rate was 66.67 % and the mean PTA improvement was （18.53 ± 13. 54）dB of the patients with the time interval between onset of symptoms and IMP within 15 days, 21.21% and （5.92±15.18）dB of the patients with the interval between 16 and 30 days,4.76% and （3.69±7.00） dB of the patients with the interval more than 30 days respectively. The significant difference in the effective rates were compared among the three groups（χ^2 =25.91 ,P〈0.01）. Regarding to the PTA improvement, the group with interval within 15 days was better than the other two groups（F=11. 182,P〈0.01）. A total of 30 cases acquired more than 15 dB hearing gain after IMP. One of them was hearing loss in low frequencies and the other 29 cases were hearing loss at all frequencies. The mean hearing gains of the 29 cases in 0.25 kHz, 0.5 kHz, 1 kHz, 2 kHz, 4 kHz and 8 kHz were 35.17±18.15 dB,35.38±15.90 dB,31.28±19.74 dB,21.31±17.34 dB,14. 97±16. 00 dB and 13.80± 16.35 dB, respectively. The mean hearing gains at lower three frequencies （0.25～ 1 kHz）were better than those at higher three frequeneies （2 k～8 kHz）（F=9. 494,P〈0.01）. OoneJusion Receiving IMP earlier might help to acquire better hearing gain for the patients with SSNHL after not fully responsive to conventional treat- ments. The hearing gains at the lower frequencies were better than those at the higher frequencies after IMP.

关 键 词：突发性聋 鼓室灌注 甲泼尼龙 听力改善 

分 类 号：R764.437[医药卫生—耳鼻咽喉科]