突发性聋挽救性治疗时机  

Time of salvage treatment on sudden sensorineural hearing loss

作　　者：刘阳云[1] 张彩霞[1] 曹杭[1] 江文[1] 杨会[1] 李正贤[1] 陈琼[1] 常恩格 樊涛[1] 胡蓉[1] 周恩[1] 

机构地区：[1]湖南师范大学医学院第二附属医院(解放军第163中心医院)耳鼻咽喉科,长沙410003

出　　处：《临床耳鼻咽喉头颈外科杂志》2015年第8期719-722,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨突发性聋挽救性治疗的最佳时机,以最大限度地提高突发性聋的疗效。方法:192例突发性聋患者纳入研究,其中63例一直接受全身激素治疗的初始治疗方案;其余患者在不同时间点开始鼓室激素注射的挽救性治疗:从初始治疗第3天后开始者29例,第7天后开始者38例,第14天后开始者43例,第1个月后开始者19例。所有患者随访2个月。结果:初始治疗第3天、第7天及第1个月判断为无效的患者,接受鼓室激素注射与未接受鼓室激素注射比较,其治愈率及总有效率差异均无统计学意义。初始治疗第14天接受与未接受鼓室激素注射者,治愈率和总有效率差异均有统计学意义(P<0.05)。结论:1在突发性聋治疗中,鼓室激素注射治疗作为初始治疗方案与全身激素治疗方案疗效相当;2鼓室激素注射治疗更适于作为全身激素治疗失败后的挽救性治疗;3鼓室激素注射治疗作为挽救性治疗的最佳时机是在接受全身激素治疗后的第2周左右。Objective：To explore the best time of intratympanic dexamethasone injection to treat sudden sensorineural hearing loss（SSNHL）as salvage therapy so that to improve the curative efficacy on sudden deafness at the utmost.Method：A total of 192 patients with SSNHL were included in this study,among whom 63 cases received the systemic steroid therapy throughout the study,while the other ones were treated with systemic steroid as initial treatment and were given intratympanic steroid administration as salvage treatment starting at different time point.The salvage treatment started on the 3rd day after the beginning of the initial treatment for 29 cases,on the 7th day for 38 cases,on the 14 th day for 43 cases,and 1month later for 19 cases.All the patients were followed up for 2months.Result：The recovery rates and total effective rates showed no statistically significant difference between the patients received only systemic steroid therapy and the ones received intratympanic steroid administration on the 3rd,7th day and 1month later after the initial treatment.The recovery rate and total effective rate exhibited statistically significant difference between the patients received intratympanic steroid administration since the 14 th day after the initial treatment and the ones received only systemic steroid therapy,with the numerical value of P 0.037 and 0.034,respectively.Conclusion：1As an initial management plan,the curative effects between the intratympanic steroid administration and the systemic steroid therapy were not significantly different.2As a salvage treatment,intratympanic steroid was a better choice for patients who have not completely recover from ISSNHL after failure of initial management with systemic steroid only.3 The best time point of salvage treatment with intratympanic steroid was about 2weeks after initial management with systemic steroid.

关 键 词：听觉丧失 突发性 挽救性治疗 初始治疗 

分 类 号：R764.43[医药卫生—耳鼻咽喉科]