布地奈德鼓室内注射治疗难治性突发性聋  

Intratympatic budesonide injection for treatment of refractory sudden sensorineural hearing loss

作　　者：孙饶奚[1] 赵宇[1] 刘军 

机构地区：[1]四川大学华西医院耳鼻咽喉头颈外科,成都610041 [2]武警成都医院耳鼻喉科

出　　处：《临床耳鼻咽喉头颈外科杂志》2016年第12期972-977,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:观察初始治疗无效的突发性聋患者行鼓室内糖皮质激素注射的疗效,探讨激素在难治性突发性聋中的作用。方法:选择难治性突发性聋患者90例,采取随机对照的方法进行临床研究。90例患者分为3组,每组30例。试验组选择鼓室内注射布地奈德,对照组1选择注射地塞米松,对照组2选择不行鼓室内注射,而是继续全身用药。试验组和对照组1每周注射3次,隔天1次,注射2周,治疗结束后再次复查纯音测听及初始言语分辨率(SDS);对照组2继续予前列地尔、甲钴胺、银杏叶提取物注射液、三七总皂苷注射液及静脉用高压氧液治疗,10d后复查纯音测听及SDS。结果:按照受损频率平均听阈提高10dB以上为有效,试验组有效率为26.7%(8/30),对照组1为30.0%(9/30),对照组2为6.7%(2/30),3组有效率比较差异有统计学意义(P<0.05);试验组、对照组1、对照组2的平均PTA提高分别为(5.0±11.1)dB、(4.2±12.5)dB及(0±3.33)dB,差异有统计学意义(P<0.05),其中试验组与对照组1的疗效差异无统计学意义(P>0.05),试验组与对照组2的疗效差异有统计学意义(P<0.01),对照组1与对照组2的疗效差异有统计学意义(P<0.05)。试验组、对照组1、对照组2的言语分辨提高率分别为16.7%、12.0%及4.2%,但差异无统计学意义。结论:布地奈德鼓室内注射治疗难治性突发性聋具有良好的安全性,其治疗效果与地塞米松相当。鼓室内激素注射可作为难治性突发性聋患者的一种可供选择的治疗方案。Objective：To investigate intratympanic steroid injection for treatment of sudden sensorineural hearing loss after failure of initial systemic therapy,and discuss the role of steroid in refractory sudden sensorineural hearing loss.Method：We included 90 patients who did not response to initial systemic therapy of sudden hearing loss.This research adopted the randomized,controlled trial of clinical research.Ninety qualified patients were divided into 3groups,30 for each group,intratympanic budesonide for experimental group,dexamethasone for control group-1while control group-2did not take intratympanic steroid injection but continue another round of systemic therapy.Intratympanic injection was performed 3times a week and last for 2weeks.Alprostadil,mecobalamin,ginkgo biloba extract injection,PNS injection and intravenous hyperbaric oxygen fluid were used for consecutive 10 days in the control group-2.Pure tone audiometry and speech Discrimination Score was retaken at the end of each therapy.Result：The results show that the average PTA of damaged frequencies improved more than 10 dB was considered significant,we had 26.7%（8/30）patients meet this criteria in experiment group,30.0%（9/30）in the control group-1and 6.7%（2/30）in the control group-2.And the recovery rate between these 3groups is statistically significant（P〈0.05）,the average PTA improvement in the experimental group,control group-1and control-2was（5.0±11.1）dB,（4.2±12.5）dB and（0±3.33）dB respectively,P〈0.05,control group-2was significantly different from control group-1and experimental group.The Speech Discrimination Score improvement rates in the experimental group,control group-1and control-2was 16.7%,12.0% and 4.2%respectively,but the difference in those 3groups was not significant.Conclusion：Budesonide intratympanic injection is a save method in treating refractory sudden hearing loss,and it is as effective as dexamethasone.Intratympanic steroids could be an option for refractory sudden sensorineural hearing loss

关 键 词：听觉丧失 突发性 鼓室 布地奈德 

分 类 号：R764.43[医药卫生—耳鼻咽喉科]