地塞米松对乳突根治术致高频感音性听力损伤的防护作用  

Application of Dexamethasone Reduces Sensorineural High Frequency Hearing Loss after Mastoidectomy

作　　者：唐凌媛 熊敏[2] 付晓燕[2] 刘雲 赖晃文[2] 杨传红[2] 李彩红[2] Tang Lingyuan;Xiong Min;Fu Xiaoyan;Liu Yun;Lai Huangwen;Yang Chuanhong;Li Caihong(Southern Medical University,Guangzhou,510010,China)

机构地区：[1]南方医科大学,广州510010 [2]广州总医院

出　　处：《听力学及言语疾病杂志》2018年第2期145-147,共3页Journal of Audiology and Speech Pathology

基　　金：国家自然科学基金(81470702)资助

摘　　要：目的探讨地塞米松对开放式乳突根治术后高频感音性听力损伤的保护作用。方法将76例(76耳)胆脂瘤中耳炎行开放式乳突根治术患者随机分为地塞米松组和非地塞米松组,每组38例,地塞米松组术中将浸有地塞米松(5 mg/ml)的明胶海绵置于圆窗表面,术后立即静脉滴注地塞米松5 mg/50 kg,非地塞米松组术中及术后均不使用地塞米松,其余治疗相同。分别于开放式乳突根治术前和术后90天行纯音听阈检测,比较两组患者术前和术后纯音听阈的变化。结果两组对象手术前各频率骨导听阈差异无统计学意义(P>0.05);地塞米松组术后6 kHz的骨导听阈较术前提高8.3±3.9 dB,8 kHz提高11.3±5.2 dB,高频(4、6、8 kHz)平均听阈提高10.1±7.2 dB;而非地塞米松组6 kHz骨导听阈较术前提高13.7±4.6 dB,8 kHz提高25.1±5.4 dB,高频平均听阈提高19.3±9.7 dB,两组患者在6 kHz(P=0.039)、8 kHz(P=0.007)和高频平均听阈(P=0.009)比较差异有统计学意义。结论术中圆窗联合术后静脉应用地塞米松能显著减轻开放式乳突根治术后高频(6、8 kHz)感音性听力损伤;建议开放式乳突根治术后应用地塞米松,以预防手术电钻声可能导致的高频感音性听力损伤。Objective To investigate the protective effect of dexamethasone on hearing loss induced by canal-wall-down mastoidectomy.Methods A total of 76 patients(76 ears)were randomized to dexamethasone group and non-dexamethasone group with 38 patients in each group.For dexamethasone group,gelfoam soaked with dexamethasone(5 mg/ml)was topically applied to the round window niche at the end of the surgery,and dexamethasone was administrated intravenously at the dosage of 5 mg/50 kg immediately after the surgery.While for non-dexamethasone group,dexamethasone was not used.The pure-tone audiograms were performed before mastoidectomy and 90 days after the surgery.Absolute hearing change was defined as the difference in hearing thresholds in decibels before and after the surgery.Results The changes of bone conduction thresholds in dexamethasone group were 8.3±3.9 dB at 6 kHz,11.3±5.2 dB at 8 kHz,and 10.1±7.2 dB for HPTA(4-6-8 kHz high tone average).As in non-dexamethasone group,the changes of bone conduction thresholds were 13.7±4.6 dB at 6 kHz,25.1±5.4 dB at 8 kHz,19.3±9.7 dB for HPTA.There were significant differences in the changes of bone conduction thresholds between dexamethasone and non-dexamethasone groups at frequencies of 6 kHz(P=0.039),8 kHz(P=0.007)and HPTA(P=0.009).Conclusion The results demonstrated that application of dexamethasone significantly reduced sensorineural high frequencies(6 kHz and 8 kHz)hearing loss after canal-wall-down mastoidectomy,thus the use of dexamethasone is recommended.

关 键 词：开放式乳突根治术 感音性听力减退 地塞米松 

分 类 号：R764.43[医药卫生—耳鼻咽喉科]