鼓室联合耳后局部应用糖皮质激素治疗难治性突发性聋的临床研究  

Therapeutic effects of local application of glucocorticoid in intratympanic and postauricular area on refractory sudden sensorineural hearing loss

作　　者：苗英章[1] 安慧琴[1] 宋晓飞[1] 步桂清[1] 卢东洪[1] 张慧平[1] 刘玉东 李琳 王荣国[1] MIAO Yingzhang;AN Huiqin;SONG Xiaofei(Department of Otolaryngology,Hebei Provincial People’s Hospital,Hebei,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院耳鼻咽喉科,石家庄市050051

出　　处：《河北医药》2018年第9期1327-1330,1335,共5页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题计划项目(编号:20160073)

摘　　要：目的探讨鼓室内联合耳后局部应用糖皮质激素治疗常规治疗无效的难治性突发性聋的疗效。方法收治的难治性突发性聋患者237例,根据甲泼尼龙治疗方案的不同,患者分为鼓室内注射组(A组,75例)、耳后注射组(B组,93例)和鼓室内联合耳后注射的联合注射组(C组,69例);依据患者听力曲线测试结果的听力下降的频率和程度,难治性突发性聋患者分成低频下降型、高频下降型、平坦下降型和全聋型四种类型。其中,A组耳内镜下鼓膜穿刺,鼓室内注入甲泼尼龙0.4 ml;B组在耳后乳突骨膜下注射甲泼尼龙1 ml;C组先在鼓室内注射甲泼尼龙0.4 ml,紧接着于耳后乳突骨膜下注射甲泼尼龙0.6 ml。3组均隔天注射1次,4次为1个疗程,同时均给予患者营养神经、改善微循环的药物配合治疗10~14 d。观察3组患者疗效和各分型患者三种治疗方法的有效率。结果 A组、B组和C组难治性突聋的有效率分别为44.00%、34.41%和53.62%,3组间有效率差异有统计学意义(χ2=6.01,P=0.0496),而显效率分别为33.33%、29.03%和42.03%,3组间显效率差异无统计学意义(χ2=3.01,P=0.222)。四种类型难治性突发性聋中,高频下降型曲线患者,3组间有效率有统计学差异(χ2=6.24,P=0.044),联合注射的C组有效率最高且显著高于B组(χ2=6.23,P=0.013);其他听力曲线类型患者,3组间的有效率差异无统计学意义(P>0.05),C组有效率最高且显著高于B组(χ2=3.99,P=0.046)。3组间不良反应发生率差异无统计学意义(χ2=3.32,P=0.190)。结论鼓室内联合耳后注射局部应用糖皮质激素挽救性治疗难治性突发性聋安全有效,三种局部治疗方法中联合注射有效率最高并且显著高于耳后注射;鼓室内联合耳后注射糖皮质激素对于高频下降型和全频损伤较重的全聋型难治性突发性聋患者更为有效。Objective To explore the therapeutic effects of local application of glucocorticoid in intratympanic and postauricular area on refractory sudden sensorineural hearing loss(SSNHL).Methods A total of 237 patients with refractory SSNHL were divided into intratympanic injection group(group A,n=75),postauricular injection group(group B,n=93)and combined intratympanic and postauricular injection group(group C,n=69)according to different treatment programs.On the other hand,all the patients were divided into low frequency hearing loss group(low frequency group),high frequency hearing loss group(high frequency group),flat hearing loss group(flat loss group)and total hearing loss group according to the frequency and degree of hearing loss.The patients in group A were treated by intratympanic injection of methylprednisolone 0.4ml,then and the patients in group B were treated by postauricular injection of methylprednisolone 1ml.The patients in group C were firstly treated by intratympanic injection of methylprednisolone 0.4ml,then by postauricular injection of methylprednisolone 0.6ml,at the interval of 3 days,with a treatment course of four times for the three groups.Meanwhile the patients in the three groups were by the drugs to improve microcirculation and nurture nerves for 10~14d.After treatment the therapeutic effects and effective rates were observed and compared among the three groups.Results The effective rates in group A,B,C were 44.00%,34.41%,53.62%,respectively,and there were significant differences in effective rates among the three groups(P<0.05),however there were no significant differences in efficiency rates among the three groups(P>0.05),which were 33.33%,29.03%,42.03%,respectively in the three groups.Among the 4 types of refractory sudden sensorineural hearing loss,there were significant differences in effective rates among the three groups(P<0.05)in patients with high frequency hearing loss.The effective rate in group C was the highest,which was significantly higher than that in group B(P<0.05).Moreover

关 键 词：难治性突发性耳聋 鼓室内注射 耳后注射 鼓室内联合耳后注射 糖皮质激素 

分 类 号：R764.437[医药卫生—耳鼻咽喉科]