不同时机鼓室内注射糖皮质激素治疗重度以上突发性聋的疗效分析  

Analysis of therapeutic effect of intratympanic glucocorticoid at different times in the treatment of patients with severe sudden sensorineural hearing loss

作　　者：董美 索利敏[2] 宋颖慧 范林静 张磊[2] 靳玲[2] 杨洁[2] 李青峰[2] 赵长青[2] DONG Mei;SUO Limin;SONG Yinghui;FAN Linjing;ZHANG Lei;JIN Ling;YANG Jie;LI Qingfeng;ZHAO Changqing(Shanxi Medical University,Taiyuan 030001,China;Department of Otolaryngology Head and Neek Surgery,The Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Otolaryngology Head and Neek Surgery,The First People’s Hospital of Jinzhong City in Shanxi Province,Jinzhong 030600,China)

机构地区：[1]山西医科大学,山西太原030001 [2]山西医科大学第二医院耳鼻咽喉头颈外科,山西太原030001 [3]晋中市第一人民医院耳鼻咽喉头颈外科,山西晋中030600

出　　处：《中国耳鼻咽喉颅底外科杂志》2021年第6期656-660,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：山西省回国留学人员科研资助项目(2017-118);山西省重点研发计划项目(201803D31122);山西省留学人员科技活动择优资助项目(2019-39)。

摘　　要：目的观察全身联合不同时机鼓室内注射糖皮质激素治疗重度以上突发性聋的疗效,探讨鼓室内注射时机,分析影响重度以上突发性聋预后的因素。方法回顾性分析108例重度以上突发性聋患者的临床资料及治疗效果,其中全身联合初始鼓室组64例,全身联合延后鼓室组44例;对两组患者出院时与随访时疗效分别进行比较,并分析治疗有效组和无效组临床特征。结果出院时和随访时两种治疗方案平均听阈、平均听阈改善值、总有效率比较差异均无统计学意义(P均>0.05),两种治疗方案痊愈率比较差异具有统计学意义(P<0.05)。两种治疗方案治疗前与出院时、治疗前与随访时分别比较差异均具有统计学意义(P均<0.001)。108例患者中,有效83例(76.9%),伴眩晕者治疗有效率低(P<0.05),治疗有效率与患者初始听阈损失程度(P<0.05)及听力曲线类型(P<0.05)相关,与年龄、性别、侧别、是否伴发耳鸣均无明显相关性(P均>0.05)。结论对于重度以上突发性聋,听力损失程度、曲线类型、是否伴发眩晕与预后相关,治疗上建议尽早全身联合局部应用糖皮质激素。Objective To observe the effect of systemic combined with intratympanic injection of glucocorticoids at different times in the treatment of severe sudden sensorineural hearing loss,to explore the timing of intratympanic injection,and to analyze the factors affecting the prognosis of severe to profound sudden sensorineural hearing loss.Methods It was retrospectively analyzed for the clinical data and treatment effects of 108 patients with severe to profound sudden sensorineural hearing loss.The patients were divided into two groups.One group is systemic combined initial intratympanic injection of dexamethasone,and the other group is systemic combined delayed intratympanic injection of dexamethasone.The curative effects of the two groups were compared at discharge and follow-up.It was analyzed for the clinical features of the effective group and the ineffective group.Results There was no significant difference for the average hearing threshold,the average hearing threshold elevation,and the total effective rate between the two treatment options at discharge and follow-up(all P>0.05).However,the difference of the recovery rate was statistically significant(P<0.05).There were statistically significant differences for the two treatment regimens between before treatment and at discharge,between before treatment and at follow-up(all P<0.001).Among 108 patients,83 cases(76.9%)were effective.The patients with vertigo had a low effective rate(P<0.05).The effective rate of treatment was correlated with the degree of initial hearing threshold loss(P<0.05)and the type of hearing curve(P<0.05),but had no significant correlation with age,gender,side and tinnitus(P>0.05).The treatment effective rate was related to the degree of the initial hearing threshold loss(P<0.05)and the type of hearing curve(P<0.05),but had no significant correlation with age,gender,side and tinnitus(all P>0.05).Conclusions For severe to profound sudden sensorineural hearing loss,the degree of hearing loss,the type of curve,and vertigo are associated with

关 键 词：突发性聋 地塞米松 鼓室注射 全身用药 

分 类 号：R764.43[医药卫生—耳鼻咽喉科]