鼓室内注射药物治疗梅尼埃病国际专家共识(全译文)  

Consensus on intratympanic drug delivery for Menière's disease

作　　者：李姝娜 Ilmari Pyykkö 张青[1,2,3] 杨军 段茂利[5,6] LI Shuna;Ilmari Pyykkö;ZHANG Qing;YANG Jun;DUAN Maoli(Department of Otorhinolaryngology-Head&.Neck Surgery,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai,200092,China;Institute of Otology,School of Medicine,Shanghai Jiaotong University;Shanghai Key Laboratory of Ear and Nose Disease Transformation;Hearing and Balance Research Unit,Field of Otolaryngology,School of Medicine,Faculty of Medicine and Health Technolo gy,Tampere University,Tampere,Finland;Department of Otolaryngology-Head&.Neck,Audiology and Neurotology,Karolinska University Hospital,Stockholm,Swe den;Division of Ear,Nose and Throat Diseases,Department of Clinical Science,Intervention and Technology,Karolinska Institute Stockholm,Sweden)

机构地区：[1]上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科,上海200092 [2]上海交通大学医学院耳科学研究所 [3]上海耳鼻疾病转化医学重点实验室 [4]Hearing and Balance Research Unit,Field of Otolaryngology,School of Medicine,Faculty of Medicine and Health Technolo gy,Tampere University,Tampere,Finland [5]Department of Otolaryngology-Head&.Neck,Audiology and Neurotology,Karolinska University Hospital,Stockholm,Swe den [6]Division of Ear,Nose and Throat Diseases,Department of Clinical Science,Intervention and Technology,Karolinska Institute Stockholm,Sweden

出　　处：《临床耳鼻咽喉头颈外科杂志》2022年第7期487-491,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：上海交通大学医工交叉项目(No:ZH2018ZDA11)资助。

摘　　要：目的:鼓室内(intratympanic,IT)注射药物治疗梅尼埃病(MD)因其疗效显著而备受关注。由于IT注射药物治疗MD的共识和新证据的发布,对IT注射药物治疗MD进行细节上的补充具有重要意义。方法:检索近二十年来有关IT注射药物治疗MD的文献,参考《梅尼埃病治疗国际共识(ICON)》(2018年),《美国梅尼埃病临床实践指南》(2020年)和《梅尼埃病诊断治疗的欧洲立场声明》(2018),并遵循来自欧洲、美国和中国的专家意见。结果:专家一致认为:①鼓室内注射甲泼尼龙(ITM)对眩晕控制的疗效优于鼓室内注射地塞米松(ITD),ITM有恢复MD患者听力的可能性。②由于氨基糖甙类药物的耳毒性,鼓室内注射庆大霉素(ITG)在听力良好MD患者中的应用持谨慎态度。但也有研究表明,小剂量ITG对听力没有显著影响,还需要高水平证据的临床研究进一步证明。③目前普遍接受的ITG治疗终点是在12个月内无眩晕发作或受累耳客观检查提示前庭功能丧失。结论:对IT注射药物治疗MD的药物类型、疗效和治疗终点还需要更多高证据水平的研究进行评价。Objective: Intratympanic(IT) drug delivery receives attention due to its effectivity in treatment for Menière’s disease(MD). Due to the release of the consensuses and new evidence on IT drug delivery for MD have been published, the review with a view to supplementing the details of IT treatment of MD is indispensable. Methods: The literatures on IT injection for MD treatment over the last two decades are retrieved, International consensus(ICON) on treatment of Menière’s disease(2018), Clinical Practice Guideline(2020) and European Position statement on Diagnosis and Treatment of Menière’s disease(2018) are taken into account for reference, and follow advice from experts from Europe, USA and China. Results: Experts agree on the following:①The effectiveness of IT methylprednisolone(ITM) on vertigo control seems to be somewhat better than that of IT dexamethasone(ITD), and ITM can restore hearing in some cases.②Due to the ototoxicity of aminoglycosides, the application of intratympanic gentamicin(ITG) in MD patients with good hearing is conservative. However, some studies suggest that ITG with low doses has no significant effect on hearing, which needs to be further proved by clinical studies with high levels of evidence.③Currently, generally accepted treatment endpoint of ITG is no vertigo attack in a 12-month period or a vestibular loss in objective tests in the affected ear. Conclusion: More studies with high level of evidence are needed to evaluate the drug type, efficacy, and therapeutic endpoint of IT therapy for MD.

关 键 词：梅尼埃病 鼓室内注射治疗 糖皮质激素 甲泼尼龙 地塞米松 氨基糖甙类药物 庆大霉素 

分 类 号：R764.33[医药卫生—耳鼻咽喉科]