耳后注射甲泼尼龙治疗合并代谢综合征的突聋伴持续性耳鸣的疗效分析

Efficacy of retroauricular injection of methylprednisolone for sudden deafness and persistent tinnitus with metabolic syndrome

摘要:

目的 研究耳后骨膜下注射甲泼尼龙在合并代谢综合征的突聋伴持续性耳鸣患者的疗效及对血糖、血压、甘油三酯水平的影响，探讨治疗合并代谢综合征的突聋伴持续性耳鸣有效方法。方法 选择2015年7月—2020年12月收治的66例合并有代谢综合征的突聋伴持续性耳鸣患者，随机分实验组和对照组。每组患者各33例，两组均治疗15 d，实验组采用耳后注射甲泼尼龙0.5 mL+利多卡因注射液0.3 mL，辅以静脉注射银杏叶提取物和口服甲钴胺片，同时行健康宣教；对照组静脉注射甲泼尼龙，余治疗同实验组。均随访3个月以上。比较实验组与对照组患者的听力恢复情况、耳鸣严重程度，血糖、血压、甘油三酯波动的差异。结果 ①实验组治疗后纯音听力总有效率为87.88%，高于对照组54.55%；3个月后随访听力，实验组总有效率为93.94%，对照组总有效率为60.61%，两次统计差异均具有统计学意义（P<0.05）。实验组（78.79%）在耳鸣疗效方面有效率高于对照组（42.42%），两者统计差异具有统计学意义（P<0.05）；②实验组治疗前后的血糖、血压和甘油三酯指标差异无统计学意义，提示该治疗方案可避免静脉用激素带来的全身不良反应，局部用药可确保有效性的同时也更安全。结论 耳后注射甲泼尼龙治疗合并代谢综合征的突聋伴持续性耳鸣患者手术操作简单，患者接受程度较高，且激素使用不会对血糖、血压、甘油三酯产生影响，毒副作用小，临床可推广应用。

Abstract:

Objective To study the efficacy of retroauricular subperiosteal injection of methylprednisolone for the treatment of sudden deafness and persistent tinnitus complicated with metabolic syndrome and its effect on blood glucose, blood pressure and triglyceride levels, so as to explore the effective treatment method.Methods Sixty-six patients with sudden deafness and persistent tinnitus complicated with metabolic syndrome were randomly and equally divided into experimental group and control group. Both groups were treated for 15 days. Patients in the experimental group were given retroauricular injection of 0.5 mL methylprednisolone and 0.3 mL lidocaine, supplemented by intravenous injection of ginkgo biloba extract and oral administration of mecobalamine tablets, as well as health education and psychological counseling. The patients in the control group received intravenous injection of methylprednisolone, and the remaining treatments were the same as the experimental group. All patients were followed up for more than 3 months. The differences of hearing recovery, tinnitus severity, blood glucose, blood pressure and triglyceride fluctuation between the two groups were compared.Results ①The total effective rate of pure tone hearing after treatment in the experimental group was 87.88%, which was higher than that in the control group (54.55%). Their total effective rates 3 months after treatment were 93.94% and 60.61%, respectively. The differences were both statistically significant (P<0.05). The effective rate of tinnitus in the experimental group (78.79%) was higher than that in the control group (42.42%), and the difference was statistically significant (P<0.05). ② There were no significant differences in blood glucose, blood pressure and triglyceride indexes in the experimental group before and after treatment, suggesting that this treatment regimen could ensure effectiveness and safety with local injection of glucocorticoid and avoid systemic adverse reactions caused by intravenous adminstration.Conclusion With advantages of satisfactory efficacy, simple operation, high acceptance of patients as well as slight toxic and side effects, the retroauricular injection of methylprednisolone should be popularized in clinical application for the treatment of sudden deafness and persistent tinnitus patients with metabolic syndrome.