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

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。

Abstract:

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 the prognosis of patients. It is recommended to use the treatment of systemic combined with intratympanic corticosteroids as soon as possible in treatment.