鼓室注射甲强龙治疗平坦下降型突发性耳聋的时机选择

Appropriate time of intratympanic injection of methylprednisolone for sudden deafness of flat descending type

摘要:

目的 探讨鼓室注射甲强龙作为联合或补救给药治疗平坦下降型突发性耳聋(简称突聋)的恰当时机。方法 收集2019年7月—2021年10月在耳鼻咽喉科住院治疗的平坦下降型单侧突聋患者，根据入选及排除标准最终选取145例患者，分为两组，对照组(62例)仅全身用药，治疗组(83例)在全身用药基础上联合了鼓室注射甲强龙20 mg，隔日1次，连用5次。治疗组患者记录从发病初始日到首次鼓室注射给药日的时间间隔，并以10 d为分界点，将治疗组分为“≤10 d组”和“＞10 d组”。记录各组患者在发病初始期(3 d内)、自发病起1个月时，自发病起6个月时的平均听阈值，并统计分析各组患者在不同时间段的听力改善程度。结果 在发病初始期，各组患者平均听阈的总体平均值差异无统计学意义(P>0.05);自发病起1个月时，治疗组中“≤10 d组”患者听力改善均值显著大于对照组，差异具有统计学意义(P<0.05)，而治疗组中“＞10 d组”与対照组及治疗组中“≤10 d组”与“＞10 d组”相比，听力改善均值(dB)差异均无统计学意义(P>0.05)；自发病起6个月时，“≤10 d组”听力改善均值显著大于“＞10 d组”，差异具有统计学意义(P=0.002)。结论 相比单纯全身用药， 联合鼓室注射激素治疗平坦下降型突聋在听力改善程度上有显著优势，早期开始(发病起10 d内)联合治疗是有必要的，能够获得更好的远期疗效。

关键词:鼓室注射;突发性;糖皮质激素;听力损失

Abstract:

Objective To investigate the appropriate time of intratympanic injection of methylprednisolone as combined or remedial administration for the treatment of sudden deafness of flat descending type. Methods Clinical data of patients with unilateral sudden deafness of flat descending type hospitalized in our department from July 2019 to Oct 2021 were collected. According to the inclusion and exclusion criteria, 145 cases were finally enrolled, including 62 cases in the control group treated with systemic medication and 83 in the treatment group receiving intratympanic injection of 20 mg methylprednisolone (once every other day, for 5 times) on the basis of systemic medication. The time interval between the onset of disease and the first intratympanic injection was recorded, and the treatment group was subdivided into “≤10 days group” and “> 10 days group” according to the cut-off point of 10 days. The mean hearing thresholds of all patients at the initial stage of onset (≤3 days), 1 month and 6 months were obtained. And then the hearing improvement in each group at different times was recorded and statistically analyzed. Results At the beginning of treatment, there were no significant differences in the average hearing threshold among all groups(P>0.05). At 1 month, the mean value of hearing improvement in the “≤10 days group” was higher than that in the control group, the difference was statistically significant (P＜0.05). However, the differences in the mean value of hearing improvement between “>10 days group” and the control group, or between “≤10 days group” and “> 10 days group” were statistically insignificant (P>0.05). At 6 months, the mean value of hearing improvement in the “≤10 days group” was significantly higher than that in the “>10 days group”(P=0.002). Conclusions Compared with systemic therapy alone, the combined intratympanic glucocorticoid injection is conducive to hearing improvement for patients with sudden deafness of flat declining type. Early initiation (within 10 days of onset) is recommended to achieve preferable long-term efficacy.

Key words:Intratympanic injection;Sudden;Glucocorticoid;Hearing loss